1. Medical Development Division, Ministry of Health Malaysia
MERS-CoV
MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS (MERS-CoV) HOSPITAL PREPAREDNESS
Taklimat Pelaksanaan Aktiviti Kesiapsiagaan Menghadapi
Jangkitan MERS-CoV di Malaysia
Dr Vidya Natthondan
Hospital Putrajaya
Medical Development Division,
Ministry of Health Malaysia

2. 4 circulars on MERS-CoV issued since September 2012
1) Surat edaran Ketua Pengarah Kesihatan
No. Ruj. (4) dlm. KKM-171/BKP/12/56/0826
bertarikh 11 Oktober 2012
2) Surat edaran Timbalan Ketua Pengarah Kesihatan (Kesihatan Awam)
No. Ruj.(6) dlm. KKM-171/12/56/0826
bertarikh 22 Mac 2013
3) Surat edaran Ketua Pengarah Kesihatan
No. Ruj. (9) dlm. KKM-171/BKP/12/56/0826
bertarikh 14 Jun 2013
4) Surat edaran Ketua Pengarah Kesihatan 14.Aug 2013
‘MAKLUMAN STATUS TERKINI MENGENAI KEJADIAN JANGKITAN NOVEL CORONAVIRUS’
Medical Development Division,
Ministry of Health Malaysia

3. ROLE OF TPKN (PERUBATAN), HOSPITAL DIRECTORs & CLINICIANS
MERS-CoV
Provide clear information regarding MERS-CoV infection to HCW under their supervision
Ensure hospital staffs involve in managing suspected patients (ie ED, Medical Dept/ID, Paeds Dept, ICU) are informed about the preparedness measures
On going planning & actions
Medical Development Division,
Ministry of Health Malaysia

4. EXTRA CAREFUl !! PROTECT OUR HCWS & PATIENTS
MERS-CoV
Widespread of virus
Source of virus
Route of transmission
Mode of transmission
Clinical Pattern
Course of disease
UNKNOWN
There is no specific treatment.
Only symptomatic & supportive treatment
Medical Development Division,
Ministry of Health Malaysia

5. HUMAN-TO-HUMAN TRANSMISSION
MERS-CoV
Evidence of non-sustained human to human transmission
Communities: sporadic cases with unknown
exposure
Families: contact with infected family members
Health care facilities: patients & HCW
Medical Development Division,
Ministry of Health Malaysia

6. Hospital preparedness in managing mers- cov
Screening & triaging
Infection Prevention & Control
Stockpile of PPE
Hospital facilities
Hospital Admission
Case Notification
Laboratory diagnosis
Medical Development Division,
Ministry of Health Malaysia

7. Screening and 'triaging'
MERS-CoV
Implemented in the Outpatient Department (OPD) & Emergency Department (ED)
in all hospitals
Medical Development Division,
Ministry of Health Malaysia

8. INFECTION PREVENTION & CONTROL
MERS-CoV
Appropriate infection prevention & control measures shall be strengthened & conducted in all hospitals
Risk of exposing our healthcare workers & other inpatients to infection if the infection control measures are not well in place
Minimize the possibilities of spreading the disease
HIACC (Head of Infection Control Committee) at each state to take lead, with the help of
State Coordinator of Infection Control Nurse at each state (JKN/Hosp)
Infection control nurses at all MOH hospitals
Medical Development Division,
Ministry of Health Malaysia

9. HEAD OF STATE infection control COMMITTEE
MERS-CoV
NEGERI
PENGERUSI
JAWATAN
HOSPITAL
PERLIS
Dr Jamaludin bin Mohamad
Ketua Jabatan Pediatrik
Hospital Tuanku Fauziah, Kangar
KEDAH
1) Dr. Low Lee Lee
2) Dr. Noraini Ismail
-Pakar Perubatan Penyakit Berjangkit
-Pakar Perunding (Microbiologi)
Hospital Sultanah Bahiyah Alor Setar
PULAU PINANG
Dr Revathy Nallusamy
Pakar Perunding & Ketua Jabatan Pediatrik
Hospital Pulau Pinang
PERAK
Dr Ker Hong Bee
Pakar Perubatan dan Penyakit Berjangkit
Hospital Raja Permaisuri Bainun, Ipoh
SELANGOR
Dr Shanaz Shah Firdaus Khan
Pakar Nefrologi
Hospital Tengku Ampuan Rahimah, Klang
WPKL
Dr Kamarul Azhar Mohd Razali
Pakar Perunding Pediatrik dan Penyakit Berjangkit
Hospital Kuala Lumpur
N. SEMBILAN
Dr Tan Kah Kee
Pakar Perunding Pediatrik dan Penyakit Berjangkit & Ketua Jabatan Pediatrik
Hospital Tuanku Jaafar, Seremban

