Recommendations for the prevention of transmission of SARS during GI endoscopy
2004; Elsevier BV; Volume: 60; Issue: 5 Linguagem: Inglês
10.1016/s0016-5107(04)01858-9
ISSN1097-6779
Autores Tópico(s)Medical Device Sterilization and Disinfection
ResumoMore than two dozen health care workers and patients at a hospital in Washington, D.C., contracted a mysterious although mild respiratory illness in the summer of 2003. Almost all of these cases were linked to the GI endoscopy suite in the hospital. Symptoms of the illness included low-grade fever, nasal congestion, headache, and dry cough. Hospital officials identified the index case as a nurse working in the GI endoscopy suite who had recently returned from a trip to the Philippines.1.Goldstein A. Sibley Hospital disrupted by respiratory illness. Washington Post. August 26, 2003:B03.Google Scholar Although this outbreak was not caused by the virus responsible for severe acute respiratory syndrome (SARS), nevertheless, health care workers who display symptoms of a respiratory illness arouse concern, heightened by recent reports around the world that document a high rate of nosocomial transmission of SARS from infected patients to health care workers.2.Hsu L-Y, Lee C-C, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis [serial online] 2003 June [cited 2004 July];9:713-7. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/03-0264.htm.Google Scholar, 3.Dwosh H.A. Hong H.H.L. Austgarden D. Herman S. Schabas R. Identification and containment of an outbreak of SARS in a community hospital.CMAJ. 2003; 168: 1415-1420PubMed Google Scholar, 4.Centers for Disease Control and Prevention Severe acute respiratory syndrome—Taiwan, 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 461-466PubMed Google Scholar, 5.Ho A.S. Sung J.J.Y. Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.Ann Intern Med. 2003; 139: 564-567Crossref PubMed Scopus (91) Google Scholar SARS, which has wreaked havoc from North America to Southeast Asia, is a potentially fatal, atypical pneumonia etiologically linked to the previously unrecognized SARS-associated coronavirus, or SARS-CoV.5.Ho A.S. Sung J.J.Y. Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.Ann Intern Med. 2003; 139: 564-567Crossref PubMed Scopus (91) Google Scholar So named because they appear to have a halo or crown-like structure,6.Wenzel R.P. Edmond M.B. Managing SARS amidst uncertainty.N Engl J Med. 2003; 348: 1947-1948Crossref PubMed Scopus (121) Google Scholar coronaviruses, in addition to being linked to SARS, are a major cause of the common cold.6.Wenzel R.P. Edmond M.B. Managing SARS amidst uncertainty.N Engl J Med. 2003; 348: 1947-1948Crossref PubMed Scopus (121) Google Scholar, 7.Sampathkumar P. Temesgen Z. Smith T.F. Thompson R.L. SARS: epidemiology, clinical presentation, management, and infection control measures.Mayo Clin Proc. 2003; 78: 882-890Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Reportedly, SARS first appeared in November 2002 in the Guangdong Province of China.2.Hsu L-Y, Lee C-C, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis [serial online] 2003 June [cited 2004 July];9:713-7. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/03-0264.htm.Google Scholar, 7.Sampathkumar P. Temesgen Z. Smith T.F. Thompson R.L. SARS: epidemiology, clinical presentation, management, and infection control measures.Mayo Clin Proc. 2003; 78: 882-890Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 8.Riley S. Fraser C. Donnelly C.A. Ghani A.C. Abu-Raddad L.J. Hedley A.J. et al.Transmission dynamics of the etiological agent of SARS in Hong Kong: impact of public health interventions.Science. 2003; 300: 1961-1966Crossref PubMed Scopus (888) Google Scholar, 9.Chiang C.-H. Chen H.-M. Shih J.F. Su W.J. Perng R.P. Management of hospital-acquired severe acute respiratory syndrome with different disease spectrum.J Chin Med Assoc. 