Infection Control for SARS

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Infection Control for SARS
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How is SARS spread?

• MOST OFTEN spread by contact and or droplet
• That is, touching a patient or their secretions
  directly (and then touching your face), or having
  droplets from their breathing, speaking, coughing
  etc. land on your hands or face
• Other possible routes
• Airborne (breathing same air without N95 mask)
• Contact with contaminated environment
• Re-aerosolization of droplets (eg. When mask
  removed, or with toilet flushing or bed sheets
  shaken out)

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How can we prevent transmission? I

• Ensure that all patients who might have SARS are
  rapidly identified and managed in precautions
• Minimize the opportunities for exposure of
  staff/other patients to SARS patients
• Minimize the number of droplets the patient
  produces (eg. minimize coughing, vomiting)

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How can we prevent transmission? II

• Control air flow and air exchanges
• Use N95 masks to protect against possibility of
  airborne spread
• Use barriers to prevent direct contact and
  droplet contact
• Handle patient area (eg. Linens) and remove
  barriers so as to prevent re-aerosolization
• Repeated, thorough cleaning of the environment

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Keys to prevention of SARS transmission

• Obsession
• Paranoia
• Self-discipline

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Identification / Management of Patients

• Fever surveillance in patients
• All patients with fever assessed for SARS risk,
  maintained in SARS precautions
• Fever/symptom surveillance in staff
• Occupational health assessment of staff with
  fever, myalgias, new cough

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Managing Known SARS patientsRoom Placement /
Entry

• Airborne isolation rooms or SARS unit (negative
  pressure, at least 6 air exchanges per hour)
• Only essential staff enter room/unit
• Minimize time in room
• Minimize time within six feet of patient
• HCW position to avoid droplets in front of
  patients face
• Minimize amount of direct contact with patient
• Do not go into patients bathroom unless
  essential for patient care

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Managing Known SARS PatientsReducing Droplets

• Medical management to reduce cough
• Medical management to reduce nausea and prevent
  vomiting
• No nebulizer treatments
• Supply oxygen dry by nasal prongs if possible
• Patient to wear surgical mask at all times when
  HCW are in the room
• Handle bed linens to avoid creating aerosols

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Managing Known SARS Patients Protective Barriers
- 1

• N95 mask
• Face shield (fluid shield mask worn upside down)
• Cap/Hair cover
• Gown
• Double Glove

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Managing Known SARS Patients Protective Barriers
- 2

• N95 mask
• Ensure mask fits on face
• Comfortable enough so that does not need
  adjustment while garbed
• Ensure overlap between gloves and gown cuff
• Double glove
• Wear first pair for direct contact with patient,
  then remove
• If top pair of gloves contaminated (eg. cleaning
  vomit), remove and replace

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Managing Known SARS Patients Protective Barriers
- 3

• Protect face
• Consciously keep hands away from face/head/neck
  while in room
• Ensure hair is tied or clipped back so that hands
  do not move to adjust
• Dont be afraid to ask for help with procedures
• Iv starts etc more difficult to perform garbed
• Most experienced person should be performing
• Do not check pager, or answer phone while in room
• Do not wear rings or watch (to allow adequate
  disinfection of hands)

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Managing Known SARS Patients Removing Barriers -
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• At door to room, remove gloves, then gown
• Disinfect hands with alcohol handwash in the room
• Leave the room
• Disinfect hands
• Hold the mask/face shield by the edge of the face
  shield and lift it up over your head
• Remove hair cover
• Remove N95 mask, by holding at the bottom and
  lifting it up over your head
• Disinfect hands
• Put on a clean N95 mask, then a clean gown

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High risk activities

• Intubation
• Noninvasive positive pressure ventilation
• Manual bagging
• Nebulized medication administration
• Use of Venturi mask
• Tracheal and oropharyngeal suction
• Nasopharyngeal aspiration / throat swab
• Percussion chest physiotherapy

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High risk activitiesActivities to be avoided

• Nebulizer (Use spacer if needed)
• Use of Venturi mask
• Noninvasive positive pressure ventilation
• Oscillatory ventilation
• Percussion chest physiotherapy
• Use of humidified oxygen

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High risk activities (contd)

• Manual bagging
• Avoid where possible minimize time
• Tracheal and oropharyngeal suction
• Always used closed suction
• Nasopharyngeal aspiration / throat swab
• Use nasal, not NP swab
• Perform swab with mask over mouth, and tissues at
  hand for the patient

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Intubation for SARS patients

• Elective intubation preferred
• Negative pressure, well ventilated room
• Minimize number of people in room
• Most experienced staff members only
• Protective gear, as usual, with addition of PAPR
• Avoid manual bagging
• Perform procedure that is safe for patient, while
  minimize cough and other droplet producing
  effects/procedures

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If you feel sick

• Early infection can present with low grade fever
  and chills only, or only aching and headache
• Check with occupational health if you are worried
• Report fever immediately assessment will be
  arranged same day
• Self-isolate at home until assessment has been
  done, or until you feel better