Who is at Risks? • Healthcare professionals • Close Family Members (care-takers/attendants) • Others • All in-patients admitted to a hospital where SARS has been recognized • Especially patients with underlying conditions • People who visit hospitals where SARS has been recognized • In the event an employee is suspected of having contracted the disease, • he/she must take steps not to expose colleagues and customers to risk.
Infection Control • Patients with SARS pose a risk of transmission to close household contacts and health care personnel in close contact • The duration of time before or after onset of symptoms during which a patient with SARS can transmit the disease to others is unknown • The following infection control measures are recommended for patients with suspected SARS in households or residential settings
Hospital Infection Control Guidance Outpatient/triage setting • Those presenting to health care facilities who require assessment for SARS should be rapidly diverted by triage nurses to a separate area to minimize transmission to others • Those patients should be given a N 95 mask to wear • Staff involved in the triage process should wear a N 95 mask and wash hands before and after contact with any patient, after activities likely to cause contamination and after removing gloves • Wherever possible, patients under investigation for SARS should be separated from the probable cases – cohort patients WHO: Revised 28 March 2003
Hospital Infection Control Guidance Inpatient settingCare for probable SARS cases • Probable SARS cases should be isolated and accommodated as follows in descending order of preference: • negative pressure rooms with the door closed • single rooms with their own bathroom facilities • cohort placement in an area with an independent air supply, exhaust system and bathroom facilities WHO: Revised 28 March 2003
Hospital Infection Control Guidance Inpatient settingCare for probable SARS cases • Turning off air conditioning and opening windows for good ventilation is recommended if an independent air supply is unfeasible. Please ensure that if windows are opened they are away from public places WHO: Revised 28 March 2003
Hospital Infection Control Guidance Inpatient settingCare for probable SARS cases • WHO advises strict adherence to the barrier nursing of patients with SARS, using precautions for airborne, droplet and contact transmission • All staff, including ancilliary staff should be trained in the infection control measures required for the care of such a patient • If possible, identify a member of the staff who will have the sole role of observing the practice of others and provide feedback on infection control WHO: Revised 28 March 2003
Hospital Infection Control Guidance Inpatient settingCare for probable SARS cases • Disposable equipment should be used wherever possible in the treatment and care of patients with SARS and disposed of appropriately. If devices are to be reused, they should be sterilized in accordance with manufacturers’ instructions. Surfaces should be cleaned with broad spectrum disinfectants of proven antiviral activity WHO: Revised 28 March 2003
Hospital Infection Control Guidance Inpatient settingCare for probable SARS cases • Movement of patients outside of the isolation unit should be avoided. If moved the patients should wear a N 95 mask • Visitors, if allowed by the health care facility should be kept to a minimum. They should be issued with personal protective equipment (PPE) and supervised WHO: Revised 28 March 2003
Hospital Infection Control Guidance Inpatient settingCare for probable SARS cases • All non-essential staff (including students) should not be allowed on the unit/ward • Handwashing is crucial: therefore access to clean water is essential Hands should be washed before and after contact with any patient, after activities likely to cause contamination and after removing gloves WHO: Revised 28 March 2003
Handwashing Recommendations Hand washing is the Cornerstone of Infection Control When coming on duty Before all patient contact Before doing invasive procedures Before taking care of a particularly susceptible patient, e.g. immunocompromised Before and after touching wound After removal of gloves After contact with blood, mucus membranes or bodily fluids, secretions or excretions After touching inanimate sources likely to be contaminated, e.g. urine measuring devices. After taking care of an infected patient or one who is likely to be colonized with micro organisms of special clinical or epidemiological significance, e.g. MRSA Before medication preparation Before and after eating After personal use of toilet When hands are soiled, including after sneezing, coughing, or blowing of nose
Hospital Infection Control Guidance Inpatient settingCare for probable SARS cases • Hands should be washed before and after contact with any patient, after activities likely to cause contamination and after removing gloves • Alcohol-based skin disinfectants could be used if there is no obvious organic material contamination • Particular attention should be paid to interventions such as the use of nebulisers, chest physiotherapy, bronchoscopy or gastroscopy; any intervention which may disrupt the respiratory tract WHO: Revised 28 March 2003
Hospital Infection Control Guidance Inpatient settingCare for probable SARS cases • PPE should be worn by all staff and visitors accessing the isolation unit • The PPE worn in this situation should be: N95 mask as a minimum Single pair of gloves Goggles Disposable gown Apron Footwear that can be decontaminated WHO: Revised 28 March 2003
Hospital Infection Control Guidance Inpatient settingCare for probable SARS cases • All sharps should be dealt with promptly and safely • Linen from the patients should be prepared on site for the laundry staff. Appropriate PPE should be worn in this preparation and the linen should be put into biohazard bags • The room should be cleaned by staff wearing PPE using a broad spectrum disinfectant of proven antiviral activity WHO: Revised 28 March 2003
Infection Control Guidelines for SARS patients • SARS patients should limit interactions outside the home and should not go to work, school, out-of-home child care, or other public areas until 10 days after the resolution of fever, provided respiratory symptoms are absent or improving. • During this time, infection control precautions should be used, as described in the following slides, to minimize the potential for transmission.
