Ministry of Health and Welfare

Measures to Reform National Infection Prevention and Control System for the Purpose of Immediate Response to Emerging Infectious Diseases

- A total of 48 main tasks were set up to prevent the emergence of infectious diseases, end them quickly, and minimize damage resulting from them.

1. Initial response systems will be built to stop the outbreak of emerging infectious diseases, and to make sure that, if any type of infectious diseases break out, the spread can be prevented at the initial stage.

2. A specialized diagnosis and treatment system, along with quarantine facilities, will be established to promptly detect and prevent the outbreak of emerging infectious diseases.

3. In order to prevent nosocomial infection, each healthcare facility will be required to establish a triage system in the emergency room, and expand the infrastructure necessary for nosocomial infection control. In addition, it is needed to reform the current customs contributing to the spread of infection such as visits by many family members and friends to patients in the hospital, and family members staying with patients at medical facilities as caregivers.

4. Governance arrangements for emerging infectious diseases will be revised to reflect the specificity of infection prevention and control for the purpose of active response.

- In the National Policy Coordination Meeting chaired by Prime Minister Hwang Kyo-ahn at three p.m. on Tuesday, September 1st, 2015, the government discussed measures to strengthen national infection prevention and control system, in order to more effectively, thoroughly respond to future infectious diseases.

- Health and Welfare Minister Chung Chin-youb announced a finalized "Measures to reform National Infection Prevention and Control System" at four p.m. on the same day at the Central Government Complex in Jongno, Seoul, Republic of Korea. To come up with specific reform measures, the government has assessed its response to MERS-CoV after the outbreak; analyzed factors contributing to the initial spread, presented at the National Assembly's Special Committee; and exchanged extensive information with epidemiologists and experts in a variety of disciplines by holding meetings such as a public hearing.

- The main points of the "Measures to Reform National Infection Prevention and Control System" are as follows:

1. Initial response systems will be built to stop the outbreak of emerging infectious diseases, and to make sure that, if any type of infectious diseases break out, the spread can be prevented at the initial stage.

1) A 24-hour-a-day Emergency Operations Center (EOC) will be established and operated to collect and monitor information on infectious diseases in real time; and to immediately detect, report, and respond to the outbreak of infectious diseases. The establishment of the EOC is based on careful examination of the EOCs operated in Centers for Disease Control and Prevention in the United States and China respectively. The aim is to collect and monitor information on infectious diseases for 24 hours a day, seven days a week, and, in case of an emergency, to immediately control any situation any time.

< Outline of the EOC >

Report of suspected cases		Information on infection from international organizations	Current status of infectious diseases occurring in the Republic of Korea	Information on infection obtained through a surveillance program
Setting up a 24-hour hotline		Collecting information on a daily basis

↓ ↓

Emergency Operations Center (EOC)

Information Analysis & Risk Assessment → Response

↓

Dispatching the Immediate response team

Information sharing with relevant organizations

2) In case a suspected case occurs, the "Immediate Response Team," led by the Division of Infectious Disease Control under the Korea Center for Disease Control and Prevention (KCDC), will be formed and dispatched along with relevant experts from private sectors without delay. Under the supervision of the immediate response team, an immediate response system will be built to take charge of taking infection prevention and control measures which involve controls of suspected hospitals and traffic, carried out by the Field Response Task Force comprised of civil servants from public medical institutions in cities and provinces and public health clinics in cities, counties and districts, infectious disease experts, police and firefighters.

< Organization of the Immediate Response Team >

(Year-round) Division of Risk Response : Organization of the Immediate Response Team
Immediate Response Team	←	Group of non-governmental experts
		Group of epidemiologists from the central government

↓ [Site Visit : hospitals, cities or counties]

Field Response Taskforce : Control tower for field operations

Cities and provinces, Public health clinics, Medical institutions, Police and Firefighters

3) As part of efforts to address lack of risk communication activities, which has been pointed out as the main cause of spread of MERS-CoV, the Department of Risk Communication will be established to make plans for risk communication activities with experts in various disciplines; to determine the scope and way of information sharing with the public beforehand; and to immediately, transparently release relevant information when an emerging infectious disease occurs.

4) For the purpose of hiring and training more specialists and experts, the government will increase the number of epidemiologists, who have been comprised mostly of public health doctors, and convert their level from non-regular workers to regular workers. Further, the government will create a post of "infection prevention and control" official, so that excellent experts can be guaranteed job security, and have various opportunities to build their career, such as participating in the Epidemic Intelligence Service (EIS) program of the US Centers for Disease Control and Prevention (CDC). Meanwhile, a two-year epidemiology training program, the Korean equivalent of the EIS, will be introduced to provide public health personnel in epidemiology with an opportunity to have various hands-on experiences at the KCDC.

