SARS in a hospital visitor and her intensivist

Mukhopadhyay, Amartya; Tambyah, Paul Ananth; Singh, Kamaljit; Lim, Tai Wei; Lee, K.-H

doi:10.1016/j.jhin.2003.12.015

Cited by 17 publications

(17 citation statements)

References 3 publications

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“…Prior outbreaks of respiratory pathogens, including the SARS virus outbreak, identified healthcare visitors as vectors in pathogen transmission in healthcare facilities and outside the hospital [16,17]. Prior investigation has implicated a hospital visitor as the source of tuberculosis spread throughout a hospital [18].…”

Section: Healthcare Visitors and Respiratory Protectionmentioning

confidence: 99%

Infection control precautions for visitors to healthcare facilities

Banach

Bearman

Morgan

et al. 2015

Expert Review of Anti-infective Therapy

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Infection transmission in healthcare facilities is a growing concern. Visitation to healthcare facilities is very common, though the potential role of visitors in the transmission of infection is unknown. Although transmission-based precautions are generally used to prevent the spread of organisms in healthcare settings by healthcare staff, the applicability of these precautions to visitors is unclear. Decisions regarding whether to implement transmission-based precautions among visitors should take into account the organism of concern and means of transmission as well as factors pertaining to the visitor and the healthcare setting. The role of visitors as vectors for organism transmission in the healthcare setting and the potential benefits and adverse consequences of visitor adherence with transmission-based precautions are important areas for additional research. BackgroundInfection transmission in healthcare settings has become an increasingly recognized threat to patients and healthcare providers. While visitation to healthcare settings is common, the potential role of visitors in the transmission of healthcareassociated infections (HAIs) remains unclear. Despite the frequency of healthcare setting visitation and heightened awareness and understanding of HAI transmission, little attention has been offered to understanding the significance of visitors in HAI transmission. The emergence of multidrug-resistant pathogens with limited treatment options highlights the need to address infection prevention strategies for visitors to healthcare facilities.Literature describing situations implicating visitors in the transmission of infections is limited. Guidelines have been issued addressing the prevention of transmission of infectious agents in healthcare, primarily focusing on healthcare staff [1]. The applicability of these guidelines to visitors is uncertain. Expert guidance was recently issued to assist healthcare epidemiology programs in formulating policies and practices

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Section: Healthcare Visitors and Respiratory Protectionmentioning

confidence: 99%

Infection control precautions for visitors to healthcare facilities

Banach

Bearman

Morgan

et al. 2015

Expert Review of Anti-infective Therapy

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“…30 However, there is evidence that some HCWs were infected with SARS following exposure to aerosol-and droplet-generating procedures despite wearing full PPE (that is N95 mask (or equivalent), gown, eye protection and gloves). 6,16,19,31 A number of reasons were proposed for this including incomplete compliance with infection control guidance such as removing PPE unsafely, reuse of single use PPE, not having masks correctly fitted prior to use and not using eye protection. In contrast, a retrospective study reported that 70% (72/102) of HCWs in the United States who cared for SARS patients did not use eye protection.…”

Section: Personal Protective Equipmentmentioning

confidence: 99%

The 2003 SARS outbreak and its impact on infection control practices

Shaw¹

2006

Public Health

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Severe Acute Respiratory Syndrome (SARS) emerged recently as a new infectious disease that was transmitted efficiently in the healthcare setting and particularly affected healthcare workers (HCWs), patients and visitors. The efficiency of transmission within healthcare facilities was recognised following significant hospital outbreaks of SARS in Canada, China, Hong Kong, Singapore, Taiwan and Vietnam. The causative agent of SARS was identified as a novel coronavirus, the SARS coronavirus. This was largely spread by direct or indirect contact with large respiratory droplets, although airborne transmission has also been reported. High infection rates among HCWs led initially to the theory that SARS was highly contagious and the concept of 'super-spreading events'. Such events illustrated that lack of infection control (IC) measures or failure to comply with IC precautions could lead to large-scale hospital outbreaks. SARS was eventually contained by the stringent application of IC measures that limited exposure of HCWs to potentially infectious individuals. As the 'global village' becomes smaller and other microbial threats to health emerge, or re-emerge, there is an urgent need to develop a global strategy for infection control in hospitals. This paper provides an overview of the main IC practices employed during the 2003 SARS outbreak, including management measures, dedicated SARS hospitals, personal protective equipment, isolation, handwashing, environmental decontamination, education and training. The psychological and psychosocial impact on HCWs during the outbreak are also discussed. Requirements for IC programmes in the post-SARS period are proposed based on the major lessons learnt from the SARS outbreak.

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“…On March 23, 2003, a 43 year old woman who reported having fever, chills, productive cough, and diarrhoea for 5 days came to the National University Hospital (NUH), Singapore; her past medical history included hypertension only. 6 The previous day, the Ministry of Health in Singapore had declared Tan Tock Seng Hospital (TTSH), where the first cluster of SARS infections happened, as the national SARS hospital. All patients who met the WHO criteria for SARS 7 were to be transferred to TTSH for isolation and treatment.…”

Section: An Illustrative Casementioning

confidence: 99%

“…The mask became ubiquitous in hospitals and in many public places in Singapore and Personal view SARS in Singapore other SARS affected countries. In Singapore, 6,10,34 as in Taiwan, 35 some healthcare workers were infected with SARS despite wearing full PPE-gloves, gown, and N95 mask. The intensivist involved in the case described at the start of this article wore full PPE but became infected during a bronchoscopy.…”

Section: Personal Protective Equipmentmentioning

confidence: 99%

“…Clinicians are unwilling to be put at risk of infection by trying to obtain deep respiratory secretions with procedures such as saline nebulisation or bronchoscopy that are associated with transmission to healthcare workers wearing PPE. 6,39 However, it is difficult for laboratory staff to work with scanty specimens. A number of serological assays 10,50,51 are available but are not sensitive until late in the course of the illness, by which time either numerous individuals will have been infected or countless others needlessly isolated.…”

Section: Diagnosismentioning

confidence: 99%

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Severe acute respiratory syndrome from the trenches, at a Singapore university hospital

Tambyah

2004

The Lancet Infectious Diseases

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The epidemiology and virology of severe acute respiratory syndrome (SARS) have been written about many times and several guidelines on the infection control and public health measures believed necessary to control the spread of the virus have been published. However, there have been few reports of the problems that infectious disease clinicians encounter when dealing with the protean manifestations of this pathogen. This is a qualitative account of some of the issues faced by an infectious disease physician when identifying and treating patients with SARS as well as protecting other healthcare workers and patients, including: identification of the chain of contagion, early recognition of the disease in the absence of a reliable and rapid diagnostic test, appropriate use of personal protective equipment, and the use of isolation to prevent super-spreading events. Many issues need to be addressed if clinicians are to be able to manage the virus should it reappear.

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SARS in a hospital visitor and her intensivist

Cited by 17 publications

References 3 publications

Infection control precautions for visitors to healthcare facilities

Infection control precautions for visitors to healthcare facilities

The 2003 SARS outbreak and its impact on infection control practices

Severe acute respiratory syndrome from the trenches, at a Singapore university hospital

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