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Severe Acute Respiratory Syndrome Another Challenge for Critical Care Nurses

Severe Acute Respiratory Syndrome Another Challenge for Critical Care Nurses. Karen M. Williamson RN, MScN, PhD(c) Maher M. El-Masri RN, PhD Susan M. Fox-Wasylyshyn RN, PhD. What is SARS?. Viral Disease Primarily airborne Contracted by exposure to a new form of coronavirus

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Severe Acute Respiratory Syndrome Another Challenge for Critical Care Nurses

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  1. Severe Acute Respiratory SyndromeAnother Challenge for Critical Care Nurses Karen M. Williamson RN, MScN, PhD(c) Maher M. El-Masri RN, PhD Susan M. Fox-Wasylyshyn RN, PhD

  2. What is SARS? • Viral Disease • Primarily airborne • Contracted by exposure to a new form of coronavirus • Symptoms are common: fever; non-productive cough • No vaccine or definitive treatment • Epidemic is NOT over: It is CONTAINED

  3. Historical Background • First case of SARS: November 2002 • Started in China • Nurses, particularly ICU and ER nurses were at risk for contracting the disease

  4. SARS Statistics: 2004Total probable/suspected • China: 2889 cases • USA: 220 cases • Canada: 438 cases • In Canada: 100 of these were HCWs • HCWs contracted SARS d/t: caring for undiagnosed SARS patients who were not isolated; contact with ill family members

  5. Etiology and Transmission • SARS viral in origin; contracted by exposure to a novel coronovirus • Transmitted: droplet spread; surface contamination; close contact

  6. Prognosis • Greatest in patients aged 65 years and older (50%) • Risk factors: older age, diabetes, tachycardia, elevated creatinine kinase and LDH levels • Predictors of mortality: HTN, diabetes, age, smokers, immunosuppression, respiratory infections

  7. Case Definition • Clinical: • Temp: 100.4°F • Cough, SOB, dyspnea, hypoxia, pneumonia • ARDS

  8. Case Definition (cont’d) • Epidemiologic: • Travel • Close contact • Laboratory: • Detection SARS-CoV • Detection SARS-CoV RNA by RT-PCR • Isolation SARS-CoV

  9. Clinical Manifestations • Fever greater than 100.4°F • Non-productive cough • Dyspnea • Radiologic infiltrates: O2 sat. on room air < 95% • No alternative diagnosis can fully explain the illness

  10. Diagnostic Criteria • Testing of SARS-CoV based on detection of virus or antibody response to viral infection • RT-PCR (nasopharangeal and stool) • ELISA or IFA (serum)

  11. The Inter-epidemic period2004/2005 • Definition of SARS alert is based on clinical evidence in the following situations: A. Individual contact/travel B. 2 or more HCWs exhibiting S&S C. 3 or more persons (HCWs and others) with symptoms

  12. Current and Future of Treatment for SARS • Antibiotics (not successful) • Anti-virals • Corticosteroids • Supportive intensive care • Immunization: in the beginning phase

  13. Clinical Management • Infection Control+++ • Early identification and patient isolation • Patients and HCWs should wear masks/HCWs wear eye protection, gloves, long sleeved gowns, respirator masks, wash hands with ETOH-based skin disinfectants,

  14. Clinical Management (cont’d) • Highly recommended: SARS patients should be placed in a room with negative pressure ventilation • Lower tidal volumes during mechanical ventilation • Continuity of care

  15. Implications for Critical Care Nurses • Be viligant for any non-ordinary reports of acute respiratory illnesses • Full infection control • Become involved in collaborative policy and research efforts to understand SARS and effective clinical management

  16. Conclusion • SARS is highly contagious • The SARS epidemic has only been contained! • Adherence by critical nurses to optimal infection control procedures is MANDATORY!

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