Severe Acute Respiratory Syndrome (SARS)

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Severe Acute Respiratory Syndrome (SARS)

• Principles of Patient Management

WHO Western Pacific Regional Office April 17,
2003
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Patient Management

• SARS Infection Control Goals
• SARS Admissions - Triage
• Components of SARS Isolation
• SARS Infection Control Practices

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SARS Infection Control Goals

• In addition to providing the best possible
  clinical care
• Detect early any suspect cases
• Implement appropriate isolation measures
• Protect healthcare personnel
• Protect other patients
• Protect family and community members

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Triage for SARS Admissions

• Where possible have a specific area for triaging
  patients who
• may have SARS
• Establish separate reception area for patient
  triage.
• Staff must wear full personal protective
  equipment (PPE).
• Patients must be given a surgical mask
• (preferably N-95 Respirator mask).
• Screen patients by closely questioning them about
  symptoms, close contacts and travel.
• Admit if they meet the case definition.

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Triage for SARS Admissions

• If possible, there should be separate wards/areas
  for
• each of the following categories
• Patients with colds, sniffles and runny noses
  should be isolated in a single room / area
• Suspect cases
• Place in a single room
• Probable cases
• If cohort nursing keep probable and suspect
  cases apart
• May share room with other probable cases where
  possible use a single room for all patients

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Components of SARS Isolation

• Facility
• Administrative Controls
• Clinical Surveillance of Staff
• Organization of Isolation Area
• Protective Equipment
• Standard Precautions

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Facility

• Isolated from other patient / staff movement
• Good ventilation
• Air movement corridor to room to outdoors
• Turn off central air-conditioning systems unless
  the room can be isolated from the system.
• Sinks and running water
• Adequate bathroom facilities
• Capacity to handle waste and laundry
• Sufficient rooms for expected number of patients
• Contingency plans for converting other areas to
  isolation facilities

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Facility

• Isolation Area Barrier Nursing Techniques
  Required
• Green (GO) General reduced staff movement
• Yellow (CAUTION) Limited staff movement
• Red (RESTRICTED) Assigned staff only

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Barrier Nursing Techniques

• Barrier nursing techniques are designed to
  prevent
• either
• The patient infecting other people (routine B/N)
• or
• The patient being infected by others (reverse
  B/N)
• Strict routine barrier nursing must be used for
  all
• SARS patients.

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Administrative Controls

• Limit, and control points, of entry to SARS
  ward(s)
• One entrance
• Guard to control entrance
• Log of permitted visitors (staff visitors)
• Visitors must be restricted or preferably
  forbidden with NO EXCEPTIONS
• Limit patient travel/transport outside unit
• Minimize the number of staff exposure to cases

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Administrative Controls

• Assignment of responsibility
• Determining patient placement
• Overseeing implementation and enforcement of
  infection control measures
• Enforcing access restrictions
• Supply acquisition and distribution
• Surveillance of Health Care Workers (HCWs)

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Clinical Surveillance of Staff

• Maintain list of all staff who worked with SARS
  patients or on the SARS ward
• Systematically monitor for fever
• Twice daily temperature for staff working in the
  area (baseline Chest X-Ray may be needed )
• Screen for symptoms of SARS-like illness among
  staff reporting for duty
• List contact information for
• Persons visiting or caring for SARS patients
• Contacts of HCWs in close contact with SARS
  patients

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Organization of SARS Isolation Area

• Signs SARS Isolation Area
• Designated area for clean protective equipment
• Instructions for using protective equipment
• Accessible to personnel
• Sufficient inventory to meet daily needs
• Separation of clean and dirty supplies including
  an area for containment of waste and soiled linen
  
• Color-coded bags and containers for contaminated
  waste and laundry
• Containers for laundry and all waste should have
  foot-operated lids

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Protective Equipment

• N-95 Respirator Mask must be worn
• Goggles (protective glasses)
• Disposable or Reusable Gowns
• Disposable Gloves
• Cap and shoe covers

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Infection Control Practices

• Standard Precautions
• (Respiratory Precautions)
• Exposure Risks
• Hand Washing
• PPE
• Patient transport

• Patient and family
• education
• Laboratories / Specimens
• Mortuary Care
• Waste and Linen Handling
• Cleaning Disinfection

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Infection Control Practice

• You can minimise YOUR risk of catching
• SARS
• by following
• infection control procedures.

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Standard Precautions(Respiratory Precautions)

• Designed to reduce the risk for occupational
  exposure to SARS infection from both recognized
  and unrecognized sources of infection

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Exposure Risks

• Patient
• Respiratory secretions
• Blood
• Body fluids including excreta
• Skin lesions
• Staff
• Visitors

• Health Care Staff
• Respiratory secretions
• Blood
• Body fluids including excreta
• Mucous membranes
• Skin lesions
• Sharps
• Visitors

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Can You Now Answer These Questions?

• What infection control principles and practices
  are required for the management of the person
  with SARS? Why?
• What will you do if a patient arrives at the
  emergency department with symptoms of SARS?
• How will you set up an isolation area for these
  patients? Why?
• What do you need in the isolation area to care
  for the SARS patient? Why?

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Can You Now Answer These Questions?

• How will you manage both suspect and probable
  cases of SARS? Why?
• What education should staff have before nursing
  SARS patients? Why?
• How should you care for the staff who are nursing
  SARS patients? Why?
• What should you do about visitors to SARS
  patients? Why?

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Take Home Messages

• Triage of Patients
• Admission of SARS Patients
• Isolation Facilities
• Surveillance of Staff
• Tracing and Control of Contacts
• Full Personal Protective Equipment (PPE)
• Standard Precautions (Respiratory)
• Exposure Risks

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Patient Management

• We hope YOU have learnt something about
• the Principles of Patient Management of
• SARS
• Thank you for listening.