Sars

Click to edit Master title style
Severe Respiratory Click to edit Acute Master text styles Syndrome (SARS) Second level Third level Fourth level Fifth level
Dr. Tjatur Winarsanto SpPD 2012
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Overview Click to edit Master title style

Epidemiology and Clinical Click to edit Master text styles Management Infection Control Precautions Second level Laboratory Third level Safety Fourth level Safety Mortuary Fifth level Linen, Laundry, Waste Management Environmental Cleaning
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Background Click to edit Master title style

Approximately 8098 cases in 29 countries Click to edit Master text styles as of 31 July 2003 Second level
Third level At least 774 deaths Fourth level Fifth level 1707 Cases (21%) have been health care workers
Chronology Click to edit Master title style

SARS, Click to anedit atypical Master pneumonia text styles of unknown was recognized at the end of etiology, Second level February 2003 Third level Fourth level The World Health Organization (WHO) coFifth level ordinated the international responses to provide epidemiological, clinical and logistical support as required
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11 February Chinese Click to health edit Master textreported styles officials atypical in Guangdong Province, pneumonia Second level China; 305 cases/5 deaths (Nov 02Feb 03) Third level Fourth level 19 February Fifth level Hong Kong confirms human infection of Influenza H5N1
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5 March in Hanoi recognized Outbreak Click to edit Master text styles 11 March Second level Hong Kong reports SARS outbreak
Third level March Fourth level 13 Singapore Fifth level reports 3 SARS cases
15 March The disease spread to outside Asia (Canada, Germany)
Chronology Click to edit Master title style WHO initiates :

Global Alert (12 March)
Click to edit Master text styles Travel Advisory Second level (15 March; 2, 23 & 29 April) Third level Enhanced global surveillance Fourth level Global Outbreak Alert and Response Network Fifth level
Specific Global Networks (Lab, Case Management, Epidemiology)
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Forward planning of Activities since then : Infection Guidelines bi-regional Click toControl edit Master text styles guidelines will now cover all issues for Second level Infection Control practice in a Health Care Third level Facility due out soon Fourth level Infection Control Programme will support member states in how to set up an IC Fifth level programme IC Audit tool for self evaluation of HCF
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Click toEpidemiology edit Master title style

Cause : SARS CoV Click to edit Master text styles Highly infectious Second level Mainly affects adults Third level Superspreading events important in transmission Fourth level process Fifth level No reports of transmission occurring before onset of symptoms
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Means of edit transmission Click to Master text styles
Second level Evidence of person to person transmission Third level Fourth level with body fluids (especially Close contact respiratory Fifth level droplets )
Contaminated hands, clothes, equipment; environment may also be important
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Risk factors transmission Click to editfor Master text styles
Second level High risk medical procedures: Third level Intubation Fourth level Bronchoscopy Fifth level
Cough-inducing procedures (sputum induction, administration of nebulised medications, suctioning)

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Incubation period Click to edit Master text styles
2 10 days and up to 13 days in exceptional Second cases level Onsetlevel and duration of infectivity unknown Third
Fourth level Fifth level Organism survival in environment

Duration unknown Data has shown SARS CoV may survive for 2-3 days
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Case Definitions Developed forto public health purposes in the interClick edit Master title style
outbreak period
Click to edit Master A person with a history of:text styles

Second Fever (> 38oC)level
AND one orlevel more of the symptoms of lower respiratory tract Third illness (cough, difficulty breathing, shortness of breath)
Fourth level AND Radiographic evidence of lung infiltrates consistent with Fifth or level pneumonia RDS or autopsy finding consistent with the
pathology of pneumonia or RDS without an identifiable cause
AND No alternative diagnosis can fully explain the illness
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Case Definitions Clickcase to definition edit Master title style Laboratory of SARS
A person with symptoms and signs that are clinically Clickof to editAND Master styles suggestive SARS with text positive laboratory findings for SARS-CoV based on one or more of the following diagnostic Second level criteria:
Third level a) PCR for SARS-CoV using a validated method from: Fourth level At least 2 different clinical specimens (eg nasopharyngeal or stool) OR level Fifth
The same clinical specimen collected on 2 or more occasions during the course of the illness
Two different assays or repeat PCR using a new RNA extract 14 from the original clinical sample on each occasion of testing
Case Definitions b) Seroconversion by ELISA or IFAtitle style Click to edit Master

Negative antibody test on acute serum followed by positive antibody testto onedit convalescent Click Masterphase text serum stylestested in parallel OR Fourfold or greater Second level rise in antibody titre between acute and convalescent phase sera tested in parallel
Third level c) Virus Isolation Fourth level Isolation in cell culture of SARS-CoV from any specimen AND Fifth level using a validated method PCR confirmation
Testing should only be undertaken in a national or regional reference laboratory as per WHO guidelines.
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Contacts Click to edit Master title style

Definition Click to edit Master text styles Close contact level : having cared for, lived with, or had Second direct contact with the respiratory secretions or body Third fluids of alevel suspect or probable case of SARS.
Fourth level Contacts oflevel persons under investigation for SARS Fifth
should be traced and quarantined until SARS has been ruled out as the cause of the illness
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Clinical picture in SARS patients

