SARS transmitted via bronchoscopy in Singapore

CDC hearing anecdotal reports in U.S.

The Centers for Disease Control and Prevention (CDC) is warning that it is receiving anecdotal reports of severe acute respiratory syndrome (SARS) being transmitted to health care workers performing aerosol-generating procedures on patients with SARS.

In addition, a confirmed case of SARS transmission to a health care worker performing a bronchoscopy in Singapore was recently reported at the annual Society for Healthcare Epidemiology of America (SHEA) conference. Paul Tambyah, MBBS, an infectious disease physician at the National University of Singapore, told SHEA attendees that a colleague was under treatment in intensive care after being infected by a SARS patient during a bronchoscopy procedure.

Procedures that induce coughing can increase the likelihood of droplet nuclei being expelled into the air. These potentially aerosol-generating procedures include aerosolized medication treatments (e.g., albuterol), diagnostic sputum induction, bronchoscopy, airway suctioning, and endotracheal intubation. For this reason, health care personnel should ensure that patients have been evaluated for SARS before initiation of aerosol-generating procedures. Evaluation for SARS should be based on the most recent CDC case definition for SARS (

Aerosol-inducing procedures should be performed on patients who may have SARS only when such procedures are deemed medically necessary. These procedures should be performed using airborne precautions as previously described for other infectious agents, such as tuberculosis. In summary, health care personnel should apply standard, (e.g., hand hygiene), airborne (e.g., respiratory protective devices with a filter efficiency of greater than or equal to 95%), and contact (e.g., gloves, gown, and eyewear) precautions when aerosol-generating procedures are being performed on patients who may have SARS.