Infection Control for SARS patients • Use of disposable gloves should be considered for any direct contact with body fluids of a SARS patient. However, gloves are not intended to replace proper hand hygiene • Immediately after activities involving contact with body fluids, gloves should be removed and discarded and hands should be cleaned. • Gloves must NEVER be washed or reused.
Infection Control for SARS patients • All members of a household with a SARS patient should carefully follow recommendations for hand hygiene (e.g., frequent hand washing or use of alcohol-based hand rubs), particularly after contact with body fluids (e.g., respiratory secretions, urine, or feces).
Infection Control for SARS patients • Each patient with SARS should be advised to cover their mouth and nose with a facial tissue when coughing or sneezing. • If possible, a SARS patient should wear a surgical mask during close contact with uninfected persons to prevent spread of infectious droplets. • When a SARS patient is unable to wear a surgical mask, household members should wear surgical masks when in close contact with the patient.
Infection Control for SARS patients • Sharing of eating utensils, towels, and bedding between SARS patients and others should be avoided, although such items can be used by others after routine cleaning (e.g., washing with soap and hot water). • Environmental surfaces soiled by body fluids should be cleaned with a household disinfectant according to manufacturer's instructions; gloves should be worn during this activity.
Infection Control for SARS patients • Household waste soiled with body fluids of SARS patients, including facial tissues and surgical masks, may be discarded as normal waste. • Household members and other close contacts of SARS patients should be actively monitored by the local health department for illness.
Infection Control for SARS patients • Household members or other close contacts of SARS patients should be vigilant for the development of fever or respiratory symptoms and, if these develop, should seek healthcare evaluation. • In advance of evaluation, healthcare providers should be informed that the individual is a close contact of a SARS patient. • Household members or other close contacts with symptoms of SARS should follow the same precautions recommended for SARS patients.
Infection Control for SARS patients • At this time, in the absence of fever or respiratory symptoms, household members or other close contacts of SARS patients need not limit their activities outside the home.
Infection Control Guidelines for Hospital Visitors • Special precautions must be taken when entering all ICU, MICU, CCU, SICU and respiratory therapy units, regardless of whether the hospital/unit is known to have SARS cases. • Hospital that have been identified of exposure to SARS must be visited only where absolutely necessary, and specialized safety procedures must be in place which must be strictly followed.
Precautions To Take When Visiting ICUs – For HCW & Visitors • Use strict Universal Precautions Guidelines • Use N95 or FFP-1grade mask • No personal belongings to be allowed • Before entering the unit, put on the mask as per instructions, and check for leakage • After entering the unit, ask for a pair of surgical gloves before handling equipment
Precautions To Take When Visiting ICUs – For HCW & Visitors • Do not place belongings, tools etc. on the floor or on exposed surfaces • Request a paper towel from the staff to spread on the surface. • If you need to bring equipment/parts back from the ICU have them sterilized according to hospital procedure by a member of the ICU staff.
When Leaving The ICU… • After exiting the unit, remove the mask first and discard it, then remove the gloves • Gloves must be discarded • Wash hands thoroughly with alcohol or chlorhexidine scrub solution • Do not re-use a mask. • Do not touch a used mask without wearing gloves.
Guidelines What To Do If You Think You Have SARS • If you develop fever, cough and muscle pain: • Inform your supervisor • Consult your physician immediately • Inform local health department
Guidelines What To Do If You Think You Have SARS • If you are quarantined by health authorities: • Inform your supervisor
Guidelines What To Do If You Think You Have SARS • If you are quarantined by health authorities: • Compile a list of colleagues (including friends and family members), co-workers and customers (patients, clients, etc.) you have had contact with for the last 3 days and forward it via e-mail to the identified authorities • Do not leave your house for any reason, or entertain visitors during the quarantine period • If you develop any of the symptoms during the quarantine period, inform relevant health authorities immediately
REVISED LIST OF QUARANTINABLE COMMUNICABLE DISEASES By the authority vested in me as President by the Constitution and the laws of the United States of America, including section 361(b) of the Public Health Service Act (42 U.S.C. 264(b)), it is hereby ordered as follows: Section 1. Based upon the recommendation of the Secretary of Health and Human Services (the "Secretary"), in consultation with the Surgeon General, and for the purpose of specifying certain communicable diseases for regulations providing for the apprehension, detention, or conditional release of individuals to prevent the introduction, transmission, or spread of suspected communicable diseases, the following communicable diseases are hereby specified pursuant to section 361(b) of the Public Health Service Act: