May 23, 2003
As Co-Chairs for the DC Hospital Association Infectious Disease and Infection Control Committee we are writing to recommend that DC Hospitals and other healthcare facilities optimize their Infection Control preparedness for the management of SARS patients and their contacts as soon as possible. In particular, we advocate updating N-95 fit-testing for persons who may be called upon to provide care to patients with possible SARS, i.e., conceptually a “SARS RESPONSE TEAM”. Such personnel could include emergency medicine workers, ICU personnel, respiratory therapists, pulmonologists, ID/infection control workers, and multiple others. An even broader range of health care personnel could receive updated fit-testing afterwards.
This recommendation is consistent with guidelines for SARS preparedness by the WHO (April 24th update at www.who.int/csr/sars/infectioncontrol/en/print.html) and the CDC (May 1st update at www.cdc.gov/ncidod/sars/infectioncontrol.htm. Fit-testing is especially advised by CDC for aerosol-generating procedures such as airway suctioning, CPAP, diagnostic sputum induction, aerosolized medication treatment, bronchoscopy and endotracheal intubation (May 20 CDC update “Guidelines and Recommendations”. Fit-testing of N-95 respirators is also consistent with OSHA guidelines (www.cdc.gov/niosh/99-143.html).
Given the infection with SARS of health care workers in Toronto, Taiwan, Hong Kong, Hanoi, Singapore, Beijing, and multiple provinces in mainland China, our anticipation of SARS and application of lessons learned from these places should help prevent or mitigate nosocomial and associated community SARS in our region.
Relevant comments include those from both the WHO (19 May Update 59 “Lapses in infection control, particularly in emergency rooms, may have been one reason for the rapid increase in cases, particularly in hospitals” in Taiwan), and CDC (regarding infection of HCWs in Toronto MMWR May 16: “…however, no formal respiratory protection program existed at the hospital, and individual workers had not been fit-tested. In addition, the primary nurse for the patient had a small beard and reported that his mask did not fit well”.
We appreciate the consideration that our DC Hospitals, as well as, our colleagues from the National Capitol Region, give to this recommendation.
Daniel R. Lucey, MD, and Judy English, RN
Co-Chairs, DC Hospital Association ID/Infection Control Committee
May 23, 2003 Friday