Exposure to SARS Fever, myalgia, dry non-productive cough cough, headache shortness of breath Incubation period ~2 to 10 days up to 13 days reported Prodrome ~ 1- to 2 days Lower respiratory phase From day 4 onwards Acute respiratory distress syndrome approx 10% Recovery approx 90%
Infectivity
None /very low Low Very high
Clinical Picture Onset / Presentation Click to edit Master title style

Sudden of high Click to onset edit Master textfever styles with chills, rigors and a nonmyalgia, Second level productive Third level cough
Fourth level Most Fifth cases level have bilateral pneumonia
~ 90% begin to recover from day 6 or 7

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Clinical Picture Click to edit Master title style Onset / Presentation

Rapid deterioration in 10% (+/-) of cases Click to edit Master text styles Second level Acute RDS Third level Require ICU admission & Fourth level mechanical ventilation Fifth level Case fatality rate: ~ 6% No specific treatment available
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Clinical Picture Management
Click to edit Master title style SUPPORTIVE TREATMENT

Click to edit Master text styles Antibiotic Therapy: to Second level cover causative organisms Third level Prophylactic Fourth level Antibiotic Therapy: prevent to Fifth level secondary bacterial infection
Maintain oxygenation: intubate and ventilate as necessary
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Clinical Picture Management

SUPPORTIVE TREATMENT
Click to edit Master text styles Avoid interventions which may cause Second level aerosolisation of respiratory secretions: Third level Bronchoscopy Fourth level Nebulised bronchodilators Chest physiotherapy Fifth level
Gastroscopy Any procedure / intervention that may release respiratory secretions

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Clinical Management Click toPicture edit Master title style

Click SUPPORTIVE to edit Master TREATMENT text styles Second level Third level In severe cases corticosteroids and ribavirin Fourth level have been used, however there is Fifth level no evidence to support their general or routine use at this stage.
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Summary SARS
Multi - Country Outbreak Click to edit Master
title style
New Pathogen: Click to edit Master text styles CoronaVirus family SARS CoV
Second level Clinical Picture: Third level Fever and respiratory symptoms Fourth level ~ case fatality rate currently 4% Fifth level
Transmission: Close contact with symptomatic case(s) Contaminated hands and objects
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Summary SARS
Click to&edit Master title style Prevention Control: Identification Isolation of suspect and probable cases Click to edit Master text styles Tracing & quarantine of close contacts Second level Infection control precautions for all Third level suspect and probable cases Fourth level Public Education Fifth level Health care workers are currently at greatest risk therefore: Infection control precautions are 24 essential
Infection Control Precautions Click to edit Master title style

Infection Control precautions (previously as Barrier nursing techniques) are known Click to edit Master text styles to prevent infection from the patient designed Second level to the staff/visitor or the staff/visitors to other Third level patients. Fourth level Fifth level Strict precautions must be used for all SARS patients.
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Patient Management Click to edit Master title style

SARS : Infection Control Goals
Click to edit Master text styles SARS Second level Admissions - Triage Third level Components Fourth level of SARS Isolation Fifth level
SARS : Infection Control Practices
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SARS : Infection Control Goals Click to edit Master title style

In addition to providing the best possible clinical Click to edit Master text styles care: Second level Third level Detect early any suspect cases. Fourth level Implement appropriate isolation measures. Fifth level Protect health care personnel. Protect other patients. Protect family and community members.
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Triage for SARS Admissions Clickthere to edit Master title style If possible, should be separate wards/areas
for each of the following categories :
Click to edit Master text styles colds, sniffles and runny noses Patients Secondwith level should be isolated in a single room / area Suspect Third level cases -Fourth level Place in a single room cases Probable Fifth level
- If cohort nursing, keep probable and suspect cases apart - May share room with other probable cases; where possible use a single room for all patients
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Components of SARS Isolation Click to edit Master title style

Facility Click to edit Master text styles Administrative Controls Second level Third level Clinical Surveillance of Staff Fourth level Organization of Isolation Area Fifth level Equipment Protective Standard Precautions
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Good ventilation
Facility Click toother editpatient Master title style Isolated from / staff movement
Click to edit Master styles Air movement: corridor text to room to outdoors Turn off level central air-conditioning systems unless the Second room can be isolated from the system. Third level Sinks and running water Fourth level Adequate bathroom facilities Fifth level Capacity to handle waste and laundry
Sufficient rooms for expected number of patients Contingency plans for converting other areas to isolation facilities
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ISOLATION WASH/TOILET
General Principles of isolation unit
Click to edit Master title style A

F GENERAL ACCESS AREA
ISOLATION Click to ROOM edit Master text styles CHANGE Negative pressure/ ROOM (e.g. blow air out of Second level E window with fan) D Third level A D B C Fourth level E A level Disinfection station A. Fifth
B. Container for disinfection of reusable items e.g. goggles C. Biohazard bag for used (personal protective equipment) disposal D. Wall-mounted alcohol handwash dispensers E. External windows only. Keep clear of public. F. Storage for general ward clothes, new PPE
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General Principles of Isolation Unit

