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

Abstract

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.

In vivo protective performance of N95 respirator and surgical facemask

“…Tambyah [2004] concluded from extensive clinic and literature review that personal protective equipment (PPE), particularly facemask, was the key to SARS infection control. Seto and his colleagues did a case-control study in five Hong Kong hospitals, with 241 noninfected and 13 infected staff with documented exposures to 11 index patients with SARS during patient care.…”

“…US Centers for Disease Control and Prevention [2005] has given recommendations for infection control in facilities caring for patients with known or suspected avian influenza: using a fit-tested respirator, at least as protective as a National Institute for Occupational Safety and Health (NIOSH) approved N95 filtering respirator. Tambyah [2004] concluded from extensive clinic and literature review that personal protective equipment (PPE), particularly facemask, was the key to SARS infection control. Seto and his colleagues did a case-control study in five Hong Kong hospitals, with 241 noninfected and 13 infected staff with documented exposures to 11 index patients with SARS during patient care.…”

Comparison of hand contamination rates and environmental contamination levels between two different glove removal methods and distances

“…Most previous studies have identified hand contamination 9,21 and the permeable effect of gloves 22,23 as problematic; however, few studies have explored the possible environmental contamination caused by the stretching motion during glove removal. Recent studies noted that some HCWs became infected with SARS despite wearing full PPE (gloves, gown, and N95 respirator). 2,24,25 This ''through precautions'' transmission might be caused by contamination during the removal of protective clothing. 26,27 A study examining self-contamination rates in HCWs wearing two personal protective systems found that the anterior neck, forearms, wrists, and hands were the likeliest zones for contamination during removal of protective systems.…”

The 2003 SARS outbreak and its impact on infection control practices

“…In Singapore where routine use of PPE was instituted early in the epidemic, it is estimated that in the first 6 weeks of the epidemic US$700 000 was spent on PPE alone. 33 Furthermore, inappropriate use of PPE and respirators resulted in shortages and guidelines had to be developed to prioritise those who should use respirators and where they should be worn. 22,33 This demonstrates the importance of planning and preparedness, particularly with regard to supplies of essential equipment.…”