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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,
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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.
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< Outline of the EOC >
Report of
suspected cases
Setting up a 24-hour
hotline
Information on
Current status of
infection from
infectious diseases
international
occurring in the
organizations
Republic of Korea
Information on
infection obtained
through a
surveillance
program
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
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(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
Group of non-governmental experts
←
Group of epidemiologists from the
Immediate Response Team
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
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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.
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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 governmentdesignated 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
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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,
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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. Negativepressure 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
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"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.
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< 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)
[Central Infection Response
Task Force (KCDC)]
Government-Wide
Meeting
CAUTION
- Emergence of an
infectious diseases in
the country
- Nosocomial
infection
* At the level of CAUTION,
both the Central Accident
Response Headquarters and the
Central Disaster and Safety
Countermeasures Headquarters
are operated
(presided by the Prime
Minister)
Management
Task Force
Support
Task Force
(Ministry of
(Ministry of
Health and
Public Safety
Response Task
Welfare)
and Security)
Force
ALERT
(KCDC)
- Community
transmission
Central Disaster
and Safety
Countermeasures
Headquarters
(Prime Minister or
Ministry of Public
Safety and Security)
EMERGENCY
- Spread throughout
the country
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
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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 highrisk 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
Ebola, MERS or H1N1 flu
Central government
(KCDC)
yet been completely
identified)
High-risk infectious
diseases
Tuberculosis, Measles or
Bioterrorism
Medium-risk infectious
Cholera, dysentery or mumps
diseases
Low-risk infectious
diseases
Malaria or Tsutsugamushi
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City and Province
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 partygovernment 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.
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