Download presentation
Presentation is loading. Please wait.
Published byGladys Bailey Modified over 9 years ago
1
Infection Control for SARS Patients Mark Simmerman, RN.MS CDC/NCID/OD International Emerging Infections Program
2
SARS Case Definition Suspect Case Symptoms after 1 November 2002 – Fever (>38°C) AND – Cough or shortness of breath – Diarrhea? Exposure within 10 days of symptoms – Traveling or living in SARS affected area OR – Close contact with SARS case No other explanation for respiratory disease
3
SARS Case Definition Probable Case Suspect case with – Chest x-ray findings of pneumonia or respiratory distress syndrome OR – Autopsy findings of pneumonia or respiratory distress syndrome
4
Close Contact Caring for patient with SARS Living with patient with SARS Contact with respiratory secretions or other bodily fluids of patient with SARS
5
Etiology: Coronavirus Single-stranded enveloped RNA virus Incubation 3-5 days Viremia documented Early evidence suggests 24+ hour survival on dry surface Some patients may shed virus for 30 days from onset of symptoms Reinfection possible
6
Transmission Droplet Direct contact Indirect contact (Fomite) Airborne in health care settings?
7
Risk to Health Care Workers (HCW) HCW and close contacts at highest risk Prince of Wales Hospital, Hong Kong – 62% (85 of 138 patients) of transmission was to HCW and medical students Bumrasnaradul Hospital, Thailand – None of approximately 70 HCWs infected from a single SARS patient who died
8
Goals of SARS Infection Control Early detection Prompt reporting Containment of infection Protection of personnel and environment
9
Management of Possible Cases 1. Immediately isolate patient with symptoms or exposure – Place a mask on the patient 2. Personnel entering the room: – Contact precautions – Airborne precautions
10
How is SARS Spread? Most often by contact and droplet - Touching patient or their secretions and then touching your face - Having droplets from patient ’ s breath, speaking or coughing fall on your hands, face Other possible routes - Airborne (breathing same air without mask)
11
Standard Precautions Frequent hand washing! – Warm water and soap – Alcohol-based hand gel ok Standard personal protective equipment (gloves, mask, eye protection, face shield, gown) Environmental control (patient care equipment, environmental hygiene, linen, trash) Bloodborne pathogen precautions
12
Contact, Droplet, and Airborne Precautions Minimize patient transport Dedicate equipment to patient if possible Clean/disinfect common equipment Use disposable equipment No visitors or non-essential staff Prepare linen on-site using protective equipment Private negative pressure isolation room with anteroom if possible
13
One Example Glass partition Nursing Station and Dressing Area Entrance to anteroom Personal protective equipment & supplies Door to patient room Entrance to hallway Anteroom
14
Negative pressure monitor Patient room
15
Air Circulation Establish negative pressure – Assure clean airflow – Ensure that ventilation and windows do not open to public places – Use fans to direct air flow Test negative pressure – Use tissue paper to test air flow – Assess airflow daily
16
Personal Protective Equipment N-95 or N-100 mask with fit testing Use surgical mask as second layer if mask reused Surgical head cover Goggles or face shield – eyeglasses not adequate Double gown Double gloves Double shoe covers
17
In Dressing Area Put on in this order: – N-95 mask or equivalent ! Ensure good fit – Eye protection essential – Head cover (all hair inside cap) – Surgical mask as outer layer (optional) – Shoe covers – Inner gown (may be cloth) and gloves – Outer gown (disposable) and gloves
18
In Preparation Area Remove in this order: – Outer shoe covers – Outer gown and outer gloves – Head cover – Surgical mask (if used)
19
Outside of Preparation Area Remove in this order: – Inner shoe covers – Inner gown and gloves – Eye protection – N-95 mask Evaluate reusable equipment – Discard damaged or soiled equipment – Clean and disinfect – Label and hang immediately outside anteroom Wash hands vigorously for 2 minutes
20
Basic Principles Minimize time in room Only essential staff Only one patient per room Minimize time within two meters of patient Minimize direct contact with patient Avoid patient ’ s bathroom unless essential Minimize equipment in patient rooms
21
Reducing Droplets Medical management to reduce cough Medical management to reduce vomiting No nebulizer treatments Closed suctioning of ventilated patients Supply oxygen dry- by nasal prongs if possible Patient must wear mask at all times Handle bed linens to avoid creating aerosols
22
High Risk Activities- AVOID When Possible Nebulized treatments Oxygen masks Noninvasive positive pressure ventilation Percussion chest physiotherapy Use of humidified oxygen
23
High Risk Activities – AVOID When Possible (cont ’ d) Manual bagging Tracheal and oropharyngeal suction Nasopharyngeal aspiration/ throat swab Use nasal, not NP swab
24
Intubation for SARS Patients Elective intubation: Paralyze and Sedate! Closed system suctioning HEPA filter or exhaust to outside Avoid manual bagging Negative pressure, well-ventilated room Minimize number of people in room Most experienced staff members only
25
Restrict Access to SARS Ward 1. No visitors 2. No Attendants 3. No students
26
Fomites: Contaminated Surfaces Door knob Bedrail IV Pole Toilet Medical Equipment
27
Clean surfaces 5% NaOCl (Bleach) Sponge Bucket for each room Hot water Clean at least once daily
28
Specimen Handling Single bag specimens in patient ’ s room Double bag outside of patient ’ s room Label and alert laboratory of incoming specimens from SARS-infected patient
29
Surveillance of Health Care Workers Keep lists of SARS case-patients and exposed health care workers Exposed personnel should be followed for fever and respiratory symptoms Health care workers with symptoms should be evaluated & isolated if necessary
30
Follow-up of Discharged Patient Home quarantine for at least 10 days – Temperature log, twice daily – Return if temperature >38°C on two occasions Convalescent serology at 3 weeks after onset of symptoms
31
Conclusion Hand Hygiene: Frequent Washing, Gloving Personal Protective Equipment- Mask+ Eye Protection Always Minimize Contact Time Monitor HCWs for Symptoms Teach and monitor your coworkers!
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.