# Presentation: 317893

## SARS Infection Control in Healthcare Settings

## Infection Control Considerations

- Some patients are highly infectious
- Hospitals must protect vulnerable patients, staff, visitors, and prevent spread to the community
- Until SARS epidemiology is better understood, infection control measures must target all possible modes of transmission

## Infection Control Strategies

- Administrative measures
- Communication
- Education
- Policies and procedures
- Enforcement
- Engineering measures
- Control of ventilation

## Infection Control Strategies

- Personal protective attire
- Masks
- Eye protection
- Gowns and gloves
- Environmental protections
- Cleaning and disinfection
- Waste, linen and laundry handling

## Key Objectives of SARS Prevention

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

## Administrative Measures

- Assignment of responsibility
- Placement of patients with SARS
- Implementation and enforcement of infection control measures
- Surveillance for transmission
- Limitation of SARS Patient contacts
- Visitation policies
- Staffing policies

## Key Objectives of SARS Prevention

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

## Early Detection 

- Clinician education
- Information on signs and symptoms of SARS
- Heightened index of suspicion in patients with history of travel or exposure to SARS areas or patients

## Early Detection

- Information at point of first healthcare encounter (ER, physician offices)
- Visual alerts
- Reporting instructions
- Provision of surgical masks for patients
- Segregation of symptomatic patients

## If you have fever and/or respiratory symptoms......	Cover your nose and 	mouth with a mask	Report your symptoms to 	the receptionist

- If you have fever and/or respiratory symptoms......	Cover your nose and 	mouth with a mask	Report your symptoms to 	the receptionist

_**Sample Alert at Hospital Entrance**_

## Early Detection

- Information at point of first healthcare encounter (ER, physician offices)
- Visual alerts
- Reporting instructions
- Provision of surgical masks for patients
- Segregation of symptomatic patients

## Early Detection

- System for immediate notification of infection control personnel
- Use of personal protective attire from point of first patient contact

## Key Objectives of SARS Prevention

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

## Containment of Infectionwith Engineering Controls

- Preferred
- Private room with engineered negative pressure and filtered air exhaust to outside
- Door closed except when needed for patient access
- Limit access to persons essential for providing care

## Containment of Infection Without Engineering Controls

- Maximize natural ventilation
- Open windows
- Control direction of air flow
- Use fans to exhaust to outside
- Place surgical mask on patients as tolerated and compatible with patient care

## Strategies for Patient Placement

- Use private rooms where available
- Designate wards for SARS patients where increased capacity is needed
- Segregate suspect SARS cases from patients being evaluated for SARS until diagnosis is established

## Limit Patient Contact

- Visitor restriction options
- Screening and restriction of symptomatic visitors (refer for evaluation)
- Restrict visits to SARS patients
- Limit all hospital visits to all but essential family members
- Dedicate staff to care of SARS patients

## Key Objectives of SARS Prevention

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

## Consider all Possible Transmission Routes

- Most likely
- Droplet
- Contact
- Direct (Contamination of skin, clothing)
- Indirect (Contaminated fomites)
- Possible
- Airborne

## Personal Protective Attire

- Respiratory protection
- N95 mask preferred
- Perform qualitative respirator fit-testing where applicable
- Surgical mask if not available
- Apply mask when entering room or ward
- Ensure snug fit over nose and mouth
- Eye protection
- Goggles or face shield as recommended for standard precautions

## Personal Protective Attire

- Contact protection of skin and clothing
- Gowns (disposable or washable)
- Gloves (disposable)
- For contact with SARS patients or their environment
- Head and shoe covers may be used if dictated by cultural norms or regulations

## Protect the Environment of Care

- Follow standard procedures or regulations for handling contaminated (infectious) materials
- Soiled linen/laundry
- Usual warm water and detergent wash cycles
- Bleach may be added but is not needed
- Avoid sorting of linen before washing
- Waste
- Dispose in accordance with local regulations for infectious waste
- Eating utensils
- Use standard warm water dishwashing methods

## Protect the Environment of Care

- Use hospital grade disinfectants or 1:100 dilution of household bleach (5.25% - 6%) and water for surface cleaning and disinfection
- Assume environment in which SARS patients are housed is heavily contaminated
- Facilitate daily cleaning by limiting clutter in patient care area
- Thoroughly clean and disinfect room and equipment after patient discharge

## Key Objectives of SARS Prevention

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

## Hand Hygiene

- Hand hygiene is the cornerstone of prevention!!!
- Perform hand hygiene following all contact with suspect SARS patients and their environment
- Methods
- Hand washing with soap and water
- Alcohol-based handrubs when...
- Hands are not visibly soiled, or
- Hand washing facilities are not available in patient rooms

## Other considerations

- Avoid use of nebulizers when possible
- If needed, perform nebulization in protected, negative pressure environment
- Limit patient movement
- If transport required for patient care, place surgical mask on patient
- Place clean attire on patient or cover with gown

## Surveillance

- Monitor personnel for signs and symptoms of SARS
- Restrict symptomatic personnel pending evaluation for SARS

## The principles are the same....methods of implementation may differ

## Factors that Influence Infection Control Practices Globally

- Cultural patterns of healthcare delivery
- Hospital infrastructure
- Knowledge and experience of healthcare personnel
- Resource limitations
- Extent of SARS spread in community and hospital

## SARS Resources

- _[http://www.cdc.gov/ncidod/sars/](http://www.cdc.gov/ncidod/sars/)_
- _[http://www.who.int/csr/sars/en/](http://www.who.int/csr/sars/en/)_

## Prevention is Primary!