Hospitals move to protect health workers from SARS
Hospitals move to protect health workers from SARS
CDC urges screening, use of protections
Faced with the alarming worldwide spread of severe acute respiratory syndrome (SARS), which has affected more than 1,500 people in 13 countries, public health authorities alerted hospitals to safeguard health care workers, visitors, and other contacts. As of March 15, more than 90% of the cases had occurred in health care workers caring for SARS patients.1
By late March, 219 health care workers had contracted the disease worldwide, two of them in the United States, according to an epidemiology report from the Centers for Disease Control and Prevention (CDC).2
Fifty-eight SARS patients have died, 34 of them in the Guangdong Province of southern China. The victims include Carl Urbani, MD, the World Health Organization (WHO) investigator who first identified the outbreak in Hanoi. Urbani died a month after he began helping treat one of the victims.
The cases were concentrated in China, Vietnam, Hong Kong, Singapore, and Canada, and at least 72 suspected cases were identified in the United States.
U.S. hospitals immediately responded to the emerging disease by asking patients with respiratory symptoms about their recent travel and contacts. The precautions have reduced the spread of the disease, but CDC reported that transmission continued to occur in hospitals and in households. The CDC advised furloughing health care workers who develop SARS symptoms after caring for SARS patients.
"It’s a simple intervention to ask people about that travel history, but that’s going to be the key, making sure that you catch it early enough to use the precautions," says Mark Russi, MD, associate professor of medicine and public health at the Yale University School of Medicine in New Haven, CT, and director of occupational health at Yale-New Haven Hospital.
Initially, the syndrome resembles influenza, with symptoms that include fever, muscle aches, dry cough, or sore throat. It progresses to atypical pneumonia and may lead to more severe respiratory distress.
Anyone with a fever of 100.4° or higher and signs of respiratory illness — cough, shortness of breath, difficulty breathing, hypoxia, radiographic findings of pneumonia, or respiratory distress — as well as history of travel to Hong Kong, Hanoi, or the Guangdong Province in China within seven days of the onset of symptoms should be placed in an isolation room with negative pressure, according to WHO and the CDC.
Anyone entering the room should wear N95 respirators, gowns, and gloves, the CDC advised.
"I think we have every reason to expect that the use of these precautions will substantially reduce the transmission to health care workers," says Russi.
"The problem is recognizing who has this syndrome," he explains.
Without the protective measures, SARS spreads quickly in the hospital setting. In Hanoi, after a single patient was hospitalized with symptoms of SARS, about 20 health care workers became ill with similar symptoms, WHO reported. Some of those health care workers developed bilateral pneumonia, and some progressed to acute respiratory distress and were placed on ventilators.
In a public hospital in Hong Kong, of 50 health care workers screened for SARS, 23 had febrile illness. In that group, eight had developed early signs of pneumonia, as identified by chest X-rays.
In a statement intended to reassure the general public, WHO stressed the nosocomial nature of the transmission: "Overall, the outbreaks in Hanoi and Hong Kong SARS appear to be confined to the hospital environment. Those at highest risk appear to be staff caring for the patients."
That high rate of infection among health care workers is unusual, says CDC director Julie L. Gerberding, MD. "In that particular hospital, barrier precautions were not in place, so that’s somewhat confusing because they’re using a different approach to infection control than we use here," she said in a press briefing.
The first SARS cases apparently began in southern China in November 2002, and appeared elsewhere in Asia in late February.
No antibiotic or antiviral regimen has been effective against the virus. Most patients (80% to 90%) show improvement of symptoms by day six or seven, but about 10% of patients progress to more severe illness, requiring support of a ventilator. Those patients are more likely to be older than 40, WHO reported.
Reference
1. Centers for Disease Control and Prevention. Outbreak of severe acute respiratory syndrome — worldwide, 2003. MMWR 2003; 52:226-228.
Faced with the alarming worldwide spread of severe acute respiratory syndrome (SARS), which has affected more than 1,500 people in 13 countries, public health authorities alerted hospitals to safeguard health care workers, visitors, and other contacts. As of March 15, more than 90% of the cases had occurred in health care workers caring for SARS patients.Subscribe Now for Access
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