Using an integrated infection control strategy during outbreak control to minimize nosocomial infection of severe acute respiratory syndrome among healthcare workers

Abstract

Healthcare workers (HCWs) are at risk of acquiring severe acute respiratory syndrome (SARS) while caring for SARS patients. Personal protective equipment and negative pressure isolation rooms (NPIRs) have not been completely successful in protecting HCWs. We introduced an innovative, integrated infection control strategy involving triaging patients using barriers, zones of risk, and extensive installation of alcohol dispensers for glove-on hand rubbing. This integrated infection control approach was implemented at a SARS designated hospital ('study hospital') where NPIRs were not available. The number of HCWs who contracted SARS in the study hospital was compared with the number of HCWs who contracted SARS in 86 Taiwan hospitals that did not use the integrated infection control strategy. Two HCWs contracted SARS in the study hospital (0.03 cases/bed) compared with 93 HCWs in the other hospitals (0.13 cases/bed) during the same three-week period. Our strategy appeared to be effective in reducing the incidence of HCWs contracting SARS. The advantages included rapid implementation without NPIRs, flexibility to transfer patients, and re-inforcement for HCWs to comply with infection control procedures, especially handwashing. The efficacy and low cost are major advantages, especially in countries with large populations at risk and fewer economic resources.

Emerging infectious diseases: Focus on infection control issues for novel coronaviruses (Severe Acute Respiratory Syndrome-CoV and Middle East Respiratory Syndrome-CoV), hemorrhagic fever viruses (Lassa and Ebola), and highly pathogenic avian influenza viruses, A(H5N1) and A(H7N9)

“…75 The infection control lessons learned from SARS have been reviewed. [76][77][78][79][80] The risk of developing SARS was 12.6 times higher for those that did not wear a mask during patient care activities. 76 Other risk factors for acquisition of infection by health care providers included contact with respiratory tract secretions; exposure to body fluids of health care providers' eyes and mucous membranes; inconsistent use of goggles, gowns, and caps; and performing aerosol-generating procedures (intubation, manual ventilation, chest physiotherapy, and suctioning).…”

Health care workers' views about respirator use and features that should be included in the next generation of respirators

“…Case control studies during the 2003 SARS crisis suggested that N95 respirators may be somewhat more protective than surgical masks against the SARS coronavirus. [31][32][33][34][35] More recently, a direct comparison of N95s to surgical masks found that surgical masks were not inferior to N95 respirators at protecting HCWs against influenza. 36 Unfortunately, this trial was terminated prematurely, limiting its power to detect differences in effectiveness, because of regulations pertaining to the 2009 H1N1 influenza pandemic.…”

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.…”