2003; 66: 328-338PubMed Google Scholar, 10.Fox M. SARS link to animals reaffirmed. New York Times. September 5, 2003.Google Scholar During the following year, SARS spread to Hong Kong, Singapore, and to more than two dozen countries, including Canada, Indonesia, the Philippines, and Vietnam. To date, more than 8500 cases of SARS have been reported, resulting in more than 900 deaths.10.Fox M. SARS link to animals reaffirmed. New York Times. September 5, 2003.Google Scholar Hopes that the worldwide spread of SARS had ended in the summer of 2003 were tempered in the early fall of 2003 when a new probable case was reported in Singapore, thereby raising a concern that the disease may have re-emerged.11.Centers for Disease Control and Prevention. Singapore reports "new probable case" of SARS. September 10, 2003. [cited 2004 July]. Available from URL: http://www.cdc.gov/ncidod/sars/singaporesep2003.htm.Google Scholar SARS is a contagious disease with an incubation period that is typically between 2 and 7 days, although it can be as long as 10 days.2.Hsu L-Y, Lee C-C, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis [serial online] 2003 June [cited 2004 July];9:713-7. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/03-0264.htm.Google Scholar, 12.Rhode Island Department of Health. Severe acute respiratory syndrome (SARS). Public health fact sheet [serial online] 2003 June 16 [cited July]. Available from URL: http://www.health.ri.gov/disease/communicable/sars/factsheet061603.htm.Google Scholar, 13.Chan-Yeung M. Yu W.C. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report.BMJ. 2003; 326: 850-852Crossref PubMed Scopus (120) Google Scholar Symptoms include fever, with temperature elevations to greater than 100.4°F; dry cough; fatigue; body aches; and shortness of breath, with or without abnormal chest radiographic findings.2.Hsu L-Y, Lee C-C, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis [serial online] 2003 June [cited 2004 July];9:713-7. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/03-0264.htm.Google Scholar, 5.Ho A.S. Sung J.J.Y. Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.Ann Intern Med. 2003; 139: 564-567Crossref PubMed Scopus (91) Google Scholar, 7.Sampathkumar P. Temesgen Z. Smith T.F. Thompson R.L. SARS: epidemiology, clinical presentation, management, and infection control measures.Mayo Clin Proc. 2003; 78: 882-890Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 12.Rhode Island Department of Health. Severe acute respiratory syndrome (SARS). Public health fact sheet [serial online] 2003 June 16 [cited July]. Available from URL: http://www.health.ri.gov/disease/communicable/sars/factsheet061603.htm.Google Scholar There is currently no specific therapy for SARS, although a "cocktail" of drugs that includes antibiotics, corticosteroids, and antiviral medications may help to improve prognosis and control the spread of the virus.2.Hsu L-Y, Lee C-C, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis [serial online] 2003 June [cited 2004 July];9:713-7. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/03-0264.htm.Google Scholar, 5.Ho A.S. Sung J.J.Y. Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.Ann Intern Med. 2003; 139: 564-567Crossref PubMed Scopus (91) Google Scholar, 6.Wenzel R.P. Edmond M.B. Managing SARS amidst uncertainty.N Engl J Med. 2003; 348: 1947-1948Crossref PubMed Scopus (121) Google Scholar, 7.Sampathkumar P. Temesgen Z. Smith T.F. Thompson R.L. SARS: epidemiology, clinical presentation, management, and infection control measures.Mayo Clin Proc. 2003; 78: 882-890Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 9.Chiang C.-H. Chen H.-M. Shih J.F. Su W.J. Perng R.P. Management of hospital-acquired severe acute respiratory syndrome with different disease spectrum.J Chin Med Assoc. 2003; 66: 328-338PubMed Google Scholar, 13.Chan-Yeung M. Yu W.C. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report.BMJ. 2003; 326: 850-852Crossref PubMed Scopus (120) Google Scholar Transmission of SARS-CoV typically requires close contact (within 3 feet) with an infected person and is primarily person-to-person via large, infectious respiratory droplets (i.e., droplet transmission).3.Dwosh H.A. Hong H.H.L. Austgarden D. Herman S. Schabas R. Identification and containment of an outbreak of SARS in a community hospital.CMAJ. 2003; 168: 1415-1420PubMed Google Scholar, 7.Sampathkumar P. Temesgen Z. Smith T.F. Thompson R.L. SARS: epidemiology, clinical presentation, management, and infection control measures.Mayo Clin Proc. 2003; 78: 882-890Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 14.Centers for Disease Control and Prevention Cluster of severe acute respiratory syndrome cases among protected health-care workers—Toronto, Canada, April 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 433-436PubMed Google Scholar, 15.Lau J.T.F. Tsui H. Lau M. Yang X. SARS transmission, risk factors, and prevention in Hong Kong.Emerg Infect Dis. 2004; 10: 587-592Crossref PubMed Scopus (174) Google Scholar, 16.Chen Y.