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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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Infection Control for SARS

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Infection control for sars l.jpg

Infection Control for SARS


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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)


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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)


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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


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Keys to prevention of SARS transmission:

Obsession

Paranoia

Self-discipline


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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


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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


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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


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Managing Known SARS PatientsProtective Barriers - 1

  • N95 mask

  • Face shield (fluid shield mask worn upside down)

  • Cap/Hair cover

  • Gown

  • Double Glove


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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


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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)


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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


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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


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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


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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


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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


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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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