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Hospital Infection Control Guidance

Care for patients with probable SARS

WHO advises strict adherence with the barrier nursing of patients with SARS using precautions for airborne, droplet and contact transmission. Triage nurses should rapidly divert persons presenting to their health care facility with flu-like symptoms to a separate assessment area to minimise transmission to others in the waiting room. Suspect cases should wear surgical masks until SARS is excluded.

Patients with probable SARS should be isolated and accommodated as follows in descending order of preference:

  1. negative pressure rooms with the door closed
  2. single rooms with their own bathroom facilities
  3. cohort placement in an area with an independent air supply and exhaust system.

Turning off air conditioning and opening windows for good ventilation is recommended if an independent air supply is unfeasible. Wherever possible, patients under investigation for SARS should be separated from those diagnosed with the syndrome.

Disposable equipment should be used wherever possible in the treatment and care of patients with SARS. If devises are to be reused, they should be sterilised in accordance with manufacturers’ instructions. Surfaces should be cleaned with broad spectrum (bactericidal, fungicidal, and virucidal) disinfectants of proven efficacy.

Patient movement should be avoided as much as possible. Patients being moved should wear a surgical mask to minimise dispersal of droplets. NIOSH standard masks (N95), often used to protect against other highly transmissible respiratory infections such as tuberculosis, are preferred if tolerated by the patient. All visitors, staff, students and volunteers should wear a N95 mask on entering the room of a patient with confirmed or suspected SARS. Surgical masks are a less effective alternative to N95 masks.

Handwashing is the most important hygiene measure in preventing the spread of infection. Gloves are not a substitute for handwashing. Hands should be washed before and after significant contact with any patient, after activities likely to cause contamination and after removing gloves. Alcohol-based skin disinfectants formulated for use without water may be used in certain limited circumstances. Health care workers are advised to wear gloves for all patient handling. Gloves should be changed between patients and after any contact with items likely to be contaminated with respiratory secretions (masks, oxygen tubing, nasal prongs, tissues). Gowns (waterproof aprons) and head covers should be worn during procedures and patient activities that are likely to generate splashes or sprays of respiratory secretions.

HCWs must wear protective eyewear or face-shields during procedures where there is potential for splashing, splattering or spraying of blood or other body substances.

HCWs are advised to wear masks whenever there is a possibility of splashing or splattering of blood or other body substances, or where airborne infection may occur. Particulate filter personal respiratory protection devises capable of filtering 0.3um particles (N95) should be worn at all times when attending patients with suspected or confirmed SARS.

Standard precautions should be applied when handling any clinical wastes. All waste should be handled with care to avoid injuries from concealed sharps (which may not have been placed in sharps containers). Gloves and protective clothing should be worn when handling clinical waste bags and containers. Where possible, manual handling of waste should be avoided. Clinical waste must be placed in appropriate leak-resistant biohazard bags or containers labelled and disposed of safely.

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