-C. Huang L.-M. Chan C.-C. Su C.-P. Chang S.-C. Chang Y.-Y. et al.SARS in hospital emergency room.Emerg Infect Dis. 2004; 10: 782-788Crossref PubMed Scopus (122) Google Scholar, 17.Yale New Haven infection control manual. Droplet precautions. [cited 2004 July]. Available from URL: http://info.med.yale.edu/ynhh/infection/precautions/droplet.html.Google Scholar, 18.The Red Cross. Questions about severe acute respiratory syndrome (SARS). In the news. May 13, 2003. [cited 2004 July]. Available from URL: http://www.redcross.org/news/hs/030402sars.html.Google Scholar Although community-acquired infection and household transmission have been reported, in a significant number of cases in 2003, transmission of SARS-CoV was nosocomial and was from SARS-infected patients to health care workers in charge of their care.2.Hsu L-Y, Lee C-C, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis [serial online] 2003 June [cited 2004 July];9:713-7. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/03-0264.htm.Google Scholar, 3.Dwosh H.A. Hong H.H.L. Austgarden D. Herman S. Schabas R. Identification and containment of an outbreak of SARS in a community hospital.CMAJ. 2003; 168: 1415-1420PubMed Google Scholar, 4.Centers for Disease Control and Prevention Severe acute respiratory syndrome—Taiwan, 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 461-466PubMed Google Scholar, 5.Ho A.S. Sung J.J.Y. Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.Ann Intern Med. 2003; 139: 564-567Crossref PubMed Scopus (91) Google Scholar, 14.Centers for Disease Control and Prevention Cluster of severe acute respiratory syndrome cases among protected health-care workers—Toronto, Canada, April 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 433-436PubMed Google Scholar, 15.Lau J.T.F. Tsui H. Lau M. Yang X. SARS transmission, risk factors, and prevention in Hong Kong.Emerg Infect Dis. 2004; 10: 587-592Crossref PubMed Scopus (174) Google Scholar In most of these cases, nosocomial transmission occurred in medical facilities in which infection control precautions were lax or were not practiced.14.Centers for Disease Control and Prevention Cluster of severe acute respiratory syndrome cases among protected health-care workers—Toronto, Canada, April 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 433-436PubMed Google Scholar In addition, SARS-CoV may be transmitted by direct contact with infected respiratory secretions and other body fluids.7.Sampathkumar P. Temesgen Z. Smith T.F. Thompson R.L. SARS: epidemiology, clinical presentation, management, and infection control measures.Mayo Clin Proc. 2003; 78: 882-890Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 15.Lau J.T.F. Tsui H. Lau M. Yang X. SARS transmission, risk factors, and prevention in Hong Kong.Emerg Infect Dis. 2004; 10: 587-592Crossref PubMed Scopus (174) Google Scholar, 16.Chen Y.-C. Huang L.-M. Chan C.-C. Su C.-P. Chang S.-C. Chang Y.-Y. et al.SARS in hospital emergency room.Emerg Infect Dis. 2004; 10: 782-788Crossref PubMed Scopus (122) Google Scholar, 19.Wenzel R.P. Edmond M.B. Listening to SARS: lessons for infection control.Ann Intern Med. 2003; 139: 592-593Crossref PubMed Scopus (25) Google Scholar Indirect contact with contaminated environmental surfaces and inanimate objects (fomites) is suspected to have resulted in the transmission of SARS-CoV, as suggested by reports that health care workers who had no direct contact with SARS-infected patients became infected.5.Ho A.S. Sung J.J.Y. Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.Ann Intern Med. 2003; 139: 564-567Crossref PubMed Scopus (91) Google Scholar, 6.Wenzel R.P. Edmond M.B. Managing SARS amidst uncertainty.N Engl J Med. 2003; 348: 1947-1948Crossref PubMed Scopus (121) Google Scholar, 9.Chiang C.