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Hospital Infection Control Guidance for Severe
Acute Respiratory Syndrome (SARS)
Revised April 24 2003
Outpatient/triage
setting :
- Those
presenting to health care facilities who require assessment for SARS
should be rapidly diverted by triage nurses to a separate area to
minimize transmission to others
- Those
patients should be given a face mask to wear, preferably one that
provides filtration of their expired air.
- Staff
involved in the triage process should wear a face mask (see below)
and eye protection and wash hands before and after contact with any
patient, after activities likely to cause contamination and after
removing gloves
- Wherever
possible, patients under investigation for SARS should be separated
from the probable cases.
- Soiled
gloves, stethoscopes and other equipment have the potential to spread
infection.
- Disinfectants
such as fresh bleach solutions, should be widely available at appropriate
concentrations.
Inpatient
setting
Care
for probable SARS cases (see Case
Definitions for Surveillance of Severe Acute Respiratory Syndrome (SARS)
)
- Probable
SARS cases should be isolated and accommodated as follows in descending
order of preference:
1. |
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negative
pressure rooms with the door closed |
2. |
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single
rooms with their own bathroom facilities |
3. |
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cohort
placement in an area with an independent air supply, exhaust system
and bathroom facilities |
- Turning
off air conditioning and opening windows for good ventilation is recommended
if an independent air supply is unfeasible. Please ensure that if windows
are opened they are away from public places.
- WHO
advises strict adherence to the barrier nursing of patients with SARS,
using precautions for airborne, droplet and contact transmission
- All
staff, including ancilliary staff should be trained in the infection
control measures required for the care of such a patient
- A
member of staff must be identified who will have the responsibility
of observing the practice of others and provide feedback on infection
control
- Disposable
equipment should be used wherever possible in the treatment and care
of patients with SARS and disposed of appropriately. If devices are
to be reused, they should be sterilized in accordance with manufacturers’
instructions. Surfaces should be cleaned with broad spectrum disinfectants
of proven antiviral activity
- Movement
of patients outside of the isolation unit should be avoided. If moved
the patients should wear a face mask
- Visitors,
if allowed by the health care facility should be kept to a minimum.
They should be issued with personal protective equipment (PPE) and supervised
- All
non-essential staff (including students) should not be allowed on the
unit/ward
- Handwashing
is crucial: therefore access to clean water is essential
Hands should be washed before and after contact with any patient, after
activities likely to cause contamination and after removing gloves
- Alcohol-based
skin disinfectants could be used if there is no obvious organic material
contamination
- Particular attention should be paid to interventions
such as the use of nebulisers, chest physiotherapy, bronchoscopy or
gastroscopy; any other intervention which may disrupt the respiratory
tract or place the healthcare worker in close proximity to the patient
and potentially infected secretions.
- PPE should be worn by all staff and visitors accessing
the isolation unit
- The PPE worn in this situation should include:
A face mask providing appropriate respiratory protection (see below)
Single pair of gloves
Eye protection
Disposable gown
Apron
Footwear that can be decontaminated
- All sharps
should be dealt with promptly and safely
- Linen
from the patients should be prepared on site for the laundry staff.
Appropriate PPE should be worn in this preparation and the linen should
be put into biohazard bags
- The room
should be cleaned by staff wearing PPE using a broad spectrum disinfectant
of proven antiviral activity
- Specific
advice concerning air conditioning units will be available soon
- Respiratory
protection. This should where feasible be provided at *P100/FFP3, or
P99/FFP2 filter level (99.97% and 99% efficiency respectively). *N95
filters (95% filter efficiency) also provide high levels of protection
and could be worn where no acceptable higher protection alternatives
are available for example staff working in triage areas, prior to isolation.
Ideally, the masks used should be fit tested using an appropriate "fit
test kit" in accordance with the manufacturing instructions. Disposable
masks should not be reused.
*N/R/P 95/99/100
or FFP 2/3 or an equivalent national manufacturing standard (NIOSH (N,R,P
95,99,100) or European CE EN149:2001(FFP 2,3) and EN143:2000 (P2) or comparable
national/regional standards applicable to the country of manufacture.
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