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SARS Infection Control in Healthcare Settings

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Perform hand hygiene following all contact with suspect SARS patients and their environment ... personnel and the environment of care. Hand hygiene. Thank you ... – PowerPoint PPT presentation

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Title: SARS Infection Control in Healthcare Settings


1
SARS Infection Control in Healthcare Settings
  • William A. Rutala, Ph.D., M.P.H.
  • University of North Carolina (UNC) Hospitals and
    UNC School of Medicine

2
Infection Control Considerations
  • Hospitals must protect vulnerable patients,
    staff, visitors, and prevent spread to the
    community
  • Until SARS epidemiology is better understood,
    infection control measures must target all
    possible modes of transmission
  • Interim recommendations that will be periodically
    updated

3
The principles are the same.methods of
implementation may differ
4
Key Objectives of SARS Prevention
  • Early detection of infection
  • Containment of infection
  • Protection of personnel and the environment of
    care
  • Hand hygiene

5
Key Elements of SARS Prevention
  • Early detection
  • Containment of infected persons
  • Protection of personnel and the environment of
    care
  • Hand hygiene

6
Early Detection
  • Clinician education
  • Information on signs and symptoms of SARS
  • Heightened index of suspicion in patients with
    history of travel or exposure to SARS areas or
    patients
  • Isolation precautions that should be used
  • SARS inservices

7
Early Detection
  • Information at point of first healthcare
    encounter (ER, information desk, ACC, Pre-Care,
    Family Practice, community-based clinics)
  • Visual alerts
  • Reporting instructions
  • Provision of surgical masks for patients
  • Segregation of symptomatic patients

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9
Early Detection
  • Information at point of first healthcare
    encounter (ER, information desk, ACC, Pre-Care,
    Family Practice, community-based clinics)
  • Visual alerts
  • Reporting instructions (notify Infection Control)
  • Provision of surgical masks for patients at point
    of first patient contact (or provide mask to
    patient before enter into hospital)
  • Segregation of symptomatic patients (private
    rooms)
  • Patients with suspected SARS admitted only if
    medically indicated
  • Contact and Airborne Precautions should be
    immediately instituted

10
Key Elements of SARS Prevention
  • Early detection
  • Containment of infection
  • Protection of personnel and the environment of
    care
  • Hand hygiene

11
Containment of Infectionwith Engineering Controls
  • Preferred-Airborne Isolation Room
  • Private room with engineered negative pressure,
    6-12 AC/hr, and air exhausted to outside
  • Door closed except when needed for patient/staff
    access
  • Limit access to persons essential for providing
    care

12
Limited Patient Contact
  • Visitors of patients with suspected SARS should
    be restricted (essential family members) and
    screened
  • Visitors should be excluded from the hospital if
    any of the following are present
  • Fever and respiratory symptoms
  • Travel to a locale with local transmission in
    previous 10 days
  • Exposure to the probable SARS case while he/she
    symptomatic within prior 10 days
  • Dedicate staff to care for SARS patient

13
Key Elements of SARS Prevention
  • Early detection
  • Containment of infected persons
  • Protection of personnel and the environment of
    care
  • Hand hygiene

14
Consider all Possible Transmission Routes
  • Most likely
  • Droplet
  • Contact
  • Direct (contamination of skin)
  • Indirect (contaminated fomites)
  • Possible
  • Airborne

15
Containment of Infection
  • Contact Precautions
  • Private rooms, gloves, gowns
  • Airborne Precautions
  • Private room, negative pressure, air exhausted to
    outside, 6 AC/hr)
  • Personnel should wear N95 and eye protection
    (face shield or goggles)
  • Gloves and gown removed just prior to exiting
    the room. Immediately outside the room remove and
    discard N95 respirator and remove goggles or face
    shield. Immediately perform hand hygiene for 15
    sec with CHG or application of alcohol hand rub.
    Wipe goggles with alcohol pad and again perform
    hand hygiene.