A
F
ISOLATION ROOM Negative pressure/ (e.g. blow air out of window E with fan) D
ROOM Click to edit Master CHANGE text styles Second level A D Third level B C E A B Fourth level A. Disinfection station Container Fifth level B. for disinfection of reusable items
C. D. E.
GENERAL ACCESS AREA
F.
e.g. goggles. Biohazard bag for used (personal protective equipment) disposal Wall -mounted alcohol hand wash dispensers External windows only. Keep clear of public. Storage for general ward clothes, new PPE
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Facility Click to edit Master title style Isolation Area Full IC Precautions required
Colour codes
Click to edit Master text styles Green Second level (GO) : General [reduced] staff movement Third level Yellow Fourth level (CAUTION) : Limited staff movement Fifth level
Red
(RESTRICTED) : Assigned staff only
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Limit and control points of entry to SARS ward(s) Click to edit Master text styles Second level One entrance Third level Guard to control entrance Fourth Log oflevel permitted visitors (staff & visitors) Fifth level Visitors must be restricted or preferably
forbidden with NO EXCEPTIONS Limit patient travel/transport outside unit Minimize the number of staff exposure to cases
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Administrative Controls Click to edit Master title style
Administrative Controls Click to edit Master title style

Assignment of responsibility Click to edit Master text styles Second level Determining patient placement Third level implementation and enforcement Overseeing of infection Fourth level control measures Enforcing Fifth level access restrictions
Supply acquisition and distribution Surveillance of Health Care Workers (HCWs)

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Maintain list of all staff who worked with SARS patients or on the SARS ward;
Clinical Surveillance of Staff Click to edit Master title style
Click to edit Master text styles Systematically monitor for fever; and Second level Twice daily temperature for staff working in the area (baseline Chest X-Ray may be needed ) Third level Screen for symptoms of SARS-like illness among staff Fourth level for duty. reporting List contact Fifth levelinformation for:
Persons visiting or caring for SARS patients; and Contacts of HCWs in close contact with SARS patients.
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Organization of SARS Isolation Area

Put Up Signs: eg. SARS Isolation Area Designated for clean protective Click to area edit Master text styles equipment
Separation of clean and dirty supplies including an Fourth level area for level containment of waste and soiled linen Fifth

Instructions for using protective equipment Second level Accessible to personnel Third level Sufficient inventory to meet daily needs
Color-coded bags and containers for contaminated waste and laundry Containers for laundry and all waste should have footoperated lids
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General Principles of Isolation Unit

A
F
ISOLATION ROOM Negative pressure/ (e.g. blow air out of window E with fan) D
ROOM Click to edit Master CHANGE text styles Second level A D Third level B C E A B Fourth level A. Disinfection station Container Fifth level B. for disinfection of reusable items
C. D. E.
GENERAL ACCESS AREA
F.
e.g. goggles. Biohazard bag for used (personal protective equipment) disposal Wall -mounted alcohol hand wash dispensers External windows only. Keep clear of public. Storage for general ward clothes, new PPE
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Infection Control Click to edit Master title style

You Click tocan edit minimize Master text YOUR styles risk of catching Second level Third level SARS Fourth level Fifth level by following
Infection Control Precautions.
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Infection Control Precautions Click to edit forMaster SARS title style

Click to edit Master text styles Standard Precautions Second level + Third level Fourth level Respiratory Precautions Fifth level +
Contact Precaution
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Exposure Risks Click to edit Master title style

Patient: Health Care Staff: Respiratory Respiratory secretions Click to edit Master text styles secretions Blood Second level Blood Body fluids including Third level Body fluids excreta Fourth level including excreta Mucous membranes Fifth Skin level lesions Skin lesions
Staff Visitors
Sharps Visitors
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Hand Washing
Click to edit Master text styles Second level Third level An essential Infection Control Fourth level precaution to prevent the Fifth level
transmission of SARS
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Principles of Hand Washing Click to edit Master title style
Hand Washing : Is the single most important and effective Click to edit Master text styles component for preventing the transmission of infection. Second level Third levelto remove transient Is designed that may have been picked microorganisms Fourth level from the environment. up Fifth level Prevents the transfer of these microorganisms to other patients, staff and equipment. Is best performed using soap (preferably liquid) and warm running water. 43
Handwashing When? After removing gloves Click to edit Master title style Before and after patient
contact contact with blood or After Click to edit Master text body fluids from any patient Second level After taking blood pressure Third level or vital signs any level patient from Fourth
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Other times:
Fifth level After using bathroom

After blowing or wiping nose Before eating Before preparing food
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Handwashing How? Click to edit Master title style