-H. Chen H.-M. Shih J.F. Su W.J. Perng R.P. Management of hospital-acquired severe acute respiratory syndrome with different disease spectrum.J Chin Med Assoc. 2003; 66: 328-338PubMed Google Scholar, 15.Lau J.T.F. Tsui H. Lau M. Yang X. SARS transmission, risk factors, and prevention in Hong Kong.Emerg Infect Dis. 2004; 10: 587-592Crossref PubMed Scopus (174) Google Scholar, 16.Chen Y.-C. Huang L.-M. Chan C.-C. Su C.-P. Chang S.-C. Chang Y.-Y. et al.SARS in hospital emergency room.Emerg Infect Dis. 2004; 10: 782-788Crossref PubMed Scopus (122) Google Scholar Data suggest that SARS-CoV can survive on hard surfaces, such as plastic and stainless steel, for several hours, if not days.9.Chiang C.-H. Chen H.-M. Shih J.F. Su W.J. Perng R.P. Management of hospital-acquired severe acute respiratory syndrome with different disease spectrum.J Chin Med Assoc. 2003; 66: 328-338PubMed Google Scholar, 12.Rhode Island Department of Health. Severe acute respiratory syndrome (SARS). Public health fact sheet [serial online] 2003 June 16 [cited July]. Available from URL: http://www.health.ri.gov/disease/communicable/sars/factsheet061603.htm.Google Scholar, 16.Chen Y.-C. Huang L.-M. Chan C.-C. Su C.-P. Chang S.-C. Chang Y.-Y. et al.SARS in hospital emergency room.Emerg Infect Dis. 2004; 10: 782-788Crossref PubMed Scopus (122) Google Scholar Furthermore, it appears that airborne transmission of SARS-CoV cannot be ruled out.12.Rhode Island Department of Health. Severe acute respiratory syndrome (SARS). Public health fact sheet [serial online] 2003 June 16 [cited July]. Available from URL: http://www.health.ri.gov/disease/communicable/sars/factsheet061603.htm.Google Scholar, 19.Wenzel R.P. Edmond M.B. Listening to SARS: lessons for infection control.Ann Intern Med. 2003; 139: 592-593Crossref PubMed Scopus (25) Google Scholar In addition to respiratory secretions and other body fluids, SARS-CoV has been identified in human feces.6.Wenzel R.P. Edmond M.B. Managing SARS amidst uncertainty.N Engl J Med. 2003; 348: 1947-1948Crossref PubMed Scopus (121) Google Scholar, 7.Sampathkumar P. Temesgen Z. Smith T.F. Thompson R.L. SARS: epidemiology, clinical presentation, management, and infection control measures.Mayo Clin Proc. 2003; 78: 882-890Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 9.Chiang C.-H. Chen H.-M. Shih J.F. Su W.J. Perng R.P. Management of hospital-acquired severe acute respiratory syndrome with different disease spectrum.J Chin Med Assoc. 2003; 66: 328-338PubMed Google Scholar, 16.Chen Y.-C. Huang L.-M. Chan C.-C. Su C.-P. Chang S.-C. Chang Y.-Y. et al.SARS in hospital emergency room.Emerg Infect Dis. 2004; 10: 782-788Crossref PubMed Scopus (122) Google Scholar Therefore, the potential exists for the transmission of SARS-CoV to health care workers and other patients during GI endoscopy. Bronchoscopy, airway suctioning, and other types of procedures that may induce coughing and may expose health care workers to potentially infected aerosolized respiratory droplets pose an increased risk of transmission of SARS-CoV.13.Chan-Yeung M. Yu W.C. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report.BMJ. 2003; 326: 850-852Crossref PubMed Scopus (120) Google Scholar Despite this risk, to date there is no published report of transmission of SARS via a contaminated GI endoscope or bronchoscope. Health care workers in close contact with infected patients are at risk for exposure to SARS.2.Hsu L-Y, Lee C-C, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis [serial online] 2003 June [cited 2004 July];9:713-7. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/03-0264.htm.Google Scholar, 3.Dwosh H.A. Hong H.H.L. Austgarden D. Herman S. Schabas R. Identification and containment of an outbreak of SARS in a community hospital.CMAJ. 2003; 168: 1415-1420PubMed Google Scholar, 4.Centers for Disease Control and Prevention Severe acute respiratory syndrome—Taiwan, 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 461-466PubMed Google Scholar, 5.Ho A.S. Sung J.J.Y. Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.Ann Intern Med. 2003; 139: 564-567Crossref PubMed Scopus (91) Google Scholar, 14.Centers for Disease Control and Prevention Cluster of severe acute respiratory syndrome cases among protected health-care workers—Toronto, Canada, April 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 433-436PubMed Google Scholar Strict adherence to established infection control guidelines, therefore, is crucial for the prevention of nosocomial transmission of SARS-CoV (and all infectious agents).2.Hsu L-Y, Lee C-C, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis [serial online] 2003 June [cited 2004 July];9:713-7. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/03-0264.htm.Google Scholar, 3.Dwosh H.A. Hong H.H.L. Austgarden D. Herman S. Schabas R. Identification and containment of an outbreak of SARS in a community hospital.CMAJ. 2003; 168: 1415-1420PubMed Google Scholar, 15.Lau J.T.F. Tsui H. Lau M. Yang X. SARS transmission, risk factors, and prevention in Hong Kong.Emerg Infect Dis. 2004; 10: 587-592Crossref PubMed Scopus (174) Google Scholar, 20.Zhao Z. Zhang F. Xu M. Huang K. Zhong W. Cai W. et al.Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China.J Med Microbiol. 2003; 52: 715-720Crossref PubMed Scopus (350) Google Scholar Routine monitoring of infection control practices to ensure compliance with these established guidelines is also to be recommended. Based on experience with SARS to date, as well as recommendations for prevention of transmission of other disease-causing agents, e.g., hepatitis C, a number of steps can be taken to prevent transmission of SARS-CoV in the GI endoscopy unit and other health care settings:•A program should be established for identification and isolation of patients who are suspected or likely to have SARS.5.Ho A.S. Sung J.J.Y. Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.Ann Intern Med. 2003; 139: 564-567Crossref PubMed Scopus (91) Google Scholar, 19.Wenzel R.P. Edmond M.B. Listening to SARS: lessons for infection control.Ann Intern Med. 2003; 139: 592-593Crossref PubMed Scopus (25) Google Scholar Prompt diagnosis of SARS-CoV infection is crucial for the prevention of transmission of the disease.2.Hsu L-Y, Lee C-C, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis [serial online] 2003 June [cited 2004 July];9:713-7. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no6/03-0264.htm.Google Scholar Screening and evaluation of patients for SARS should be based on the current case definition of SARS as established by the Centers for Disease Control and Prevention (CDC) in the United States. During a known SARS outbreak, a high index of suspicion for infection is warranted.5.Ho A.S. Sung J.J.Y. Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.Ann Intern Med. 2003; 139: 564-567Crossref PubMed Scopus (91) Google Scholar The current CDC definition (dated January 8, 2004) of a suspect case and a probable case of SARS can be found in the document entitled "Updated interim U.S. case definition for severe acute respiratory syndrome (SARS)," which can be read at the following web link: http://www.cdc.gov/ncidod/sars/casedefinition.htm•Health care workers must be educated with respect to the following principles: infection control, standard precautions, contact precautions, and airborne precautions for both suspect and probable SARS-infected patients.3.Dwosh H.A. Hong H.H.L. Austgarden D. Herman S. Schabas R. Identification and containment of an outbreak of SARS in a community hospital.CMAJ. 2003; 168: 1415-1420PubMed Google Scholar, 6.Wenzel R.P. Edmond M.B. Managing SARS amidst uncertainty.N Engl J Med. 2003; 348: 1947-1948Crossref PubMed Scopus (121) Google Scholar, 19.Wenzel R.P. Edmond M.B. Listening to SARS: lessons for infection control.Ann Intern Med. 2003; 139: 592-593Crossref PubMed Scopus (25) Google Scholar, 20.Zhao Z. Zhang F. Xu M. Huang K. Zhong W. Cai W. et al.Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China.J Med Microbiol. 2003; 52: 715-720Crossref PubMed Scopus (350) Google Scholar, 21.Emergency Nurses Association. Infection control precautions for aerosol-generating procedures on patients who have suspected severe acute respiratory syndrome (SARS). [cited 2004 July]. Available from URL: http://www.ena.org/news/news/SARS/SARS-InfectioncontrolCDC.asp.Google Scholar, 22.Seto W.H. Tsang D. Yung R.W. Ching T.Y. Ng T.K. Ho M. et al.Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS).Lancet. 