A large percentage of the early SARS cases have been healthcare workers who treated SARS patients before infection control precautions, such as using gloves and respirators, were instituted. Once precautions were taken, however, there were very few secondary infections and the disease was contained.
The Center for Disease Control recommends that healthcare workers treating SARS or suspected SARS patients use personal protective equipment appropriate for standard, contact, and airborne precautions (e.g., hand hygiene, gown, gloves, and N95 respirators) in addition to eye protection. See below, Guidelines for Healthcare Workers.These are interim guidelines which
may change as more information become available, so you should check with your employer or visit the CDC website at http://www.cdc.gov/ ncidod/sars/
Guidelines for healthcare workers Health-care workers caring for patients with Severe Acute Respiratory Syndrome (SARS) are at risk for acquiring SARS. Health-care workers appear to have contracted the disease after close contact with
people already displaying symptoms of SARS, such as high fever, coughing, and difficulty breathing.
The Center for Disease Control recommends the use of personal protective equipment appropriate for standard, contact, and airborne precautions (e.g., hand hygiene, gown, gloves, and N95 respirators) in addition to eye protection.
The transmission of SARS appears to occur mainly by direct contact with infectious material, including dispersal of large respiratory droplets. However, it is also possible that SARS can be spread through the airborne route. Accordingly, CDC
has recommended the use of N-95 respirators, consistent with respiratory protection for airborne diseases,such as tuberculosis.
SARS, unlike tuberculosis, also appears to spread by direct contact with respiratory secretions, which makes touching contaminated objects a potential concern. Infectious material deposited on a respirator may cause it to become a vehicle for direct or indirect transmission. Therefore, additional infection control measures applicable to this specific situation are needed.
Respiratory protection important
Respirators should be used in the context of a complete respiratory protection program in accordance with OSHA regulations. This includes training and fit testing to ensure a proper seal between the respirator’s sealing surface and the wearer’s face. Detailed information on respirator programs, including fit test procedures can be accessed at www.osha.gov/SLTC/etools/respiratory.
Once worn in the presence of a SARS patient, the respirator should be considered potentially contaminated with infectious material, and touching the outside of the device should be avoided. Upon leaving the patient’s room, the disposable respirator should be removed and discarded, followed by thorough hand washing with soap and water.
Reuse of respirators
If a sufficient supply of respirators is not available, healthcare facilities may consider reuse as long as the device has not been obviously soiled or damaged (e.g., creased or torn). Data on reuse of respirators for SARS are not available. Reuse may increase the potential for contamination; however, this risk must be balanced against the need to fully provide respiratory protection for healthcare personnel.
If N-95 respirators are reused for contact with SARS patients, implement a procedure for safer reuse to prevent contamination through contact with infectious droplets on the outside of the respirator.
Consider wearing a loose-fitting barrier that does not interfere with fit or seal (e.g., surgical mask, face shield) over the respirator.
Remove the barrier upon leaving the patient’s room and perform hand hygiene. Surgical masks should be discarded; face shields should be cleaned and disinfected.
Remove the respirator and either hang it in a designated area or place it in a bag. Consider labeling respirators with a user’s name before use to prevent reuse by another individual.
Use care when placing a used respirator on the face to ensure proper fit for respiratory protection and to avoid contact with infectious material that may be present on the outside of the mask.
Perform hand hygiene after replacing the respirator on the face.
When reusable respirators (e.g., elastomeric [rubber], powered air purifying respirators [PAPR]) are used, the reusable elements should be cleaned and disinfected after use, in accordance with manufacturer’s recommendations. In addition, if
reusable respirators are used by more than one individual, filters must be replaced between individual users. The used filters must be safely discarded.
Respiratory protective devices with a filter efficiency of 95% or greater (e.g., N95, N99, N100) may not be available in some settings due to supply shortages or other factors. In this situation, a surgical (procedure) mask should be worn. Surgical
masks will provide barrier protection against large droplets that are considered to be the primary route of SARS transmission. However, surgical masks may not adequately protect against aerosol or airborne particles, primarily because they allow for leakage around the mask and cannot be fit tested. The mask should resist fluid penetration and fit tightly around the mouth and nose when properly applied to the face.
For the inpatient setting
If a suspect SARS patient is admitted to the hospital, infection control personnel should be notified immediately. Infection control measures for inpatients (www.cdc.gov/ncidod/hip/isolat/isolat.htm) should include:
- Standard precautions (e.g., hand hygiene); in addition to routine standard precautions, health-care personnel should wear eye protection for all patient contact.
- Contact precautions (e.g., use of gown and gloves for contact with the patient or their environment).
- Airborne precautions (e.g., an isolation room with negative pressure relative to the surrounding area and use of an N-95 filtering disposable respirator for persons entering the room).
If airborne precautions cannot be fully implemented, patients should be placed in a private room, and all persons entering the room should wear N-95 respirators. Where possible, a qualitative fit test should be conducted for N-95 respirators; detailed information on fit testing can be accessed at http://www.osha.gov/SLTC/etools/respiratory/oshafiles/fittesting1.html. If N-95 respirators are not available for health-care personnel, then surgical masks should be worn. Regardless of the availability of
facilities for airborne precautions, standard and contact precautions should be implemented for all suspected SARS patients.
For the outpatient setting
If possible, suspect SARS patients, on arrival to the outpatient or ambulatory setting, (e.g., clinic or Emergency Department [ED]), should be evaluated in a separate assessment area to determine if they meet the case definition for suspected SARS and require isolation. A surgical mask should be placed on the patient if possible.
All health-care personnel should wear N-95 respirators while taking care of patients with suspected SARS. Precautions should be used when evaluating or transporting patients (e.g., emergency medical technicians), or in any ambulatory health-care setting (e.g., ED or clinic personnel). If N-95 respirators are not available, surgical masks should be worn by personnel.
Guidelines for all workers—page 8