Use this CDC guidance when no SARS is in facility

Most hospitals will be at category zero’

Draft guidelines by the Centers for Disease Control and Prevention ratchet up increasing infection control and administrative measures depending on whether severe acute respiratory syndrome (SARS) has appeared globally, within a community, or within a facility.1 The current draft recommendations for inpatient facilities and emergency departments that have no SARS activity within the facility are as follows:

1. Triage Activities/Facility Access Controls

A. The SARS coordinator should be notified of any transfers from facilities that have SARS cases.

B. All patients with respiratory symptoms should be instructed to wear a surgical mask (if they can tolerate it) and should be managed with droplet precautions until it is determined that the cause of the symptoms is not an infection that requires droplet precautions. Patients who cannot wear a mask should be instructed to cover their nose and mouth with tissues when coughing or sneezing.

C. If there are cases of SARS elsewhere in the world, but no known SARS transmission in the area around the facility:

i. Place signs at all entry points detailing symptoms of and any current epidemiologic risk factors for SARS. The signs should direct any person meeting these criteria to an appropriate screening area for evaluation.

ii. Initiate screening of patients on entry to the emergency department (ED) for symptoms and epidemiologic links suggesting SARS. Patients with febrile illness and epidemiologic risks should be instructed to wear a surgical mask and placed in airborne isolation. Cohorting, with all patients wearing surgical masks, can be considered if airborne isolation is not possible.

iii. Intake/triage staff should wear full SARS personal protection equipment.

iv. Limit visitors to the hospital (e.g., one per patient per day).

v. Screen all visitors for SARS epidemiologic risks and symptoms.

vi. Maintain a log of all visitors to SARS patients to assist in contact tracing.

vii. Limit elective admissions/procedures.

viii. Designate an area as a "SARS assessment clinic." All febrile patients who present to EDs and clinics should be sent to the SARS assessment clinic.

2. Patient Placement

A. If there are cases of SARS elsewhere in the world but no known SARS transmission in the area around the facility, patients presenting with febrile respiratory and epidemiologic SARS risk factors should be instructed to wear a surgical mask and placed in airborne isolation. Cohort-ing, with all patients wearing surgical masks, can be considered if airborne isolation is not possible.

B. If there is known SARS transmission in the area around the facility, all febrile patients should be instructed to wear a surgical mask and placed in airborne isolation. Cohorting, with all patients wearing surgical masks, can be considered if airborne isolation is not possible.

3. Designated Personnel

A. Only selected, trained, and fit-tested ED staff should be assigned to evaluate possible SARS cases and should follow full SARS personal protection guidance.

4. Surveillance

A. Depending on directives from local/state health departments, consider reporting of all HCWs hospitalized with unexplained pneumonia.

5. HCW Restrictions

A. Health care workers should notify the facility SARS coordinator, and have daily symptom checks, in these situations:

i. They are caring for a SARS patient in another facility.

ii. They also are working in another facility that has reported nosocomial SARS transmission.

iii. They have close contact with SARS patients outside the hospital.

Reference

1. Centers for Disease Control and Prevention. Draft document. Guidance for SARS Preparedness and Response in Healthcare Facilities. Atlanta; Sept. 9, 2003.