2003; 361: 1519-1520Abstract Full Text Full Text PDF PubMed Scopus (715) Google Scholar, 23.Centers for Disease Control and Prevention. Updated interim domestic infection control guidance in the health-care and community setting for patients with suspected SARS. May 1, 2003. [cited 2003 May]. Available from URL: http://www.cdc.gov/ncidod/sars/infectioncontrol.htm.Google Scholar Steps should be taken to ensure that health care workers properly and diligently practice these important principles, because failure to understand and use each one of them may significantly increase the risk of nosocomial transmission of SARS-CoV. In addition to eye protection, personal protective equipment should be used, including gloves, gowns, and both head and shoe covers.13.Chan-Yeung M. Yu W.C. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report.BMJ. 2003; 326: 850-852Crossref PubMed Scopus (120) Google Scholar, 16.Chen Y.-C. Huang L.-M. Chan C.-C. Su C.-P. Chang S.-C. Chang Y.-Y. et al.SARS in hospital emergency room.Emerg Infect Dis. 2004; 10: 782-788Crossref PubMed Scopus (122) Google Scholar, 24.Centers for Disease Control and Prevention Use of quarantine to prevent transmission of severe acute respiratory syndrome—Taiwan, 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 680-683PubMed Google Scholar, 25.Centers for Disease Control and Prevention. Interim domestic guidance for management of exposures to severe acute respiratory syndrome (SARS) for health-care settings. June 24, 2003. [cited 2003 June]. Available from URL: http://www.cdc.gov/ncidod/sars/exposureguidance.htm.Google Scholar Adherence to airborne precautions requires that health care workers be fitted with disposable respirators certified by the National Institute for Occupational Safety and Health as N95 or better,14.Centers for Disease Control and Prevention Cluster of severe acute respiratory syndrome cases among protected health-care workers—Toronto, Canada, April 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 433-436PubMed Google Scholar which, unlike surgical masks,5.Ho A.S. Sung J.J.Y. Chan-Yeung M. An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.Ann Intern Med. 2003; 139: 564-567Crossref PubMed Scopus (91) Google Scholar, 26.Centers for Disease Control and Prevention. Interim domestic guidance on the use of respirators to prevent transmission of SARS. May 6, 2003. [cited 2003 May]. Available from URL: http://www.cdc.gov/ncidod/sars/respirators.htm.Google Scholar appear to prevent transmission of SARS. Placement of a SARS-infected patient in an isolated room with negative air pressure also is recommended. Proper hand hygiene and frequent hand washing with soap and water (or an alcohol-based hand rub) are essential, both before and after each patient contact.13.Chan-Yeung M. Yu W.C. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report.BMJ. 2003; 326: 850-852Crossref PubMed Scopus (120) Google Scholar, 14.Centers for Disease Control and Prevention Cluster of severe acute respiratory syndrome cases among protected health-care workers—Toronto, Canada, April 2003.MMWR Morb Mortal Wkly Rep. 2003; 52: 433-436PubMed Google Scholar, 19.Wenzel R.P. Edmond M.B. Listening to SARS: lessons for infection control.Ann Intern Med. 2003; 139: 592-593Crossref PubMed Scopus (25) Google Scholar, 26.Centers for Disease Control and Prevention. Interim domestic guidance on the use of respirators to prevent transmission of SARS. May 6, 2003. [cited 2003 May]. Available from URL: http://www.cdc.gov/ncidod/sars/respirators.htm.Google Scholar, 27.Centers for Disease Control and Prevention. Frequently asked questions about SARS. August 27, 2003. [cited 2003 August]. Available from URL: http://www.cdc.gov/ncidod/sars/faq.htm.Google Scholar, 28.Centers for Disease Control and Prevention. Hand hygiene in healthcare settings. [cited 2004 July]. Available from URL:http://www.cdc.gov/handhygiene/.Google Scholar The contribution of hand washing to the prevention of transmission of SARS (and other infectious agents) cannot be overstated.16.Chen Y.-C. Huang L.-M. Chan C.-C. Su C.-P. Chang S.-C. Chang Y.