5) Human resources exchanges with the world's public health-related organizations or agencies such as WHO or CDC will be promoted for stronger international coordination. Epidemiologists will be dispatched to the countries where emerging infectious diseases occur to exactly identify specific characteristics of viruses.

6) Screening measures at borders against all the travelers returning from countries with a high risk of infection will be carried out. Strengthened border quarantine measures include monitoring them for the development of symptoms during the incubation period, and notifying travelers who will leave the country that there are things that they need to be aware of before departure. An interconnected network for "smarter quarantine" will be built to ensure effective communication between quarantine stations and medical institutions at every stage from early detection to diagnosis and treatment.

2. A specialized diagnosis and treatment system, along with quarantine facilities, will be established to promptly detect and prevent the outbreak of emerging infectious diseases.

1) In order to increase the number of negative-pressure isolation rooms, central and local medical institutions with more than 300 beds will be designated by the government for specialized treatments of infectious disease patients. In addition, the number of government-designated isolation facilities will be increased to accommodate up to 117 infected patients, and the availability of a single negative-pressure isolation room will be increased around 144 regional emergency medical centers. Meanwhile, upper-scale general hospitals and all general hospitals with over 300 beds will be required to establish a certain number of negative-pressure isolation rooms.

- The National Medical Center is designated as the central hospital specializing in infectious diseases ranging from treatment to clinical research and education, and a specialized facility will be built separately.* * negative-pressure isolation rooms with more than 150 beds and laboratories with Biosafety Level 4 will be run. - Three to five regional specialized facilities are selected among public medical institutions such as national university hospitals. - The building of central, municipal and provincial intensive care facilities is financed by the government, and, when any type of infectious diseases occurs, the designated medical institutions are used exclusively to treat infected patients.

2) Temporary isolation facilities will be also designated around Seoul, and 17 cities and provinces to effectively quarantine contacts. The infectious disease information system will be set up to manage and share comprehensive information such as monitoring, epidemiological investigation, and the management of contacts and confirmed cases.

3) The number of laboratories exclusively to carry out diagnostic testing for infectious diseases will be increased at the Korea National Institute of Health to build a quick, accurate diagnosis system. Certain diagnosis methods will be passed down to municipal and provincial Public Health and Environment Research Institutes and private laboratories to strengthen capacity to handle the potentially increased workload. When it comes to diagnostic reagents for testing or therapeutic agents which have not been approved by the Ministry of Food and Drug Safety, the government will take steps to ensure that they can be promptly used upon an urgent request of the Health and Welfare Minister.

4) Inter-ministerial R&D projects will be carried out for the development of vaccines and remedies against emerging infectious diseases, and diagnosis devices. A database for clinical and diagnosis data regarding MERS-CoV will be created to be used for ICT-based analysis of infection characteristics and the development of medical devices and medicines.

* The National Science & Technology Council will establish "strategies to carry out R&D projects for response to infectious diseases."

Research activities with regard to emerging infectious diseases will be enhanced at the Korea National Institute of Health, in order to strengthen the state-led research base.

3. In order to prevent nosocomial infection, each healthcare facility will be required to establish a triage system in the emergency room, and expand the infrastructure necessary for nosocomial infection control. In addition, it is needed to reform the current customs contributing to the spread of infection such as visits by many family members and friends to patients in the hospital, and family members staying with patients at medical facilities as caregivers.

1) In order to prevent spread of infectious diseases through emergency rooms, each emergency room is required to reform the current system: establishing the adequate triage process to quickly separate patients with potential infection from other patients, adding negative-pressure isolation facilities, restricting visits by family members to patients, and strictly managing the name list of visitors. To solve crowding in emergency rooms, the patients who stay for 24 hours or more, waiting for diagnosis and treatment, will be checked, and the number will become a factor to determine whether the emergency room can be designated as the Emergency Medical Center. Meanwhile, non-emergency patients will be burdened with higher fees when using emergency rooms of large-scale hospitals, as part of measures to reduce crowding in emergency rooms. Measures to discourage an inflow of mild cases into emergency rooms of large-scale hospitals will be also set up.

2) The availability of negative-pressure isolation rooms exclusively for infected patients will be increased (Upper-scale hospitals will be required to establish a certain number of them), and general isolation rooms with a single bed or two beds will be expanded. Negative-pressure isolation rooms require a single bed, an independent heating and air-conditioning equipment, a front room, and a special ventilation system. Emergency rooms will be encouraged to be converted from six beds to four beds, and will be required to eliminate environmental factors contributing to transmission, such as making adequate space between beds, and setting an adequate ventilation standard. Meanwhile, the full nursing care service, where main caregivers of infected patients will be changed from their family members to nurses, will be offered around the infection control department of upper-scale hospitals.

