Severe Acute Respiratory Syndrome (SARS)

1. Severe Acute Respiratory Syndrome (SARS) Principles of Patient Management WHO Western Pacific Regional Office April 17, 2003

2. Patient Management • SARS : Infection Control Goals • SARS Admissions - Triage • Components of SARS Isolation • SARS : Infection Control Practices

3. 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

4. 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.

5. 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 allpatients

6. Components of SARS Isolation • Facility • Administrative Controls • Clinical Surveillance of Staff • Organization of Isolation Area • Protective Equipment • Standard Precautions

7. 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

10. Facility Isolation Area – Barrier Nursing Techniques Required • Green (GO) : General [reduced] staff movement • Yellow (CAUTION) : Limited staff movement • Red(RESTRICTED) : Assigned staff only

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

13. 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

14. 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)

15. 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

16. 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

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

20. 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 Infection Control Practices

21. Infection Control Practice “You can minimise YOUR risk of catching SARS by following infection control procedures.”

22. Standard Precautions(Respiratory Precautions) Designed to reduce the risk for occupational exposure to SARS infection from both recognizedand unrecognized sources of infection

23. 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 Exposure Risks

24. 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?

25. 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?

26. 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

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