Handwashing procedure : Click to edit Master text styles Second level Running water Third level Soap (preferably liquid) Fourth level Fifth level Friction Or use Alcohol-based hand rub
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Handwashing Steps
Click to edit Master title style Step 1 Click to edit Master text styles
Second Wet hands level and wrists. Third level Apply soap Fourth level Fifth level
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Handwashing Steps
Click to edit Master text styles Second level Right palm over left. Third level Fourth level Left over right. Fifth level
Click to edit Master title style Step 2
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Handwashing Steps
Click Step 3 to edit Master text styles
Second level Palm to palm Third level Fourth level with fingers Fifth level interlaced.
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Back of the Second level fingers to the Third level opposing fingers Fourth level and interlocked. Fifth level
Handwashing Steps
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Handwashing Steps
Rotational rubbing of Second level Third the right level thumb by Fourth level clasping it in the left Fifth level
palm. And vice versa.
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Click to edit Master title style Step 6

Click to edit Master text styles Rotational rubbing Second level backwards and forwards with tops of Third level fingers and thumb of Fourth level right hand in left. Fifth level
And vice versa.
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Handwashing Steps
Drying Your Hands Click to Master title style It is important to edit dry your hands thoroughly after
washing them because :
Click to edit Master text styles Damp hands collect microorganisms Second level Damp hands spread potentially infectious microorgansims Third level Damp hands may become colonised with Fourth level potentially infectious microorganisms Fifth level
Therefore it is important to pat dry your hands thoroughly. Pat drying also helps to prevent damage to skin.
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Handwashing Tips Click to edit Master title style

Remember: Click to edit Master text styles Second level Wash hands for a minimum of 15 to 20 Third level seconds. Fourth level Ensure you have washed all areas properly. Fifth level
Dry hands thoroughly.

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Handwashing Tips Click to edit Master title style

Alcohol based hand gels/ lotions Click to edit Master text styles Use on clean (unsoiled) hands Second level Use enough of the product to cover hands Third level Vigorously rub hands using the same steps as Fourth Step 1 6 level (do not wet hands prior to applying the solution/gel) Fifth level
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Handwashing in Difficult Situations
If running water is not immediately available, Click to edit Master what should you do? text styles Second level Use a basin of clean water and wash hands. Third level Use a clean basin each time. Fourth level Use fresh water each time. Fifth level DO NOT contaminate sources of fresh / clean water by handling ladles or dippers.
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Handwashing in Difficult Situations
Click to edit Master title style If water is not immediately available, what
should you do? Click to edit Master styles Use an 70% alcohol text based hand rub solution. Second levelamount to completely cover Use sufficient your hands. Third level Wash your hands using running water Fourth level and soaplevel as soon as they become soiled Fifth
NB: Alcohol is very effective when hands are clean (i.e.. not soiled with blood, body fluids etc)
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Standard Precautions Second level Respiratory Precautions Third level Fourth Precautions level Contact Hand FifthWashing level PPE Exposure Risks Patient transport
Infection Control Precautions
Other Infection Control Click to edit Master text styles Factors

Patient and family education Laboratories / Specimens Mortuary Care Waste and Linen Handling Cleaning & Disinfection
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Precautions
Personal Protective Equipment (PPE)

N-95 Respirator Mask must be worn
Disposable Gloves
Click to edit Master text styles Goggles (protective glasses) Second level Third level Disposable or Reusable Gowns Fourth level Fifth level
Cap and shoe covers are optional

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Personal Protective Equipment for SARS

Click to edit Master text styles Second level Third level Fourth level Fifth level
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Personal Protective Equipment Click to edit(PPE) Master title style

N-95 Respirator Mask Click to edit Master text styles Gloves Second level Gown Third level Goggles Fourth level Fifth level Optional Cap Shoe covers
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Principles for Using PPE Click to edit Master title style Personal Protective Equipment (PPE) is used
to care workers by preventing protect Click tohealth edit Master text styles potentially infectious microorganisms from: Second level Third level Contaminating their hands, eyes and Fourth level clothing; Fifth level and Being transmitted to other patients and staff.
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Principles for Using PPE Click to edit Master title style

PPE reduces but does not completely eliminate Click to edit Master text styles the possibility of infection. Second level Third level PPE is only effective if used correctly. Fourth level Fifth level The use of PPE does not replace basic
hygiene measures such as hand washing hand washing is still essential to prevent transmission of infection. 62
N-95 Click to Respirator edit Master Masks title style

Click to edit Master text styles types of Different Second level N-95 Respirator Masks Third level Fourth level Fifth level
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Principles for Using the N-95 Respirator Click to edit Master Mask title style
Click edit Master text styles The N-95 to respirator mask is used to protect health care workers, other patients, staff or visitors by Second level preventing potentially infectious microorganisms Third level such as respiratory secretions from:
mouth. Being inhaled or ingested.
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Fourth level Fifth level their face including the nose and Contaminating
N-95 Respirator Mask Click to edit Master title style

Click to edit Master text styles For respiratory Second level protection wear Third level an N-95 Fourth level respirator mask Fifth level during all patient contact
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Proper use of N-95 Respirator Click to edit Master title style Mask
DO Click NOT to edit touch Master the front text styles of the mask once mask has been fitted the Second level Third level Wear only one N-95 mask no need for Fourth level additional respiratory protection Fifth level
REMOVE the N-95 respirator mask before leaving the isolation unit / area
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WHY an N-95 Respirator Mask? Click to edit Master title style

