Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among healthcare workers

Abstract

The traffic control bundle consists of procedures designed to help prevent epidemic nosocomial infection. We retrospectively studied the serial infection control measures to determine factors most effective in preventing nosocomial infections of healthcare workers (HCWs) during the 2003 Taiwanese severe acute respiratory syndrome (SARS) epidemic. Fever screening stations, triage of fever patients, separating SARS patients from other patients, separation of entrances and passageways between patients and HCWs, and increasing hand-washing facilities all demonstrated a protective effect for HCWs (univariate analysis; P<0.05). By multiple logistic regression: (i) checkpoint alcohol dispensers for glove-on hand rubbing between zones of risk, and (ii) fever screening at the fever screen station outside the emergency department, were the significant methods effectively minimising nosocomial SARS infection of HCWs (P<0.05). The traffic control bundle should be implemented in future epidemics as a tool to achieve strict infection control measures.

From SARS in 2003 to H1N1 in 2009: lessons learned from Taiwan in preparation for the next pandemic

“…As the SARS epidemic subsided, the TCDC conducted an analysis of the protective efficacy of the Traffic Control Bundling protocols in preventing infection among HCWs. 23 A total of 51 hospitals that cared for SARS patients during the SARS epidemic were studied. Among them, 18 hospitals had HCWs infected by SARS; the remaining 33 hospitals had no cases of HCW-acquired nosocomial SARS infections.…”

“…PPE, personal protective equipment. (Adapted with permission from Yen et al 23 ) system. This model enables streamlined command and information flows through communications such as regular face-toface meetings, video conferences and telephone conferences during emergency events.…”

“…Outdoor fever screening stations successfully triaged fever patients and controlled the SARS epidemic in 2003. 23 However, as the severity of pandemic influenza 2009 H1N1 was only mild, activating fever screening stations outside of hospitals was not indicated. Instead, Taipei established 212 CICs citywide, each equipped with alcohol dispensers, rapid antigen test kits, and government-funded oseltamivir for those who screened positive or who fit the criteria for illness with 2009 pandemic H1N1.…”

Clinical management and infection control of SARS: Lessons learned

“…Always washed hands after returning home showed smaller reduction in risk Guangzhou Case-control study (91 vs 657) to identify risk factors for nosocomial transmission among HCWs Incidence of SARS among HCWs was significantly associated with performing tracheal intubations for SARS patients, OR 2.76, 95%CI, 1.16 to 6.53, p < 0.05 (Chen et al, 2009) Guangzhou Retrospectively studied the ventilation of wards and nosocomial transmission of SARS Among 4 types of isolation wards, when the ratios of the area of the ventilation windows to the volume of the room were 0, 0, 1:95, and 1:40, and the total time of hospitalization were 43, 168, 110, and 1272 h, the infection rates of the HCWs in the areas mentioned above were 73.2%, 32.1%, 27.5% and 1.7%, respectively (Jiang et al, 2003) HCWs, healthcare workers; OR, odd ratio; RR, relative risk; 95% CI, 95% confidence interval. (Yen et al, 2006) Taipei Retrospectively studied the serial infection control measures to determine factors most effective in preventing nosocomial infections of HCWs in Taiwan Checkpoint alcohol dispensers for glove-on hand rubbing between zones of risk, and fever screening at the fever screen station outside the emergency department were the significant methods effectively minimizing nosocomial SARS infection of HCWs (P < 0.05) (Yen et al, 2011) HCWs, healthcare workers; OR, odd ratio; 95% CI, 95% confidence interval.…”

“…In Taiwan, an integrated infection control approach was implemented at a SARS designated hospital where airborne infection isolation rooms were not available. Fever screening stations, triage of fever patients, separating SARS patients from other patients, separation of entrances and passageways between patients and healthcare workers, and increase of hand-washing facilities all demonstrated a protective effect for healthcare workers (Yen et al, 2011(Yen et al, , 2006.…”