1

Training KitsFor Severe Acute

Respiratory Syndrome (SARS)

Jan 2007Prepared by

Infectious Disease Control Training Centre, Hospital Authority Infection Control Branch, Centre for Health Protection,

Department of Health

2

Objectives By the end of this unit, you will be familiar with :

1. Signs & symptoms2. Case definition 3. Mode of transmission 4. Infection control precautions for

SARS5. HA infection control policy on SARS

Pandemic

3

1. Begin, Fever > 38oC

2. + / - chills OR other symptoms (headache, general feeling of discomfort, and body aches)

3. + / - Mild respiratory symptoms

4. + / - Diarrhea

5. After 2 to 7 days, may develop a dry, nonproductive cough that might be progress to hypoxia.

6. + / - Require mechanical ventilation

7. Develop pneumonia

Signs & Symptoms

4

Case Definition

5

Fever (>38oC)AND

One or more symptoms of lower respiratory tract illness (cough, difficulty breathing, shortness of breath)

AND

Radiographic evidence of lung infiltrates consistent with pneumonia or ARDS, OR autopsy findings consistent with the pathology of pneumonia or ARDS without an identifiable cause

ANDNo alternative diagnosis can fully explain the illness

Clinical Evidence

6

• PCR positive for SARS-Co V using a validated method

• Seroconversion by ELISA or IFA

• Virus isolation

Laboratory Evidence

7

Mode of Transmission- By respiratory

droplets- During coughing,

sneezing and talking

1 meter- Airborne transmission cannot be

completely ruled out.

8

Spreading infection through direct contact with

• Patient’s secretions eg. respiratory secretions

• Patient’s excreta and fomites• Contaminated surfaces e.g door knob,

keyboard, bedside tables• Contaminated equipments

9

Infection Control for SARS

10

Isolation Precautions (a two-level approach)

• Standard Precautions

• Respiratory hygiene and cough etiqutte

• Additional (Transmission-based) precautions which include, Droplet precautions and Contact precautions

• Airborne precautions - performing high risk procedures/activities

11

IsolationPrecautions

Patient Transport

Linen & laundry Waste Management

Decontamination

PPE

Hand hygiene

Patient placement

12

Standard precautions• Synthesize the major features of Universal

Precautions• Apply to all patients • Apply to blood • Apply to all body fluids, secretions, and

excretions except sweat and tear.• Applies to non-intact skin and mucus

membrane

13

• Cover the nose/mouth when coughing or sneezing

• Perform hand hygiene if contact respiratory secretions and contaminated objects

• Put on a surgical mask

Respiratory hygiene and cough etiquette

• Use tissue paper to contain respiratory secretions and dispose in the waste receptacle

14

Additional (Transmission based) Precautions

In addition to standard precautions, airborne, droplet and contact precautions should be applied.

• negative pressure isolation room if available• cohort confirmed cases in cubicles and

separate from each other > 1 metre• do not nurse confirmed cases with unconfirmed

cases in the same cubicle.• designated areas for gowning and degowning

15

• provide hand hygiene facilities• wear recommended PPE• eye protection should be worn when he/she is

within one metre to the patient.• apply further precautions for high risk

procedures.• easy access to shower facilities for staff

Additional (Transmission based) Precautions

16

Droplet Precautions

1 meter

Perform Hand Hygiene

17

When touching Infectious materialsecretions

Contact Precautions

Wear gowns when splashing is likely

Perform hand hygiene

18

Hand HygienePerform hand hygiene: • After touching blood, body fluid,

excretions, secretions, mucus membranes, non-intact skin, contaminated items and environment

• Before touching face • Before leaving wards and

hospital/clinics• After removal of gloves• Before and after patient contact• Use alcohol-based handrub when

hands are not visibly soiled

19

Hand Hygiene Technique:潔手技巧:

Backs of fingers to opposing palm with fingers interlocked兩手互握，互擦指背

Palm to palm掌心擦掌心

Right palm over left dorsum & vice versa掌心擦手背，兩手互

換

Palm to palm with fingers interlaced

掌心對掌心十指交錯，互擦指

罅

Right thumb clasped over left palm & vice versa

拇指在掌中互擦，兩手互換

Clasped fingers of right hand in left palm & vice

versa指尖擦掌心，兩手互換

Wrists are rubbed掌心擦手腕，兩手互

換

1

765

432

20

Personal Protective Equipment

21

PPE - Gloves1. When expose to blood, body fluids, secretions,

excretions, mucous membrane and non-intact skin, and contaminated items.

3. Perform hand hygiene immediately after glove removal.

2. Change gloves when heavily contaminated.

4. Disposable glove should not be reused.

http://hk.wrs.yahoo.com/;_ylt=AtMeawQxhsrVPRN1n.QXsae1ygt.;_ylu=X3oDMTA2bTQ0OXZjBHNlYwNzcg--/SIG=1h2bd0le5/EXP=1123312927/**http%3A%2F%2Fhk.search.yahoo.com%2Fimages%2Fview%3Fback%3Dhttp%253A%252F%252Fhk.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dgloves%2526ei%253DBIG5%26h%3D600%26w%3D800%26imgcurl%3Dscd.mm-c1.yimg.com%252Fimage%252F986444476%26imgurl%3Dwww.c2csafety.com%252Fimages01%252Fgloves_800x600.jpg%26size%3D108.6kB%26name%3Dgloves_800x600.jpg%26rcurl%3Dhttp%253A%252F%252Fwww.c2csafety.com%252Fc2c-MRK.html%26rurl%3Dhttp%253A%252F%252Fwww.c2csafety.com%252Fc2c-MRK.html%26p%3Dgloves%26ei%3DBIG5%26type%3Djpeg%26no%3D7%26tt%3D309%2C747

22

PPE - Gown1. When splashes or sprays of blood and

body fluids, secretions and excretions to skin and working clothes are likely.

