Take steps to prevent spread of SARS cases
If you don’t assess patients preoperatively for severe acute respiratory syndrome (SARS), you run the risk of spreading the potentially fatal disease in your facility, infectious disease experts warn. At press time, there were 332 "suspect" and "probable" SARS cases, but there had been no deaths in the United States, according to the Centers for Disease Control and Prevention (CDC). At least one of the cases is a health care worker who provided care to a reported probable SARS patient, according to the CDC. Worldwide, there were 7,296 cases, including 526 deaths, according to the World Health Organization (WHO).
Notify the surgeon if a patient is positive for SARS symptoms, says Joan Blanchard, RN, MSS, CNOR, CIC, perioperative nursing specialist at the Center for Nursing Practice at the Association of periOperative Registered Nurses (AORN) in Denver. SARS symptoms include fever greater than 100.5° F (38° C), as well as chills and rigors; one or more clinical findings of respiratory illness (for example, runny nose, cough, shortness of breath, difficulty breathing, hypoxia, or X-ray findings of pneumonia); myalgia or diarrhea; and travel to southeast Asia, or close contact with someone who has suspected symptoms of SARS. People with SARS have a history of travel to southeast Asia, including Hong Kong, Guangdong Province, China, Vietnam, Thailand, and Singapore. They develop fever and flulike symptoms within 10 days of exposure. Experts theorize that SARS is caused by a novel coronavirus. Consider Blanchard’s suggestions for preventing your staff and patients from contracting SARS:1
• Follow all transmission-based precautions, including droplet, airborne, and contact. (See "Recommended practices for standard and transmission-based precautions in the perioperative practice setting," in Standards, Recommended Practices, and Guidelines. Denver: AORN; 2003.) The typical incubation period for SARS is two to seven days, but it can be one to 12 days, Blanchard says.
• Isolate potentially affected patients early.
Patients who have SARS symptoms, traveled to affected areas, or are in close contact with someone who has SARS should be isolated or quarantined, she says. "Even if you suspect it, until you’ve done an assessment and know for sure, it’s best to isolate them," Blanchard says.
Place a surgical mask on the patient immediately, she advises. "Putting a surgical mask on them would stop the droplets," she says.
For facilities that have negative airflow rooms, escort the patient immediately to that area, she says. If your facility doesn’t have a negative airflow room, the physician and probably the anesthesiologist should be notified, she suggests. The patient can be moved to a hospital or instructed to see his or her primary care physician, Blanchard advises. "Moving them out of center as quickly as possible is the best option," she says.
When a potential SARS patients is identified, restrict visitors in the perioperative area, she adds.
• When a potential SARS case is identified, perioperative staff members should wear N95 (respiratory protective device) masks, gowns, gloves, and eyewear if the patient is coughing.
Wear a surgical mask if an N95 mask is unavailable, Blanchard adds.
• Clean and disinfect all areas in which the patient is placed.
"Coronavirus 229E, one of the strains isolated from a SARS patient, may survive on a surface for up to three hours," she says.1 Blanchard suggests you refer to "Recommended practices for environmental cleaning in the surgical practice setting," in Standards, Recommended Practices, and Guidelines (Denver: AORN; 2003).
• Minimize the handling of linen, because this step prevents aerosolization of the pathogens.
"One of the things you don’t want to do is unnecessarily moving that linen or triaging it," Blanchard says. "You don’t want to move that linen from out of that bag."
• When transporting an affected patient, place a surgical mask on the patient and a blanket over his or her arms and hands to prevent contact with surfaces in the environment.
• Practice proper hand hygiene.
Wash your hands with warm water and soap after removing gloves and between patients, Blanchard suggests. "Alcohol preparation may be used if hands are not visibly soiled or there is no sink available," she says.1
• If health care workers report to work with fever or respiratory symptoms after any unprotected exposure to SARS patients, they should report to the staff responsible for employee health or infection control and be excluded from duty for 10 days.
For more information on SARS, visit www.who.int or call your local or state public health department, Blanchard suggests.
For more information on SARS, contact:
• Joan Blanchard, RN, MSS, CNOR, CIC, Perioperative Nursing Specialist, Center for Nursing Practice, Association of periOperative Registered Nurses, Denver. E-mail: email@example.com.
1. Association of periOperative Registered Nurses. AORN Report on CDC Update: SARS. SSM Online 2003; April 11. Web: www.ssmonline.org/News/ViewRelease.asp?ReleaseID=3249.