Care for patients with probable SARS

Healthcare Purchasing News, Sept, 2003

The World Health Organization advises strict adherence with the harrier nursing of patients with SARS using precautions for airborne, droplet and contact transmission. Triage nurses should rapidly divert persons presenting to their healthcare facility with flu-like symptoms to a separate assessment area to minimize transmission to others in the waiting room. Suspect cases should wear surgical masks until SARS is excluded.

Patients with probable SARS should be isolated and accommodated as follows in descending order of preference: 1- negative pressure rooms with the door closed; 2- single rooms with their own bathroom facilities; 3- cohort placement in an area with an independent air supply and exhaust system.

Turning off air conditioning and opening windows for good ventilation is recommended if an independent air supply is unfeasible. Wherever possible, patients under investigation for SARS should be separated from those diagnosed with the syndrome.

Disposable equipment should be used wherever possible. If devices are to be reused, they should be sterilized in accordance with manufacturers' instructions. Surfaces should be cleaned with broad spectrum (bactericidal, fungicidal, and virucidal) disinfectants of proven efficacy.

Patient movement should be avoided as much as possible. Patients being moved should wear a surgical mask to minimize dispersal of droplets. NIOSH standard masks (N95) are preferred if tolerated by the patient. All visitors, staff, students and volunteers should wear a N95 mask on entering the room of a patient with confirmed or suspected SARS. Surgical masks are a less effective alternative to N95 masks.

Handwashing is the mast important hygiene measure in preventing the spread of infection. Gloves are not a substitute for handwashing. Hands should be washed before and after significant contact with any patient, after activities likely to cause contamination and after removing gloves. Alcohol-based skin disinfectants formulated for use without water may he used in certain limited circumstances. Wear gloves for all patient handling. Gloves should be changed between patients and after any contact with items likely to be contaminated with respiratory secretions (masks, oxygen tubing, nasal prongs, tissues). Gowns (waterproof aprons) and head covers should be worn during procedures and patient activities that are likely to generate splashes or sprays of respiratory secretions.