2. When working clothes has substantial contact with patient, environmental surfaces or patient items.

3. Select an appropriate gown for the procedure and amount of fluid likely to be encountered.

4. Remove a soiled gown as promptly as possible and perform hand hygiene to avoid transfer of microorganisms to other patients or environments.

23

Surgical masks and eye protection: – When splashes or sprays of blood,

body fluids, secretions and excretions are likely.

N95 Respirator– Airborne isolation precautions

Change PPE promptly if heavily contaminated during the procedure

PPE – Respiratory & eye protection

24

PPE removal1. Designated de-gowning area is

preferred.2. Gowning down carefully.3. Avoid touching the external surface of

PPE.4. Perform hand hygiene immediately

after PPE removal and whenever contaminated.

5. PPE should not be worn / taken out of the workplace into non-clinical areas.

6. Disinfect reusable items and store properly to avoid recontamination.

7. Single used items should be properly disposed.

De-growing Area

25

HA policyRecommended Staff PPEs in HA Hospitals during

SARS Alert LevelAlert Level

Standard precautions for all patients # Transmission based precautions as indicated

Activity(based on risk assessment)

High risk patient areas* for caring suspected SARS

Other patient areas

Non-patient areas

Enter into isolation room(no patient contact)

N95 respirator/ surgical mask ** # ***

Close patient contact (< one metre) N95 respirator/ surgical mask **Eye protectionDisposable gown

# ***

Procedures with • aerosol generating potential or,• extensive dispersal of droplets or,• prolonged close contact of dependent patients (for high risk areas only)

N95 respiratorDisposable gownEye protectionLatex glovesCap

Surgical mask/ N95 respirator #Disposable gownEye protectionLatex gloves

***

Other activities, no anticipated patient contact

Surgical mask *** ***

26

Standard precautions for all patients # Transmission based precautions as indicated

Activity(based on risk assessment)

High risk patient areas* for caring suspected or

confirmed SARS

Other patient areas

Non-patient areas

Enter into isolation room(no patient contact)

N95 respirator/ Surgical mask **

Surgical mask #

Surgical mask #

Procedures with• aerosol generating potential or,• extensive dispersal of droplets or,• prolonged close contact of

dependent patient (for high risk areas only)

N95 respiratorDisposable gownEye protectionLatex glovesCap

Surgical mask/ N95Respirator #Disposable gownEye protectionLatex gloves

***

Surgical mask

***

Close patient contact (

27

Decontamination – Patient Care Items1. Dedicated non-critical patient care items for

suspected and confirmed cases.

2. Clean and disinfect reusable equipment before used on other patients.- Use 1,000 ppm of hypochlorite solution (i.e. add

1 part of 5.25% hypochlorite in 49 parts of water) to disinfect non-critical items

- Use 70% alcohol on metallic surfaces

3. Reusable respiratory equipment should undergo high level disinfection before reused on other patients.

28

Decontamination - Environmental ControlDisinfect isolation and procedure rooms after use by a high risk patient

• Set up regular schedule of cleaning and disinfection of the environment and additional session for frequently touched surfaces.

• Use 1,000 ppm of hypochlorite solution (i.e. add 1 part of 5.25% hypochlorite in 49 parts of water) to disinfect facilities contaminated with body fluid, secretions and excretions.

29

If blood spills occur:- involve a small amount of blood,

• for non-metallic items (use one part of hypochlorite solution add in 49 parts of water)

• for metallic items (use 70% alcohol)

- involve large amount of blood,• should be removed by disposable material

soaked with one part of hypochlorite solution add in 4 parts of water before further cleaning and disinfection.

Decontamination - Environmental Control

30

Linen and laundry management1. Proper handling of soiled linen:

– Avoid sorting in patient care areas– Minimum agitation and shaking– Well pack soiled linen to prevent leakage– Wear appropriate PPE when handling soiled linen– Clean linen should be transported and stored

separately to prevent recontamination

2. Follow hospital policy

31

Waste Management1. All waste generated from isolation

room/ area housing patient(s) with SARS should be treated as clinical waste.

2. Wear appropriate PPE when handling clinical waste.

3. Waste should be placed in the bag without contaminating the outside surface of the bag.

4. Biohazard labeling

32

Screen clients with febrile respiratory illness and separate from immunocompromisedpatients

33

Using nebulizer that generate

aerosols is not recommended.

34

Hand-held medication small volume nebulizersis not recommended

35

SPACER

36

Staff Early Sickness Alert System (SESAS)

37© 2003 Hospital Authority

HA Institute of Health Care Institute of Advanced Nursing Studies

Revised in Dec 06 by Infectious Disease Control Training Centre,

Hospital Authority Infection Control Branch, Centre for Health Protection,

Department of Health

Spreading infection through direct contact withStandard precautionsAdditional (Transmission based) Precautions�Additional (Transmission based) Precautions�Hand HygieneHand Hygiene Technique:�潔手技巧: PPE - GlovesPPE - GownPPE – Respiratory & eye protectionPPE removalHA policy�Recommended Staff PPEs in HA Hospitals during �SARS Alert LevelDecontamination – Patient Care ItemsDecontamination - Environmental ControlLinen and laundry managementWaste Management