Hospital‐based salient prevention and control measures to counteract the 2022 monkeypox outbreak

Abstract Monkeypox (MPX) has been declared a public health emergency of international concern by the World Health Organization. As of November 4, 2022, 78,000 verified cases from 109 countries and territories, and 40 deaths have been reported due to MPX. The present article highlights salient hospital‐based prevention and control measures to be adopted and their critical role to mitigate the ongoing MPX outbreaks and global public health emergency.


| INTRODUCTION
Monkeypox (mpox) has been declared a public health emergency of international concern by the World Health Organization (WHO). As of November 4, 2022, 78,000 verified cases from 109 countries and territories, and 40 deaths have been reported due to mpox. 1 After eradication of smallpox in 1980, its vaccination has been stopped, therefore non-vaccinated population is vulnerable and at more risk to contract monkeypox virus (MPXV) infection. Few researchers have also emphasized the feasibility of another pandemic to happen amid the ongoing COVID-19 pandemic. 2,3 Rising cases of mpox underline the need to better understand the sources and dynamics of transmission and to equip people with the knowledge and resources needed to safeguard themselves and others in such emergency health situations. To date, the clinical appearance of patients with mpox during this outbreak has been varied. More research is required to comprehend the ongoing and new sources of infection in countries where mpox has been a concern for a long time.
Regardless of sexual orientation or gender identity, healthcare workers (HCWs) should be tested if they have a rash similar to that of mpox. Transmission of MPXV can occur through close physical contact with an infected person's lesions, respiratory secretions, or contaminated objects, such as clothing or bedding. Currently, the level of danger among the general public is low. Although the risks of healthcare-associated illnesses have not yet been reported for this epidemic, it is possible to prevent infections in health professionals who come into contact with infected cases while adopting appropriate personal safety measures including wearing adequate personal protective equipment (PPE). Given that immunocompromised individuals have a higher risk of developing severe mpox illness and dying from it, there is the potential for a greater negative impact on health should mpox begins to spread more broadly among more vulnerable groups. 4 Healthcare personnel, including nurses, play a major role in controlling the human-to-human spread of mpox through raising public awareness, early case detection, diagnosis and care, isolation, contact tracing, clinical management, and infection prevention control. 5 The present article highlights salient hospitalbased prevention and control measures to be adopted and their critical role to mitigate the ongoing mpox outbreaks and global public health emergency.

| HUMAN RESOURCES MANAGEMENT
The management at hospitals must address human resources, and healthcare personnel must be empowered and trained to handle stressful circumstances, including disease outbreaks. A mpox management team comprising of motivated young employees and experienced professionals who had already encountered the earlier epidemics and pandemics of highly infectious diseases such as H1N1 influenza, SARS, Ebola, COVID-19, and others, should be formed. The team members should include nurses, physicians, and other hospital HCWs. Recruitment of young HCWs ≤45 years of age is preferred because of their relatively lower risk of developing serious MPXV infections. However, high-risk HCWs must be barred from the team, including senior consultants aged >60 years, those using immunosuppressive medicine, and those with numerous comorbid conditions. The hospital staff must be divided into numerous groups based on their competence levels. Rotation and cooling-off can be used to keep personnel from becoming overworked and to maximize their safety. A standby duty roster of registrars and consultants for a mpox outbreak can be planned to prevent unanticipated staffing shortage.
Residents and medical professionals in all disciplines should be trained to work in mpox affected and non-mpox areas, in accordance with their skills so that they can be deployed as needed.

| HEALTHCARE PROFESSIONALS TRAINING
Continuous on-site, online, or hybrid training is very important to enable healthcare professionals to upskill, continue the delivery of high-quality care, and maintain good patient outcomes. Healthcare professionals should be trained to provide screening, clinical management and treatment, needful care, and support to patients to combat the infectious diseases. This training should make use of evidence-based education approaches and cutting-edge online learning resources. The mpox readiness and response curriculum was developed to enable quick scaling-up of response activities in highrisk countries. This curriculum needs to be delivered via a live online platform and created using a training-of-trainers methodology, along with a free e-Learning program that users can access on their own devices. In accordance with the WHO's recommendations, it must be updated based on current knowledge of the virus and best practices. 6 Volunteers must be trained in skills necessary to help their communities, respond to crises, and save lives worldwide.

| MONKEYPOX (Mpox) PATIENT MANAGEMENT & TREATMENT
Managing patients with mpox first requires clinical recognition of the disease; the key characteristics for identifying this disease include the appearance of firm or rubbery lesions that typically develop simultaneously and evolve together on any given part of the body. Second, exposed persons should be closely monitored. Anyone who is exposed to people or animals with mpox should self-monitor their health or should be monitored for signs or symptoms consistent with MPX for 21 days after their last exposure, which includes assessing the person for signs and symptoms, skin examination, and examination of the genitals and anus for rash or lesions. Third, isolation and Occupational Safety and Health-approved particulate respirator equipped with N95 filters or higher. 7 In light of the limited resources and the likely increase in hospitalization of mpox cases in the coming days as a result of the ongoing outbreaks, coordinated efforts for disease prevention, and control need to be implemented adequately to maximize their effectiveness as well as protecting health of frontline health workers and healthcare personnel's in hospitals. 5,18 To achieve this goal, it is necessary to collaborate and coordinate with other institutions to make optimum use of available resources and facilities as well as expertise utilization in crisis management. Kuldeep Dhama: data curation; formal analysis; investigation; methodology; project administration; resources; software; supervision; validation; visualization; writingoriginal draft; writingreview & editing.