Click to edit Master text styles N-95 masks offer a Second respirator level higher Third level level of filtration for Fourth level respiratory secretions than a Fifth level surgical mask
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HOW to use an N-95 Respirator Click to editMask Master title style

Use for single shift unless excess moisture necessitates Click to edit Master text styles replacement during each shift or it has contaminated by touching or soiling become Second level
Label with the wearers name Third level Fourth level Dispose of with medical waste Fifth level
NB: You must fit the mask securely over both your nose and mouth 68
HOW to use an N-95 Respirator Click to editMask Master title style

Always correct Click to use editthe Master textsized stylesmask. Second level The incorrect size will not fit properly and Third level will fail the fit test. Fourth level Fifth level NB: You must fit the mask securely over both your nose and mouth so size is important.
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N-95 Respirator Mask Click to edit Master title style

This is to only one Click edit Master text styles example (brand) of an Second level N95 respirator mask.
Third level Fourth level Other types of N95 masks must be fitted Fifth level
according to the manufacturers instructions
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N-95 Respirator Masks Click to edit Master title style - Fitting Instructions
Step 1 Click to edit Master text styles Cup the respirator your Second level in hand with the nosepiece Third level at your fingertips Fourth level allowing the Fifth level headbands to hang freely below your hand.
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Click Step 2 to edit Master text styles Second level Position the Third level respirator under your chinlevel with the Fourth nosepiece up. Fifth level
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Step 3 Pull the top strap Click to edit Master text styles over your head Second level resting it high at the Third top backlevel of your head. Pulllevel the Fourth bottom strap over Fifth level your head and position it around the neck below the ears.
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N-95 Respirator Masks Fitting Instructions Click to edit Master title style Step 4
Place the fingertips of both hands at the ofMaster the Click totop edit text metal nosepiece. Mould the Second level nosepiece to the shape of your nose by pushing Third level inward while moving your fingertips down both sides Fourth level of the Fifth level nosepiece. Pinching the nosepiece using one hand may result in less effective respirator performance.
styles
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Step 5.1
N-95 Respirator Masks - Fitting Instructions Click to edit Master title style
The seal of the respirator the Click toshould edit Master on face be fit- text styles Second level checked prior to wearing in work area. the Third level
Fourth level Cover the front of the Fifth level respirator with both
hands, being careful not to disturb the position of respirator.
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N-95 Respirator Masks - Fitting Instructions Click to edit Master title style
Step 5.2 Positive Fit Test
Exhale sharply. A Master positive Click to edit pressure should be felt Second level inside the respirator. If Third level any leakage is detected, adjust the position Fourth level of the respirator and/or tension Fifth level of straps. Retest the seal. Repeat the steps until the respirator is sealed properly.
text styles
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N-95 Respirator Masks Click edit Master title style - to Fitting Instructions
Step 5.3 Negative Fit Test Click to edit Inhale deeply. If Master there is text styles no negative leakage, Second the level pressure make the Thirdwill level mask cling to your face. Fourth level A poor seal will result in Fifthloss level prompt of negative
pressure in the mask due to air entering through gaps in the seal.
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When to change your N-95 ClickRespirator to edit Master title style Mask?
If you the front of the mask Click to touch edit Master text styles
Second level Third level If it is grossly contaminated Fourth level Fifth level
If it becomes wet
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Principles for Using Goggles, Gowns, Click to edit Master title style Gloves, Caps and Overshoes
Click to edit Master text styles Goggles, gowns, gloves, caps and overshoes are Second level used to protect health care workers, by preventing Third level potentially infectious microorganisms from : Fourth level Fifth level their eyes, clothing, hands, hair and Contaminating
shoes and Being transmitted to other patients and staff.
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Goggles Click to edit Master title style

Assign one pair to each worker at the beginning Click to edit Master of a shift text styles Second level Third goggles level in room with SARS patients Wear Fourth level level Fifth Leave in the container in the anteroom at the end of the shift to be cleaned and disinfected
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Goggles Click to edit Master title style

Click to edit Master text styles Second level You should use Third level goggles to cover Fourth level all of the eye area. Fifth level
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Long sleeved gowns must be worn when in direct contact Clickwith to edit the Master patient text styles Second level Wear gown at all times in patients room the Third level Gowns must be removed Fourth level before leaving the patients room Fifth orlevel dedicated anteroom Remove used gowns as soon as possible particularly when grossly contaminated
Gowns
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Gowns A new Gown be worn for everystyle patient Click to should edit Master title
contact
Click to edit MasterReusable text styles Gowns Disposable Gowns If necessary, gowns may be Second level reused during one shift for Third level for Use a new gown the same patient, e.g. when each patientlevel contact. short of supplies. Fourth Discard immediately if Fifth level Visibly contaminated.
Discard immediately if visibly contaminated.
Hang gown with outside facing in when not in use. Discard at the end of the shift.
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Gloves Click to edit Master title style

