# Presentation: 236081

## SARS Infection Control

## SARS Infection Control

- _Key Objectives_
- Early detection
- Containment of infection
- Protection of personnel and the environment of care
- Hand hygiene

- _Key Strategies_
- Administrative measures
- Infection precautions
- Standard
- Contact (droplet)
- Airborne
- Environmental cleaning/disinfection

## SARS Transmission During Aerosol-Generating Procedures

- Transmission of SARS to healthcare personnel during aerosol-generating procedures may be particularly efficient
- Clusters detected in Toronto, Hong Kong, Singapore and Hanoi
- Intubation, suctioning and nebulization specifically implicated

## Why? How?

- Patient infectivity higher?
- Is it: Droplet?  Contact? Airborne?
- Is it failure _to wear_ protective equipment?
- Is it failure _of_ protective equipment?

## Until Risks During Aerosol-Generating Procedures Better Defined.....

- Limit cough-inducing procedures
- Avoid use of non-invasive positive pressure ventilation (e.g., CPAP, BiPAP)
- Protect the environment
- Use closed suctioning devices
- HEPA filtration on exhalation valve port

## Protect Healthcare Personnel DuringAerosol-Generating Procedures

- Limit personnel to those essential for performing procedure
- Wear appropriate personal protective equipment
- Gowns and gloves
- Sealed eye protection (i.e., goggles)
- Respiratory protection device

## Respiratory Protection During Aerosol-Generating Procedures

- Proper fit is essential
- Reassess respirator fit among personnel who may be involved in intubation of SARS patients
- Consider better fitting respiratory protection devices
- Disposable respirators with better seal, e.g., N99, N100
- Half- or full-face elastomeric (rubber)
- Powered air-purifying respirators (PAPR)

## Management of SARS Exposures in Healthcare Settings

- Surveillance of healthcare personnel
- Develop list of personnel who have contact with SARS patients (I.e., enter room, participate in care)
- Encourage reporting of unprotected exposures
- Monitor absenteeism for SARS-like illness
- Management of asymptomatic exposed HCWs

## Management of Asymptomatic Exposed Healthcare Workers

- No evidence of transmission from asymptomatic persons
- Symptomatic HCWs have transmitted
- Active surveillance of HCWs who have unprotected exposure is recommended
- Monitor temperature and symptoms before reporting to duty
- Ten-day exclusion from duty for HCWs who have unprotected exposures during aerosol-generating procedures

## Addressing the limited supply of respirators

- Should respirators be reused?
- Disposal after one-time use preferred
- Use up higher level respirators first
- Reuse preferred to no respirator
- Consider using surgical mask to protect respirator from contact with respiratory droplets
- Carefully handle contaminated respirator
- Use surgical masks only when respirators are unavailable

## Cleaning and Disinfection of the SARS Patient Environment

- Environment may be a key to transmission
- Clean/disinfect frequently touched surfaces daily in in-patient areas
- Bed rails, over-bed table, door knobs, lavatory surfaces
- Perform more thorough cleaning at transfer or discharge
- Use EPA-registered hospital detergent disinfectant
- No need for air “fogging” or washing of ceilings and walls

## Management of Exposed and Symptomatic Persons

## Infection Control Principles Applied in the Home

- Early detection of infection
- Containment of infection
- Protection of household members
- Limiting contamination in the home environment

## Key Time Periods

- 10 days after last exposure –
- Duration of post-exposure monitoring period
- “72 hour rule”
- Period for reassessing early symptoms of SARS
- 10 days after resolution of fever
- Duration of post-SARS confinement

## Guidance for Persons Exposed to SARS

_**Asymptomatic**_ exposed persons
- No change in daily activities
- Monitor for respiratory symptoms and fever (i.e., measure temperature twice daily) for 10 days after last exposure
- Fever _**or**_ respiratory symptoms develop
- Notify healthcare provider
- Limit interactions outside the home
- Reassess in 72 hours

## 72 Hour Reassessment

## Infection Control for Persons with SARS*

- Avoid interactions outside the home (school, work, day care, church, shopping)
- Wear surgical mask and avoid public transportation if travel outside home is necessary
- Limit persons coming into the home

*** Including persons who have not been diagnosed with SARS but have SARS symptoms **

## Infection Control Advice to SARS Patients

- _Wear a surgical mask_ when in the presence of other household members
- _Contain respiratory secretions_ in facial tissue and place in lined container for disposal with household waste
- _Perform hand hygiene_ frequently and especially after touching respiratory secretions and other body fluids (e.g., urine, stool)

## Advice to Household Members of SARS Patients

- Wear surgical mask when around SARS patient (if patient cannot wear mask)
- Perform hand hygiene frequently (hand washing with soap and water or use of alcohol-base gel)
- Consider wearing disposable gloves for direct contact with body fluids of SARS patients

## Other Infection Control Measures in the Home

- Do not share personal items until thoroughly washed with soap and water (towels, linen, eating utensils)
- Consider separate sleeping arrangements
- Clean surfaces that are touched frequently or come into contact with body fluids (e.g., food preparation areas, phones, lavatories)

## Anticipatory Guidance for SARS Patients

- How will they get food and other supplies (e.g., surgical masks)?
- How will they travel to and from necessary appointments (e.g., medical)
- How will they deal with family members who are afraid?

## Prevention is Primary!