Infection Control for SARS

1. Infection Control for SARS

2. 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)

3. 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)

4. 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

5. Keys to prevention of SARS transmission: Obsession Paranoia Self-discipline

6. 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

7. 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

8. 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

9. Managing Known SARS PatientsProtective Barriers - 1 • N95 mask • Face shield (fluid shield mask worn upside down) • Cap/Hair cover • Gown • Double Glove

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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