Before all patient contact Click to edit Master text styles
Second level Third level Before all cleaning Fourth level Before handling Fifth level
soiled linen & waste
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Gloves Click tocontact edit with Master title style Remove after
patients or lab specimens
Click to edit Master text styles Do not wear gloves outside Second level of the patients room / anteroom Third level Fourth level Do not re-use Fifth level gloves
Wash hands after removing your gloves
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Plastic disposable aprons must be worn there is atext likelihood whenever Click to edit Master styles of other PPE such as gowns becoming wet. Second level Third level They are worn to reduce the risk of Fourth level breakthrough and contamination of clothing Fifth level worn underneath the PPE. They must be disposed of after use.
Plastic Disposable Aprons Click to edit Master title style
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Plastic Disposable Aprons Click to edit Master title style Aprons must be worn when :
Performing patient care activities where soiling Click to edit Master text styles or increased moisture is likely; Second level Cleaning and disinfecting the patient environment. Third level Cleaning and disinfecting medical; other Fourth level patient care equipment. Fifth level Laundering used linen. Cleaning and disinfecting the cleaning equipment.
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Caps Click to edit Master title style

Caps are optional and worn to protect hair text styles Click to editthe Master from aerosols that may Second level occur from high risk Third level procedures such as intubation Fourth or level bronchoscopy
Fifth level
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Overshoes Click to edit Master title style

Overshoes are Click to editworn Master optional and to text styles Second level protect the health care worker Third levels shoes and feet from being Fourth level splashed by spills Fifth level such as blood or other body fluids or aerosols
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gowns, gloves (and hats, overshoes optional in high risk situations) for all patient contact & aprons Click when to edit Master text styles necessary
Key Points Click edit Master title style Wear N-95 to respirator mask, goggles, disposable
Second level Wash hands Third levelusing soap (preferably liquid) and water when leaving the anteroom Fourth level Fifth levelalcohol-based hand rub solution after Use an 70%
hand washing
Wash hands when leaving the unit
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Personal Protective Equipment for SARS

Click to edit Master text styles Second level Third level Fourth level Fifth level
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Patient Transport Click to edit Master title style

It is essential to avoid all unnecessary Click to edit Master text styles transport of isolated SARS patients to Second level control and prevent the potential spread of Thirdinfection. level SARS Fourth level Fifth level
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Patient Transport If the patient needs to be out of their room for an Click to edit Master title style essential procedure, e.g. X-Ray

Transport route must avoid Click to edit Master textpopulated styles areas. Second level Patient must wear an N-95 respirator mask (standard surgical masks can be used by patients if N-95 Third level respirator masks are not tolerated or are in insufficient supply)level and an isolation gown. Fourth Accompanying Fifth level staff must wear :
N-95 respirator mask Gloves Gown Goggles

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Patient Transport Click to edit Master title style Transport Ambulance
N-95 respirator mask, disposable gown, goggles, gloves Thirdand level Clean disinfect ambulance after transport Fourth level Standard cleaning and disinfecting or Fifth level
No dedicated ambulance needed Click edit (N-95 Master text styles Maskto patient respirator mask) Transporters wear personal protective equipment Second level
1:100 dilution of bleach; after 10 minute contact time, clean and disinfect using standard procedures. DO NOT use spray cleaners
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Patient, Family & Community Click to edit Master title style Education
Education forMaster the patient, their family and Click to edit text styles community the Second level is essential in the control and prevention of the SARS Virus. Third level Fourth level It is particularly essential for those persons Fifth level requiring hospital or home isolation to understand the necessary restrictions.
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Patient, Family & Community Click to edit Master title style Education
Explain: Click to edit Master text styles What SARS is (to date)
Second level Third level Why isolation is required. Fourth level Fifth level Precautions required including PPE
Hand washing procedures

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Patient and Family Education Click to edit Master title style

Teach the patient and family members:
Click to edit Master text styles about the SARS illness Second level and the reason for the precautions being used Third level Fourth level Teach the patient and visiting family members: Fifth level

how to perform hand hygiene how to wear an N-95 respirator mask, gown, gloves and goggles (if available)
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Patient and Family Education Click to edit Master title style

Explain to the patient and family why Click to edit Master text styles disposable equipment is being used Second level such as: Third level Fourth level Eating utensils Fifth level Medical equipment Patient gowns
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Laboratories Click to edit Master title style

Laboratory staff must ensure that their practices Click to edit Master text styles are meticulous. Second level Third level Fourth level Fifth level
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Click to edit Master title style Laboratories

