infection control for sars
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Infection Control for SARS. 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

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how is sars spread
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)
how can we prevent transmission i
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)
how can we prevent transmission ii
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
keys to prevention of sars transmission
Keys to prevention of SARS transmission:

Obsession

Paranoia

Self-discipline

identification management of patients
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
managing known sars patients room placement entry
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 patient’s face
  • Minimize amount of direct contact with patient
  • Do not go into patient’s bathroom unless essential for patient care
managing known sars patients reducing droplets
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
managing known sars patients protective barriers 1
Managing Known SARS PatientsProtective Barriers - 1
  • N95 mask
  • Face shield (fluid shield mask worn upside down)
  • Cap/Hair cover
  • Gown
  • Double Glove
managing known sars patients protective barriers 2
Managing Known SARS PatientsProtective 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
managing known sars patients protective barriers 3
Managing Known SARS PatientsProtective 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
  • Don’t 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)
managing known sars patients removing barriers 4
Managing Known SARS PatientsRemoving Barriers - 4
  • 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
high risk activities
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
high risk activities activities to be avoided
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
high risk activities cont d
High risk activities (cont’d)
  • 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
intubation for sars patients
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
if you feel sick
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
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