10. Head OF STATE infection control COMMITTEE
MERS-CoV
NEGERI
PENGERUSI
JAWATAN
HOSPITAL
MELAKA
Dr Nor Hayati Shaharuddin
Pakar Perubatan (Penyakit Berjangkit)
Hospital Melaka
PAHANG
YBhg. Dato’ Dr Hj Sapari Satwi
Pakar Perunding & Ketua Jabatan Perubatan
Hospital Tengku Ampuan Afzan, Kuantan
JOHOR
YBhg. Datin Dr. R. Ganeswrie
Pakar Perunding Patologi & Ketua Unit Mikrobiologi
Hospital Sultanah Aminah, Johor Bahru
KELANTAN
1) Dr. Mahiran Mustafa
2) Dr. Nurahan Maning
-Pakar Perunding Perubatan Kanan (Penyakit Berjangkit)
-Pakar Perunding Kanan Mikrobiologi Klinikal
Hospital Raja Perempuan Zainab II, Kota Bahru
TERENGGANU
1) YBhg. Dato' Dr. Hj. Abdul Jamil Abdullah
2) Dr. Ahmad Kashfi Abdul Rahman
-Pakar Perunding Pembedahan
-Pakar Perunding Perubatan (Penyakit Berjangkit)
Hospital Sultanah Nur Zahirah, K. Terengganu
SABAH
Dr. Foong Siew Moi
Dr. Timothy William
-Pakar Perunding Pediatrik (Penyakit Berjangkit)
-Hospital Wanita dan Kanak-kanak Likas
-HQE, KK
SARAWAK
Dr. Chua Hock Hin
Pakar Perunding Perubatan (Penyakit Berjangkit)
Hospital Umum Sarawak

11. INFECTION CONTROL NURSE : state coordinator
MERS-CoV
NEGERI
PENGERUSI
JAWATAN
JKN/HOSPITAL
PERLIS
Pn Sariana Bt Radzi
Penyelia Jururawat Kesihatan
Jabatan Kesihatan Negeri Perlis
KEDAH
Mahinder Kaur a/p Pritam Singh
Ketua Penyelia Jururawat Negeri Gred U 44
Jabatan Kesihatan Negeri Kedah Darul Aman
PULAU PINANG
Pn Hafizah binti Hamzah
Ketua Jururawat Kawalan Infeksi
Unit Kawalan Infeksi, Hospital Pulau Pinang
PERAK
Pn Rosena binti Hassan
Penyelia Jururawat Kawalan Infeksi U 36
Unit Kawalan Infeksi, Hospital Raja Permaisuri Bainon, Ipoh
SELANGOR
Pn Ng Siew Koon
Penyelia Jururawat U44
JKN Selangor
WPKL
Pn Marina Idi
Unit Kawalan Infeksi, Hospital Kuala Lumpur
WP PUTRAJAYA
Pn Zaiton Noordin
Penyelia Jururawat U36
Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur
N. SEMBILAN
Pn Selvarani a/p Palany
Penyelia Jururawat U42
JKN Negeri Sembilan

12. INFECTION CONTROL NURSE : state coordinator
MERS-CoV
NEGERI
PENGERUSI
JAWATAN
HOSPITAL
MELAKA
Pn Teh Siew Fah
Ketua Jururawat Kawalan Infeksi
Unit Kawalan Infeksi, Hospital Melaka
PAHANG
Pn Jama'iah binti Alang Abd Rais
Penyelia Jururawat U42
JKN Pahang (Perubatan)
JOHOR
Pn Rohaida Abdullah
Ketua Jururawat U32
Unit Kawalan Infeksi, Hospital Sultanah Aminah, JB
KELANTAN
Pn Wan Maimunah binti Wan Yusoff
Bhg Perubatan, JKN Kelantan
TERENGGANU
Pn Fadilah binti Hassan
Unit Kualiti, Bahagian Perubatan, JKN Terengganu
SABAH
Pn Latifah Muh Noor
Penyelia Jururawat U36
Unit Kualiti Penjagaan Kesihatan, Bahagian Perubatan, JKN Sabah
SARAWAK
Fu Choon Kee
Hosp Umum Sarawak
WP LABUAN
Pn Anih binti Gapar
Ketua Jururawat
Unit Kawalan Infeksi, Hospital Nukleus Labuan

13. Medical Development Division, Ministry of Health Malaysia
Stockpile for PPE
MERS-CoV
Ensure stocks of Personal Protective Equipment (PPE) for MERS-CoV infection in each state & hospital is sufficient .
Liase with Pharmaceutical Services Division, both at MOH & state level on PPE stockpiles.
Medical Development Division,
Ministry of Health Malaysia

