A Message to America's Hospitals:
We have all read reports about patients with severe acute respiratory syndrome (SARS) from China, Hong Kong, and other parts of Asia as well as Canada. To date, the World Health Organization (WHO) is reporting 306 suspected cases and 11 confirmed deaths. Closer to home, the Centers for Disease Control and Prevention (CDC) is reporting 13 suspected cases (no deaths) in the U. S., with patients in AZ, CA, CO, HI, NJ, NM, NC, TN, VA and WI. All 13 patients have a travel history to Asia. None of these suspected transmissions appears to have occurred in the U.S., according to the CDC.
In daily updates from the WHO and CDC, the number of cases and deaths continue to climb and your hospital could be affected soon. In response to these developments, on Tuesday, March 18, the CDC issued "Updated Interim Infection Control Guidance in the Health Care And Community Setting for Patients with Suspected SARS." We summarize the agency's recommendations below; however, we strongly urge hospitals to obtain a copy of the guidance at http://www.cdc.gov/ncidod/sars/infectioncontrol.htm. To minimize the potential for transmission, the CDC recommends hospitals follow these precautions, as feasible given available resources, until the causative agent is isolated or the epidemiology of the illness transmission is better understood.
The bottom line: Proper hand washing is essential for health care workers. In fact, many of the international SARS cases are caregivers who did not follow proper infection control procedures, such as hand washing. Make sure your caregivers and other employees follow proper hand washing techniques. If hands are visibly soiled, soap and water are advised; otherwise, alcohol-based handrubs may be used as an alternative to hand washing. More information on hand hygiene is available at www.cdc.gov/handhygiene.
To make sure your hospital is prepared for the possibility of suspected SARS patients presenting in the emergency departments (EDs) and ambulatory care clinics, your chief medical officer and infection control director should review and share with their staffs:
Infection Control Notification Procedures
Infection Control Measures for Inpatients and Outpatients
- Standard Precautions
- Contact Precautions
- Airborne Precautions
CDC's SARS recommendations to clinicians (www.cdc.gov/ncidod/sars/clinician_alert.htm)
Symptoms. Early manifestations include a fever greater than 100.4 degrees and influenza-like symptoms such as myalgia, headache, sore throat, dry cough, shortness of breath or difficulty breathing. The illness is contagious and seems to spread among people who come in close contact with infected individuals, including health care workers, who have developed similar illnesses. The cause of the illnesses is unknown and is being investigated.
Case Definition. The case definition for suspected SARS is subject to change, particularly concerning travel history as transmission is reported in other geographic areas; the most current definition can be accessed at www.cdc.gov/ncidod/sars/casedefinition.htm. Hospitals should apply appropriate infection control precautions for any contact with patients with suspected SARS.
Inpatient Setting. If a suspect SARS patient is admitted to the hospital, infection control personnel should be notified immediately. Infection control measures for inpatients should include:
Standard precautions (e.g., hand hygiene); in addition to routine standard precautions, caregivers should wear eye
protection for all patient contact.
Contact precautions (e.g., use of gown and gloves for contact with the patient or their environment).
Airborne precautions (e.g., an isolation room with negative pressure relative to the surrounding area and use of an
N- 95 filtering disposable respirator for persons entering the room).
If airborne precautions cannot be fully implemented, patients should be placed in a private room, and all persons entering the room should wear N-95 respirators. If N-95 respirators are unavailable, then surgical masks should be worn. Regardless of the availability of facilities for airborne precautions, standard and contact precautions should be implemented for all suspected SARS patients.
Outpatient Setting. Patients presenting with atypical pneumonia in the ED and clinic, should be queried about their previous travel and possible exposure to individuals who may have traveled to areas with documented cases of SARS. The suspected SARS patient should be evaluated in a separate assessment area to determine if they meet the case definition for suspected SARS and require isolation. A surgical mask should be placed on the patient, if possible. All caregivers should wear N-95 respirators while taking care of suspected SARS. If N-95 respirators are unavailable, caregivers should wear surgical masks.
The CDC Web site offers in-depth information about SARS at www.cdc.gov/ncidod/sars/index.htm. You may also want to visit the WHO Web page at www.who.int/csr/sars/en/. The AHA will keep you informed as this situation evolves.