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17
Personal Protective Attire
  • Respiratory protection
  • N95 mask preferred
  • Perform qualitative respirator fit-testing where
    applicable
  • Surgical mask if not available
  • Apply mask when entering room or ward
  • Ensure snug fit over nose and mouth
  • Eye protection
  • Goggles or face shield as recommended for
    standard precautions

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20
Effectiveness of Precautions
  • Study Design case-control study in 5 Hong Kong
    hospitals
  • Staff (241 non-infected, 13 infected) surveyed
    about use of mask, gloves, gowns, and handwashing
  • Results 69 staff who reported all four measures
    were not infected all infected staff omitted at
    least one measure. Fewer staff who wore masks
    (N95 and surgical masks), gowns, and washed their
    hands became infected compared to those who did
    not.
  • Conclusion practice of Contact and Droplet
    Precautions is effective in reducing risk of
    infection after exposure.
  • WH Seto et al. Lancet 20033611519-1520

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22
Stability of SARS Coronavirus
  • Virus is stable in feces and urine at RT for at
    least 1-2 d
  • Virus survival in cell-culture supernatant
  • Minimal reduction in virus conc after 21 days at
    4oC and 80oC
  • 1 log reduction at RT for 2 days
  • Heat (56oC) kills SARS coronavirus
  • Virus loses infectivity after exposure (to 2 phenol, 75 ethanol, 110 Clorox
  • WHO Laboratory Network. May 2003.

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24
Protect the Environment of Care
  • Use hospital-grade disinfectants or 1100
    dilution of household bleach (5.25 - 6.0) and
    water for surface cleaning and disinfection
  • Assume environment in which SARS patients are
    housed is heavily contaminated
  • Facilitate daily cleaning by limiting clutter in
    patient care area
  • Thoroughly clean and disinfect room and equipment
    after patient discharge
  • No need to routinely disinfect walls, window
    drapes

25
Disinfectants Effective Against Human Coronavirus
  • Efficacy criteria of 3 log10 reduction after 1
    min
  • 1000 and 5000 ppm chlorine (150 and 110
    dilution of bleach)
  • Povidone iodine (1 iodine)
  • Ethanol (70)
  • Glutaraldehyde (2)
  • Phenolics
  • Sattar SA et al. Epidem Inf 1989 102493-505

26
Key Elements of SARS Prevention
  • Early detection
  • Containment of infected persons
  • Protection of personnel and the environment of
    care
  • Hand hygiene

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28
Hand Hygiene
  • Hand hygiene is the cornerstone of prevention!!!
  • Perform hand hygiene following all contact with
    suspect SARS patients and their environment
  • Methods
  • Hand washing with soap and water or CHG and water
  • Alcohol-based handrubs when
  • Hands are not visibly soiled, or
  • Hand washing facilities are not available in
    patient rooms

29
Protect the Environment of Care
  • Follow standard procedures or regulations for
    handling contaminated (infectious) materials
  • Soiled linen/laundry
  • Usual warm water and detergent wash cycles
  • Bleach may be added but is not needed
  • Avoid sorting of linen before washing
  • Waste
  • Dispose in accordance with local regulations for
    infectious waste
  • Eating utensils
  • Use standard warm water dishwashing methods

30
Other considerations
  • Avoid use of nebulizers when possible
  • If needed, perform nebulization in protected,
    negative pressure environment
  • Limit procedures that generate aerosols
  • Limit patient movement
  • If transport required for patient care, place
    surgical mask on patient
  • Place clean attire on patient or cover with gown
  • Transporters should wear N95, gloves, gowns, eye
    protection

31
Management of Exposures
  • Exposed HCW who develops fever and/or respiratory
    symptoms should not report to work. Should report
    their symptoms to the appropriate health care
    provider
  • Exposed unprotected HCW who are asymptomatic must
    be evaluated prior to work each day by OHS.
  • Exclude close contacts with SARS cases who have
    fever or respiratory symptoms

32
SARS Resources
  • http//www.cdc.gov/ncidod/sars/
  • http//www.who.int/csr/sars/en/
  • Chiarello, Linda. SARS Infection Control. CDC

33
Prevention is Primary!
34
Key Objectives of SARS Prevention
  • Early detection of infection
  • Containment of infection
  • Protection of personnel and the environment of
    care
  • Hand hygiene

35
Thank you
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