Intubation of SARS patients: infection and perspectives of healthcare workers

Abstract

Purpose:The outbreak of severe acute respiratory syndrome (SARS) in 2003 presented major challenges to the safety of anesthesiologists and other healthcare workers (HCWs). This study determined the incidence of SARS transmission to HCWs who intubated patients and analyzed the concerns of HCWs regarding personal and patient safety. Methods: Healthcare workers who performed tracheal intubation in 10 Toronto hospitals were identified using the Ontario Public Health database. A questionnaire was used to collect information from the HCWs. To determine if the patterns of personal protection or concerns changed over time, data were analyzed according to whether the intubation occurred during SARS 1 (February 23 to April 21) or SARS 2 (April 22 to July 1). Results: Thirty-three HCWs who performed 39 intubations on 35 SARS patients were interviewed. Three of 23 HCWs (13%) acquired SARS during SARS 1 whereas none (0/10) acquired SARS during SARS 2. Personal protection increased from SARS 1 to SARS 2 and HCWs' concerns changed over time. During SARS 1, concerns focused on the need for personal protective equipment whereas during SARS 2, concerns focused on the need for strict training and patient care protocols. HCWs perceived that their experiences were ineffectively integrated into risk management protocols. Conclusions: Protection guidelines failed to completely prevent the transmission of SARS to HCWs. Nine percent of the interviewed HCWs who intubated patients contracted SARS. A Risk Analysis Framework is presented to facilitate the rapid integration of HCWs' experiences into practice guidelines. Objectif : L'éclosion du syndrome respiratoire aigu sévère (SRAS) en 2003 a présenté des défis importants à la sécurité des anesthésiologistes et des autres travailleurs de la santé (TS). L'étude a déterminé l'incidence de transmission du SRAS aux TS qui ont intubé des patients et a analysé les préoccupations des TS concernant la sécurité du personnel et des patients. Méthode : Nous avons repéré les TS qui ont réalisé des intubations dans 10 hôpitaux de Toronto grâce à la base de données sur la santé publique de l'Ontario. Un questionnaire a été utilisé pour recueillir les informations des TS. Pour vérifier si les modèles de protection individuelle et les préoccupations avaient changé avec le temps, l'analyse a tenu compte des intubations réalisées pendant les phases I ou II du SRAS

Practical lessons from the first outbreaks: Clinical presentation, obstacles, and management strategies for severe pandemic (pH1N1) 2009 influenza pneumonitis

“…This led to early, elective intubation of these patients in the isolation rooms of the ICUs. Although considered, there was no formal plan to have anesthesiologists intubate these patients as there had been with the severe acute respiratory syndrome epidemic in Toronto, Canada (3).…”

Pandemic preparedness and protective clothing: priorities of health care workers in a Canadian teaching hospital

“…During the severe acute respiratory syndrome (SARS) crisis of 2003, 9% of HCWs in Toronto who were involved with the intubation of SARS patients contracted the disease. 2 At the time, the Ontario Ministry of Health and Long-Term Care and the US Center for Disease Control and Prevention (CDC) developed protective clothing recommendations for HCWs who were performing aerosol-generating procedures in patients with SARS. At a minimum, they stipulated the use of personal protective equipment (PPE) combined with an N95 mask or the use of a personal protective clothing system that combined higher levels of respiratory protection, such as a powered air-purifying respirator (PAPR).…”

What have we really learned from SARS?

“…Many of these problems are well described in the article by Caputo et al in this issue. 1 Team training in the local hospital environment is critical to success. It is one thing to practice donning the PPE at one's leisure.…”

“…présentent les événements de cette période et donnent aussi l'occasion de réévaluer ce que nous avons appris de cette crise. 1 On Caputo et coll. ont pu documenter l'impression d'absence de dialogue et d'informations entre les déci-deurs et le personnel de soins de première ligne pendant le SRAS.…”

“…Nombre de ces problèmes sont bien décrits dans l'article de Caputo et coll. 1 Une formation en équipe dans le cadre de l'hôpital local est indispensable au succès. C'est une chose de revêtir l'EPI pour s'exercer.…”