3) A system for nosocomial infection control will be strengthened: an increasing number of hospitals will be required to build an "infection control room" (hospitals with more than 200 beds → hospitals with more than 150 beds), and more infection specialists and related workers will be hired. Based on this, an investigation into the status of nosocomial infection around the country will be regularly carried out. In addition, the nosocomial infection infrastructure and management activities will be assessed, and there will be incentives or penalties depending on the results. The availability of personal protective gear will be expanded by making it possible that anti-infection equipment is covered in health insurance.

4) As part of efforts to reform the existing system to deliver medical information, health insurance fees for a referral from a physician to another physician will be established to encourage doctors to make a medical request depending on their own medical judgment. Coordination between provincial major hospitals and small clinics will be promoted, medical information sharing among hospitals will be built, and the interactive telemedicine system will be strengthened. In order to eliminate cultural factors contributing to transmission, a "guideline for hospital visitors," which involves restricting visiting hours, will be developed, and private and public joint campaign to raise public awareness about that will be conducted.

4. Governance arrangements for emerging infectious diseases will be revised to reflect the specificity of infection prevention and control for the purpose of active response.

1) Under its restructuring, the KCDC will supervise infection prevention and control, and will be granted greater autonomy and specialty. First, the head of the KCDC will be appointed as the ministry's joint vice minister. Second, the head of the KCDC will have authority in managing human resources and deciding on budgets, including hiring full-time epidemiologists and empowering them to take real action on the scene. Third, the KCDC will take full charge of preventing and controlling diseases at every stage from the initial stage of the outbreak to the final stage, while other government agencies, the Prime Minister's Office, the Ministry of Health and Welfare, and the Ministry of Public Safety and Security, will play a supporting role. With regard to this, a standard for alert level will be separately set up based on the distinct characteristic of each infectious disease, when the manual for outbreak management is revised.

< Revised Response System According to Alert Level >

Alert level	Current system	Revised system
ATTENTION - Prevalence of an infectious disease in foreign countries	- Situation monitoring - Border quarantine measures - Prevention education and campaign (KCDC)	- Situation monitoring - Border quarantine measures - Prevention education and campaign (KCDC)
CAUTION - Emergence of an infectious diseases in the country - Nosocomial infection	[Central Infection Response Task Force (KCDC)] * At the level of CAUTION, both the Central Accident Response Headquarters and the Central Disaster and Safety Countermeasures Headquarters are operated	Government-Wide Meeting (presided by the Prime Minister) Management Task Force (Ministry of Health and Welfare) Support Task Force (Ministry of Public Safety and Security) Response Task Force (KCDC)
ALERT - Community transmission
EMERGENCY - Spread throughout the country	Central Disaster and Safety Countermeasures Headquarters (Prime Minister or Ministry of Public Safety and Security) Central Accident Response Headquarters (Ministry of Health and Welfare) * The two Headquarters are operated when the Prime Minister deems it necessary or the Minister of Public Safety and Security makes a suggestion	Central Disaster and Safety Countermeasures Headquarters (supervised by the Prime Minister, and supported by the Ministry of Public Safety and Security) Central Accident Response Headquarters (Ministry of Health and Welfare) Response Task Force (KCDC)

* Central Disaster and Safety Countermeasures Headquarters (headed by the Minister of Public Safety and Security or the Prime Minister) will establish measures to mobilize resources and use non-governmental human resources at the pan-ministerial level.

* Central Accident Response Headquarters (headed by the Health and Welfare Minister) will establish measures to mobilize and use resources from the Ministry of Health and Welfare and related organizations.

2) Infectious diseases will be reclassified according to the level of risk. Emerging and high-risk infectious diseases will be dealt with by the central government led by the KCDC, and low-risk infectious diseases will be addressed by cities and provinces. The KCDC will build a system to provide a support program for epidemiologists belonging to local governments, including technical assistance, assessment and training, and will establish another measures to reform local governments' infection prevention and control system and strengthen their roles.

< Revised Classification System of Infectious Diseases >

Classification	Example	Field Response
Emerging infectious diseases (Their dangers have not yet been completely identified)	Ebola, MERS or H1N1 flu	Central government (KCDC)
High-risk infectious diseases	Tuberculosis, Measles or Bioterrorism
Medium-risk infectious diseases	Cholera, dysentery or mumps	City and Province
Low-risk infectious diseases	Malaria or Tsutsugamushi	City, County and District

- The Ministry of Health and Welfare will make all-out efforts to effectively implement this package of measures announced on September 1st, in close collaboration with relevant ministries, local governments, medical circles and non-governmental organizations. Further, additional revisions will be made to this reform measures by reflecting the results of a party-government consultative meeting, a parliamentary inspection of the administration, an inspection by the Board of Audit and Inspection and a comprehensive white paper on infectious diseases; and based on this, detailed action plans will be soon established.