Triage nurse acts swiftly to detect SARS

Screening prevents exposure in hospital

When the elderly woman walked into the newly designed emergency department (ED) at Saint Joseph’s Hospital in Atlanta, she went directly to the registration desk. A triage nurse greeted her, learned that she had a cough and difficulty breathing, and asked the telltale question: Have you traveled to Asia in the past 10 days?

The answer: Yes. [The Centers for Disease Control and Prevention (CDC) has since added Toronto to that question.]

Suspecting a case of severe acute respiratory syndrome (SARS), the nurse immediately placed a surgical mask on the 83-year-old patient and her daughter, who had accompanied her to the hospital — and on the trip to Hong Kong and China. The woman was taken swiftly to a negative pressure isolation room in the ED.

Because of her quick action, the triage nurse was the only person in the hospital who had unprotected exposure to the patient. And even that exposure was limited, only lasting about 10 minutes.

"I really am proud of how the whole hospital responded," says infection control specialist Janet Keen, RN, MS, CIC, who had posted information in the ED and conducted education.

"There wasn’t anything magical about it," says Robert Capparell, MD, chair of the infection control committee and hospital epidemiologist. "It was something they had been trained to look for."

Once the patient was in isolation, health care workers entering the room wore gowns, gloves, masks, booties, head covers, and eye protection. The patient was taken to the intensive care unit. She recovered fully and was discharged after about a week.

The triage nurse took a 10-day leave of absence, the quarantine period for this disease. In this case, the CDC did not recommend quarantine, but the hospital decided to take an extra precaution, says Capparell. "Because it’s new and we don’t know all the ways it’s spread, we felt it was best we take her out of the triage position and have her sit out the incubation period."

The nurse did not develop any symptoms and returned to work. The patient’s daughter also did not develop symptoms.

In addition to the importance of training, this episode demonstrates the value of incorporating infection control into hospital design, notes Keen. For example, the ED uses nonrecirculated air, she says.

Keen also had prepared as soon as she learned of the emergence of SARS. She ordered extra respirators and checked on other supplies. "It had been my experience in the past that we could run out of isolation materials," she says. "I could see that it was spreading rapidly in some areas. I didn’t know if it would spread rapidly in the United States or not, but I wanted to be prepared."

Meanwhile, education about SARS continues to be important to reduce concern among health care workers, says Capparell. "We certainly don’t need the fear factor interfering with anything we do," he says. "Our job is to make sure people are educated and not fearful."