Severe Acute Respiratory Syndrome (SARS)

1. Severe Acute Respiratory Syndrome (SARS) Patient Transport Patient, Family & Community Education Laboratory Procedures WHO Western Pacific Regional Office April 17, 2003

4. Patient Transport It is essential to avoid all unnecessary transport of isolated SARS patients to control and prevent the potential spread of SARS infection.

5. Patient Transport If the patient needs to be out of their room for an essential procedure, e.g. X-Ray • Transport route must avoid populated areas. • Patient must wear an N-95 respirator mask (standard surgical masks can be used by patients if N-95 respirator masks are not tolerated or are in insufficient supply) and an isolation gown. • Accompanying staff must wear : • N-95 respirator mask • Gloves • Gown • Goggles

6. Patient Transport • Transport –Ambulance • No dedicated ambulance needed • Mask patient (N-95 respirator mask) • Transporters wear personal protective equipment • N-95 respirator mask, disposable gown, goggles, gloves • Disinfect ambulance after transport • Standard cleaning and disinfecting or 1:100 dilution of bleach; after 10 minute contact time, clean and disinfect using standard procedures. DO NOT use spray cleaners

7. Patient, Family & Community Education • Education for the patient, their family and the community is essential in the control and prevention of the SARS Virus. • It is particularly essential for those persons requiring hospital or home isolation to understand the necessary restrictions.

8. Patient, Family & Community Education Explain: • What SARS is (to date) • Why isolation is required. • Precautions required including PPE • Hand washing procedures

9. Patient, Family & Community Education • Teach the patient and family members : • about the SARS illness and • the reason for the precautions being used • Teach the patient and visiting family members : • how to perform hand hygiene • how to wear a mask, goggles, gown, gloves, cap and overshoes

10. Patient and Family Education Explain to the patient and family why disposable equipment is being used such as : • Eating utensils • Medical equipment • Patient gowns

11. Laboratories • Laboratory staff must ensure that their practices are meticulous. • Advance planning in each designated laboratory is essential to ensure that specimen handling, transportation and storage is managed according to the guidelines.

12. Use a Bio Safety 3 ( BSL-3 ) laboratory If a BSL-3 laboratory is not available you must : Use BSL-3 procedures in a BSL-2 laboratory Bio Safety in Laboratories

13. Wear full PPE Write clinical details on the request form Samples should be collected by clinical staff Label the clinical samples clearly Change PPE between patients Discard all disposable materials in a biohazard bag Specimen Collection

14. Respiratory samples and frozen tissues : store at –70oC Serum : store at 4 - 8oC for 24-48 hours or at -20oC for longer periods Storage of Specimens

15. Treat all patient specimens as highly infectious Use leak proof containers for collection Do not contaminate outside of container Transport specimens in leak-proof outer containers e.g. a sealed plastic bag Patient Specimens

16. Mortuary Care Health care workers must wear full PPE, that is, an N-95 respirator mask, Goggles, Gown, Gloves, Cap and overshoes. Health Care Workers must : • Prepare the body • Place in a body-bag or leak-resistant bag or • Place in plastic sheeting, wrap the body and tape with waterproof adhesive tape

17. Mortuary Care The body must be placed in cold storage (3°C : +/- 2°C ) as soon as possible after the body is washed and wrapped in a bag or plastic sheeting. The need for a post mortem must be discussed with the designated national laboratory as there are potential infection risks for personnel during a post mortem. Post mortems must be performed wearing full PPE

18. Mortuary Care Although all due deference must be given to local cultural and religious customs associated with the death of a member of the community, the following must be considered to minimise the potential risk of spread of the SARS Virus. • The body must not be embalmed, to reduce exposure risk • The need for cremation with minimal delay • The delaying of a ‘wake’ to celebrate the life of the individual until all close contacts and possible secondary contacts are cleared.

19. Can You Now Answer These Questions? Transport • What should you do if a SARS patient needs to be moved from their room? Why? Education • What sort of information should you give the : • Patient • Family • Community about SARS?

20. Can You Now Answer These Questions? Laboratories • How should specimens from SARS patients be collected? Why? • What should those collecting the specimen do to protect themselves? Why? • How should specimens be handled after collection? Why? • How should specimens be transported? • To the health care facility laboratory • To a laboratory overseas

21. Can You Now Answer These Questions? Mortuary Care • How should you handle the body of a person who has died from the SARS virus? Why? • How should you protect yourself when caring for some-one who had died of SARS? Why? • Should there be a post mortem on the person who has died of SARS? Why? • How should the body of a person who has died from the SARS virus be transported to the mortuary or funeral home? Why?

22. Take Home Messages • Health care workers must plan carefully if the patient requires transport from the isolation area for essential treatment. • It is essential patients, their families and the community are educated about the SARS infection and the practices associated with necessary isolation. • Laboratory staff must plan carefully and must use meticulous practices.

23. Patient TransportPatient, Family & Community EducationLaboratory Procedures We hope YOU have learnt about the need for careful planning in the care of patients with SARS infection to prevent transmission and as comply with infection control measures. Thank you for listening.