SARS Infection Prevention & Control Overview of Precautions

See CDC SARS website. www.cdc.gov/ncidod/sars/infectioncontrol.htm

A. Inpatient Setting:

1. Standard precautions (e.g., Hand hygiene: Wash hands often). Plus EYE Protection.

2. Contact precautions (e.g., gown and gloves).

3. Airborne (e.g., negative pressure isolation room, or at minimum a private room with toilet; all persons

    entering room should wear an N-95 respirator that has been fit-tested where possible (male beards will

    prevent an adequate N-95 seal). If no N-95 is available, then a surgical mask should be worn.

4. When removing equipment: gloves first, followed by mask and goggles (CDC MMWR. May 16 p. 434).

B. Outpatient Setting:

1. If SARS suspected (acute respiratory infection: fever, cough, dyspnea) ask about travel to SARS areas

    or close contact with possible SARS patients or contacts e.g., at home or work who have traveled.

2. Place surgical mask on patient if SARS suspected and place in respiratory (negative pressure) isolation,

     if available, or in private room. Follow above standard, contact, and airborne precautions.

C. Home or residential setting:

1. Place surgical mask on patient during contact with others at home.

2. Household contacts should wash hands often and wear a surgical mask if patient cannot.

3. Avoid sharing utensils, towels, and bedding. Use gloves for direct contact with body fluids.

Ref: CDC. May 1. Updated Interim Infection Control Guidance in the Health Care and Community Setting

See: CDC. April 29. Interim Guidance for Infection Control Precautions for SARS in Households

D. Surveillance of Health Care Personnel for SARS:

1. Maintain a list of all personnel who enter the rooms of SARS patients or are involved in their care.

2. Instruct personnel to notify occupational health, infection control, or their designee if they have

    unprotected exposure to SARS, or if fever or respiratory symptoms develop.

3. Monitor employee absenteeism that may suggest an emerging illness cluster. Notify local/state Health.

    CDC website. May 20. Interim Guidance for Management of Exposures to SARS for Health-Care

    Settings.

E. To Prevent Unprotected Exposures to SARS Health Care Facilities Should:

1. Review procedures of early detection and isolation of SUSPECTED SARS patients.

2. Educate ALL health care personnel on signs/symptoms of SARS and ANTI-SARS INFECTION CONTROL.

3. Review use of personal protective equipment (PPE) ( N-95, removal of gloves before masks or goggles)

4. Follow CDC recommendations for aerosol-generating procedures in SUSPECTED or probable cases

    CDC website. May 20. Interim Guidance for Management of Exposures to SARS for Health-Care

    Settings.

F. Aerosol-Generating Procedures that are “ High-Risk” if Unprotected against SARS

1. Aerosolized medication Rx

5. Endotracheal intubation

2. Diagnostic sputum induction

6. Positive pressure ventilation via facemask (CPAP, BiPAP)

3. Bronchoscopy

7. High frequency oscillatory ventilation (HFOV)

4. Airway suctioning

Ref: CDC website. May 20. Infection Control Precautions for Aerosol-Generating Procedures.

G. Aerosol-Generating Procedures: Additional Infection Prevention & Control Measures

 1. Follow the multiple specific guidelines provided in the 3-page CDC May 20^th document including use of

     goggles that “fit snugly around the eyes”. A face shield alone is NOT adequate eye protection for

     aerosol-generating procedures, but a face shield can be worn over goggles.

 2. Use an N-95, N-99, N-100 respirator mask, or a PAPR (Powered Air Purifying Respirator).

 3. Limit the number of people present during these procedures to those who are essential.

 4. Perform procedures in an airborne isolation room if possible. If not, perform in a private room. If

     possible increase air exchanges. Avoid recirculation of the room air, but if this unavoidable the air

     should be passed through a HEPA filter before recirculation as recommended for TB.

 5. Keep doors closed and minimize entry and exit to the room.

 H. Management of Unprotected Exposures to SARS in Health Care Settings

1. High-risk: Even if ASYMPTOMATIC, health care workers who have unprotected exposures to aerosol-generating procedures “should be excluded from duty (administrative leave) for 10 days following the exposure--and should not go to work, school, church, or other public areas” (CDC. May 20).

2. Non-high-risk (non-aerosol-generating): If ASYMPTOMATIC after an unprotected exposure, then need

NOT be excluded from duty, but must have ACTIVE surveillance: measure temperature at least twice/day for 10 days and PRIOR to reporting to work be interviewed about respiratory symptoms AND have temperature measured by employee health or their designee.

I. Management of Potential Exposures to SARS with Infection Control Precautions:

1. Even when adhering to infection control precautions, if exposed to SARS patients: check temperature at least twice/day & be vigilant for respiratory symptoms. Occupational Health, Infection Control, or their designee should contact these health workers “regularly over the 10-day period” after exposure to ask about fever or respiratory symptoms.

J. Management of Symptomatic, Exposed health Care Workers

1. If EITHER fever OR respiratory symptoms develop in any health care worker exposed to SARS they should not report for duty but should contact the appropriate health facility immediately.

2. If already at work, they should immediately apply a surgical mask and leave the patient care area. In advance of clinical evaluation information should be provided that the person may have been exposed to SARS so that arrangements can be made to prevent transmission of SARS.

3. See CDC May 20 document pages 2-4 for a detailed algorithm, including when to observe for 72 hours, when to test for SARS-Coronavirus, and how long infection control precautions must be maintained after symptoms resolve.

Refs:

CDC website. May 20. Infection Control Precautions for Aerosol-Generating Procedures.

CDC website. May 20. Guidance for Management of Exposures to SARS for Health-Care Settings

CDC. MMWR. May 16, 2003. Cluster of SARS among Protected HCWs. Toronto, April 2003.

[Format 6/10/03: Daniel Lucey, MD, MPH. Center for Biologic Counterterrorism & Emerging Disease,

Washington Hospital Center. ID Consultant to DC DOH, DC Hospital Association, Medical Society of DC

www.bepast.org for information on SARS, monkeypox, emerging diseases and bioterrorism agents.]