Questions lead to answers in what-if’ SARS scenarios

Hospital-based health care workers should consider how patients with known or suspect severe acute respiratory syndrome (SARS) will be handled from the point of initial contact, the Centers for Disease Control and Prevention advises. One way is to create scenarios based on possible events that might occur and conduct planning exercises to develop a workable procedure for managing SARS patients. Two questions that could be used are:

  1. What will happen today if a patient with suspect or probable SARS is admitted to the hospital?
  2. What will happen today if a patient who has been in the hospital for a week with a diagnosis of pneumonia is found to have SARS?

A response plan for the scenarios can be developed from an individual (e.g., infection control professional, head nurse, attending physician) or group (e.g., nursing unit) perspective. These are some questions to start the planning process:

  • Where will the patient be isolated?
  • How will the patient be handled throughout the admissions process?
  • Who will care for the patient?
  • Do staff know what personal protective equipment (PPE) to wear for working with suspect or probable SARS?
  • Do staff know how to properly don, use, and remove PPE
  • Plan for a situation in which a SARS patient needs to be placed on a ventilator. Determine:
  • Who will perform the procedure.
  • Where it will be performed.
  • What PPE will be worn.

Plans also should be made for how family members and others who’ve had contact with the SARS patient will be managed and whether they will be permitted to enter the hospital.

Identify who needs to be in the communications loop and obtain their contact numbers (e.g., local health department, infection control, hospital administration).

The key concerns about a hospitalized patient with unrecognized SARS are the implementation of immediate control measures and establishing systems to identify and monitor exposures:

  • Has the patient been isolated? If not, what isolation room will be used?
  • Does anyone else have symptoms of SARS? How do we find out?
  • Who has been exposed (e.g., health care workers, other patients, visitors)? How do we find out?
  • What will be done with exposed patients and health care workers?