Click to edit Master text styles Second level Advance planning in each Third level laboratory is essential to designated Fourth level ensure that specimen handling, Fifth level transportation and storage is managed according to the guidelines.
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Bio Safety for SARS in Click toLaboratories edit Master title style
The following activities may be performed in biosafety Click to edit facilities Master text level 2 (BSL-2) withstyles appropriate work practices Second level Routine tests Third diagnostic level Manipulations Fourth level involving known inactivated viru and/or incomplete, non-infectious portions of the Fifth level viral genome Routine examination of mycotic and bacterial cultures Final packing of specimens for transport
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Precautions for BSL-2 labs
Click to edit Master text styles biological safety cabinet for any procedure that may generate aerosols Second level
PPE be worn: toThird level
disposable gloves
Fourth level solid-front or wrap-around gowns with cuffed sleeves Fifth level eye protection
surgical mask, or full-face shield, according to the risk of aerosols and exposure
When working at a biological safety cabinet, a full face shield is not necessary.
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Precautions for BSL-2 labs
Click to edit Master text styles Use sealed centrifuge cups unload in a safety cabinet Second level Decontaminate work surfaces and equipment Third level Biological waste should be treated as outlined in the WHO Laboratory Biosafety Manual 2nd Edition (Revised), 2003 Fourth level Fifth level
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BSL-3 facilities & BSL-3 work practices are required Click to edit Master text styles for:
Viral Second level cell culture of the etiologic agent Manipulations Third level involving growth or concentration of the agent. etiologic Fourth level When a procedure Fifth level or process cannot be conducted within a
biological safety cabinet, then appropriate combinations of personal protective equipment (e.g., respirators, face shields) and physical containment devices (e.g., centrifuge safety cups or sealed rotors) must be used.
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Specimen Collection Click to edit Master title style

Wear full PPE Click to edit Master text styles Write clinical details on the request form Second level Samples should be collected by clinical staff Third level Label clinical samples clearly Fourththe level Change PPE between patients Fifth level Discard all disposable materials in a biohazard bag
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Storage of Specimens Click to edit Master title style

Respiratory samples and frozen tissues: Click to edit Master text styles o store at 70 C Second level Third level Serum: Fourth level o store at 4 - 8 C for 24-48 hours Fifth level or
at -20oC for longer periods

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Patient Specimens Click to edit Master title style

Treat all patient Click to edit Master text styles specimens as Second level highly infectious Third level Do not contaminate outside of container
Fourth level Fifth level Use leak

proof containers for collection
Transport specimens in leak-proof outer containers e.g. a sealed plastic bag

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Mortuary Precautions Click to edit Master title style

Health care workers must wear full PPE:
(N-95 respirator mask, Goggles, Gown, Gloves) Click to edit Master text styles
Second level Health Care Workers must: Third level Prepare the body Fourth level Place in a body-bag or leak-resistant bag Fifth level or Place in plastic sheeting, wrap the body and tape/seal with waterproof adhesive tape
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Mortuary Precautions tobe edit Master title (3 style The Click body must placed in cold storage C :
+/- 2C ) as soon as possible after the body is Click to edit Master styles prepared and wrapped intext a bag or plastic sheeting.
Second level The need for a post mortem must be discussed Third level with the designated Fourth level national laboratory as there are potential infection risks for personnel during a Fifth level
post mortem. Post mortems must be performed wearing full PPE
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Mortuary Care Click to deference edit Master titletostyle Although all due must be given local
cultural and religious customs associated with the death of a to member of the community, Click edit Master text stylesthe following must be considered Second level to minimize the potential risk of spread of the SARS Virus. Third level The body must not be embalmed, to reduce Fourth level exposure risk. Fifth The need for cremation with minimal delay. level The delaying of a wake to celebrate the life of the individual until all close contacts and possible secondary contacts are cleared.
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Linen & Laundry Waste Management Click to edit Master title style
Health care and laundry workers must the Master importance ofstyles handling linen understand Click to edit text correctly to prevent the spread of potentially infectious Second level microorganisms
Third level Linen can be washed using routine laundry Fourth level practices. Fifth level
The health care facility should follow routine waste management practices but all waste must be incinerated.
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All contaminated or soiled linen is potentially Click to edit Master infectious therefore:
Linen
text styles
Second level Wear full PPE when handling Third level linen. Fourth level Fifth level Separate grossly contaminated
linen from non- contaminated linen in the patients room for ease of handling in the laundry.
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Laundry Click to edit Master title style Place in color-coded bags and double bag for
transport. Click to edit Master text styles Do not sort linen in the laundry to avoid the creation oflevel aerosols. Second Staff handling Third level linen should wear full PPE as per standard procedures for SARS. Fourth level Use routine detergents.
Fifth level
Bleach may be added if desired, and compatible with the detergent being used.
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Waste Click to edit Master title style