-Y. et al.SARS in hospital emergency room.Emerg Infect Dis. 2004; 10: 782-788Crossref PubMed Scopus (122) Google Scholar After each patient contact, gloves should be removed and hands washed thoroughly; the use of gloves does not eliminate the need for proper hand hygiene and frequent hand washing. Proper disposal of used gloves is also essential. A surveillance program to monitor and to evaluate compliance with these principles and precautions is advisable.•Bronchoscopy, airway suctioning, and other types of procedures that may induce coughing and thereby expose health care workers to potentially infected aerosolized respiratory droplets should be performed with caution on SARS-infected patients and then only when deemed a medical necessity.7.Sampathkumar P. Temesgen Z. Smith T.F. Thompson R.L. SARS: epidemiology, clinical presentation, management, and infection control measures.Mayo Clin Proc. 2003; 78: 882-890Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 20.Zhao Z. Zhang F. Xu M. Huang K. Zhong W. Cai W. et al.Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China.J Med Microbiol. 2003; 52: 715-720Crossref PubMed Scopus (350) Google Scholar, 21.Emergency Nurses Association. Infection control precautions for aerosol-generating procedures on patients who have suspected severe acute respiratory syndrome (SARS). [cited 2004 July]. Available from URL: http://www.ena.org/news/news/SARS/SARS-InfectioncontrolCDC.asp.Google Scholar•GI endoscopes, bronchoscopes, and other flexible endoscopes and ancillary endoscopic equipment should be thoroughly cleaned and subjected to either high-level disinfection or sterilization as required. Whereas high-level disinfection is recommended for GI endoscopes, bronchoscopes, and other "semicritical" instruments, sterilization is recommended for "critical" instruments, including biopsy forceps, papillotomes, and polypectomy snares. Single, disposable endoscopic accessories and devices are an alternative to sterilization of reusable devices; proper disposal of these devices also is essential. Adherence to current guidelines for reprocessing of endoscopes also is recommended for prevention of transmission of SARS-CoV via both potentially contaminated GI endoscopes and bronchoscopes.•Rooms occupied by SARS-infected patients, as well as other areas in a medical facility that may be visited by SARS-infected patients (e.g., the emergency room), should be cleaned and disinfected once per day or more often, as required. Routine and terminal cleaning and disinfection of all necessary bedside equipment, furniture, floors, and other environmental surfaces, particularly surfaces that are touched frequently, are recommended.13.Chan-Yeung M. Yu W.C. Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report.BMJ. 2003; 326: 850-852Crossref PubMed Scopus (120) Google Scholar, 19.Wenzel R.P. Edmond M.B. Listening to SARS: lessons for infection control.Ann Intern Med. 2003; 139: 592-593Crossref PubMed Scopus (25) Google Scholar, 29.Centers for Disease Control and Prevention. Supplement I: infection control in healthcare, home, and community settings. January 8, 2004. [cited 2004 January]. Available from URL: http://www.cdc.gov/ncidod/sars/guidance/I/index.htm.Google Scholar For these purposes, any Environmental Protection Agency registered hospital-grade detergent-disinfectant shown to be effective against coronaviruses is suitable. The label instructions on the product for use and dilution (i.e., concentration), contact time, and care in handling should be followed carefully.29.Centers for Disease Control and Prevention. Supplement I: infection control in healthcare, home, and community settings. January 8, 2004. [cited 2004 January]. Available from URL: http://www.cdc.gov/ncidod/sars/guidance/I/index.htm.Google Scholar Although the role of environmental surfaces in the transmission of SARS-CoV is not fully defined, contamination of such surfaces has been reported, suggesting that intensive environmental cleaning and disinfection are essential for both control and prevention of the spread of SARS-CoV.16.Chen Y.-C. Huang L.-M. Chan C.-C. Su C.-P. Chang S.-C. Chang Y.-Y. et al.SARS in hospital emergency room.Emerg Infect Dis. 2004; 10: 782-788Crossref PubMed Scopus (122) Google Scholar
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