14. Medical Development Division, Ministry of Health Malaysia
HospitAL FACILITIES
MERS-CoV
Ensure hospital facilities/equipment especially in isolation rooms & intensive care units ( ICU )to be functioning optimally.
Medical Development Division,
Ministry of Health Malaysia

15. HospitAL FACILITIES MERS-CoV TYPE OF HOSPITAL TOTAL HOSPITAL WITH ...
NEGATIVE PRESSURE ISOLATION ROOMS
VENTILATOR FACILITIES IN INTENSIVE CARE SETTINGS
State Hospital 14
Major Specialist 25 15 24
Minor Specialist 9 20
Non-specialist 69 10
Special hospital/institution 2
OVERALL TOTAL
141 50 58

16. Medical Development Division, Ministry of Health Malaysia
HOSPITAL ADMISSION
MERS-CoV
Hospital admissions : refer ‘Criteria for Hospital Admission’
Clinical assessment tool
Co-morbidities & risk factors
Admission to any nearest MOH hospital
non-specialist hosp MO to inform & consult specialist’s opinion for further Mx
Urgent referral & transfer to the respective hospital if the nearest hospital doesn’t have any of the facilities needed (ICU, isolation rooms)
Non-MOH Hospitals to admit & manage patients
Admission policies will be updated from time to time
Medical Development Division,
Ministry of Health Malaysia

17. Flowchart for management of acute respiratory infections when mers-cov Is suspected

18. MERS-CoV

19. MERS-CoV

20. Flowchart for management of severe acute respiratory infections when mers-cov Is suspected

21. MERS-CoV

22. Medical Development Division, Ministry of Health Malaysia
Case notification
MERS-CoV
Currently notification is by using the form ‘Notification Form For MERS-CoV Case’ as Lampiran KKM/BKP/NCoV/2013/1
Medical Development Division,
Ministry of Health Malaysia

23. MERS-CoV

24. Flowchart of specimen collection for mers-cov laboratory diagnosis

25. Medical Development Division, Ministry of Health Malaysia
MERS-CoV
CURRENT
Medical Development Division,
Ministry of Health Malaysia

28. LESSONS LEARNT FROM H1N1 PANDEMIC 2009
MERS-CoV
Action plan is very important to minimize the impact on the morbidity & mortality due to the MERS-CoV
State level commitment required at earlier stage
Public response : panic , complaints & unhappiness among the public
how patients is being treated
overcrowding of the clinic & ED
patients waiting for a longer time
health staff not sure what needed to be done
Generally, to the way the pandemic is being managed
Sudden surge of patients coming to the hospital & clinics.
Extra efforts should be taken to provide better facilities( eg waiting area) & better methods of managing patients despite limited resources
Medical Development Division,
Ministry of Health Malaysia

29. Medical Development Division, Ministry of Health Malaysia
Take home messages
MERS-CoV
State Directors to take lead in addressing issues at the ground level:
 analyse situation & suggest remedial measures
->assist Hospital Directors in
- addressing the related problems & issues.
- analyse our capacity & facilities eg if there is a need for
‘redeployment’ of the staff & equipment
conduct sessions with HCW ( MOH & non-MOH ) hospitals/ private hospitals/GPs with input from State Physician
 for better understanding
 strengthen involvement of private practioners/hospitals
engage the state government & various agencies
-> activate an interagency meeting
Medical Development Division,
Ministry of Health Malaysia

30. Medical Development Division, Ministry of Health Malaysia
Take home messages
MERS-CoV
Hospital Directors & clinicians : working hand in hand
Activities in the hospitals have to be adjusted accordingly
HCW to be well-informed about the preparedness measures
Screening & triaging
Infection Prevention & Control
Stockpile for PPE & medication
Optimize hospital facilities & capacity (eg ED, wards, isolation rooms, ICUs, laboratory services)
Case notification
Keep HCW updated on the latest directive from MOH
Medical Development Division,
Ministry of Health Malaysia

31. Medical Development Division, Ministry of Health Malaysia
Take home messages
MERS-CoV
State physician/ Senior physician in the state to take lead in coordinating
the patients’ management within the hospitals & clinics (OPD)
the involvement of the private GPs & private hospitals
Involvement of the private practitioners & private hospitals need to be strengthened
participate & actively involve in managing MERS-CoV
Medical Development Division,
Ministry of Health Malaysia

32. Medical Development Division, Ministry of Health Malaysia
THANK YOU
Medical Development Division,
Ministry of Health Malaysia