Wear full PPE when handling waste. Click to edit Master text styles Second level Clinical waste: all items from treatment Third level areas Fourth level Soiled surgical dressings Fifth level Swabs
Masks Gowns Other contaminated waste
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Waste Sharps Containers. Click to edit Master title style
Click to edit Master text styles Collect waste in designated color-coded plastic Second level bags for incineration. Third level Fourth level Double bag for transport. Fifth level Contact the local authorities for assistance if the health care facility does not have incineration facilities.
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Disposal containers should be puncture-resistant and leak- proof.
Sharps Disposal Click to edit Master title style
Click to edit Master text styles Second level Do not overfill container Third level Do not reach into Fourth level container Dispose of used sharps Fifth level
into the sharps container
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Cleaning & Disinfecting the Hospital Click to edit Master title style Environment and Equipment
Cleaning is usually sufficient for prevention and control Click to Master text styles infection the use of edit infection, but for SARS a disinfectant of Second level following cleaning is recommended Third level to clean thoroughly before It is essential the environment or equipment. disinfecting Fourth level Cleaning and disinfection must be carried out at least Fifth level daily and particularly when gross contamination occurs. In some instances it may be necessary to disinfect to render the item safe to handle.
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Click to edit Master text styles Cleaning and disinfecting patient Second level rooms and equipment is one of the best ways Third level to reduce transmission of infection Fourth level Fifth level
Wear full PPE when cleaning and disinfecting
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To communicate infection risk, use signs.
Click to edit Master text styles eg. SARS Isolation Second level Third patients level & staff by: Protect Fourth level and disinfecting - Cleaning Fifth level
equipment. - Cleaning and disinfecting the room and anteroom.
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Cleaning & Disinfecting the Hospital Environment and Equipment Click to edit Master title style
Click to edit Master text styles The immediate area around patients
must be
heavily contaminated. considered Second level Third level Bedside table, bed stand, and accessible areas of bed Fourth level must be cleaned with detergent and floors warm water at least daily (preferably twice a and Fifth level
day).
In addition, disinfect all surfaces after cleaning.

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Contain and dispose of infectious materials in containers : waste Click to edit Master text styles Put waste containers near entrance / exit to Second patientlevel room.
Third level Provide patient equipment when Fourth dedicated level possible. Fifth level
Clean and disinfect patient care equipment immediately after use depending on the type of equipment.
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Use standard procedures and agents Click to edit Master text styles for cleaning And disinfecting environmental surfaces and Second level patient care equipment.
Third level Fourth level and warm water, rinse in hot Use detergent water Fifth and level dry.
Use disinfectant afterwards.
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When areas and inanimate objects are grossly Click to edit Master text styles contaminated use: Second level hypochlorite (bleach) solution 1:100 sodium to disinfect Third level (before cleaning) it will reduce the viral load and the potential Fourth level to spread. for infection Fifth level Then use the standard cleaning and disinfecting procedures mentioned previously.
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All reusable patient items such as basins and bedpans Click toshould edit Master be: text styles
Second level Cleaned and disinfected before being used on another Third level patient Fourth level Taken to the dirty utility room for cleaning Fifth level
Staff should wear full PPE when handling contaminated equipment.
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DO NOT spray clean the room / area.
Click to edit Master text styles Why? Second level Because it: Third level Spreads droplets Fourth level Fifth level aerosols Spreads
Is not effective as a surface disinfectant

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Click to edit Master title style

Overview Click to edit Master title style

Background Click to edit Master title style

Chronology Click to edit Master title style

Chronology Click to edit Master title style

Chronology Click to edit Master title style

15 March The disease spread to outside Asia (Canada, Germany)

Chronology Click to edit Master title style WHO initiates :

Chronology Click to edit Master title style

Click toEpidemiology edit Master title style

Click toEpidemiology edit Master title style

Click toEpidemiology edit Master title style

Cough-inducing procedures (sputum induction, administration of nebulised medications, suctioning)

Click toEpidemiology edit Master title style

Fourth level Fifth level Organism survival in environment

Click to edit Master A person with a history of:text styles

Case Definitions b) Seroconversion by ELISA or IFAtitle style Click to edit Master

Contacts Click to edit Master title style

Clinical picture in SARS patients

Clinical Picture Onset / Presentation Click to edit Master title style

~ 90% begin to recover from day 6 or 7

Clinical Picture Click to edit Master title style Onset / Presentation

Clinical Picture Management

Click to edit Master title style SUPPORTIVE TREATMENT

Clinical Picture Management

Click to edit Master title style

Gastroscopy Any procedure / intervention that may release respiratory secretions

Clinical Management Click toPicture edit Master title style

Infection Control Precautions Click to edit Master title style

Patient Management Click to edit Master title style

SARS : Infection Control Goals Click to edit Master title style

Components of SARS Isolation Click to edit Master title style

General Principles of isolation unit

Click to edit Master title style A

General Principles of Isolation Unit

Click to edit Master title style

GENERAL ACCESS AREA

Administrative Controls Click to edit Master title style

Administrative Controls Click to edit Master title style

Supply acquisition and distribution Surveillance of Health Care Workers (HCWs)

Clinical Surveillance of Staff Click to edit Master title style

Organization of SARS Isolation Area

Click to edit Master title style

General Principles of Isolation Unit

Click to edit Master title style

GENERAL ACCESS AREA

Infection Control Click to edit Master title style

Infection Control Precautions Click to edit forMaster SARS title style

Exposure Risks Click to edit Master title style

Click to edit Master title style

Principles of Hand Washing Click to edit Master title style

Fifth level After using bathroom

Handwashing How? Click to edit Master title style

Click to edit Master title style Step 2

Click to edit Master title style Step 6

Handwashing Tips Click to edit Master title style

Dry hands thoroughly.

Handwashing Tips Click to edit Master title style

Click to edit Master title style

Handwashing in Difficult Situations

Handwashing in Difficult Situations

Click to edit Master title style

Infection Control Precautions