Severe Acute Respiratory Syndrome (SARS)

A number of countries have now reported cases of a new disease termed severe acute respiratory syndrome (SARS) which first emerged in Asia and has now disseminated to other regions.

The etiology of this illness is suspected to be a new strain of the Coronavirus – a virus that causes severe common cold-like symptoms. The virus is named for the crown of spikes emanating from its principal spherical body structure.

Early and general symptoms typically manifest as flu-like such as fever, headache, sore throat, dry cough and body aches. Symptoms may deteriorate in some individuals to pneumonia, and occasionally acute respiratory distress and death (http://www.cdc.gov/ncidod/sars/clinicians.htm).

SARS is believed to be transmitted by close contact of a healthy individual with an infected person whether it be a family member, hospital patient or healthcare worker. Greater global linkages through air travel may also assist in increasing the frequency of dissemination, resulting in restricted travel warnings.

Dr Ling Moi Lin, Director, Quality Management at Singapore General Hospital, says that the Ministry of Health has already taken extensive steps to isolate anyone who is really ill with SARS, or quarantine those who have come into contact with a SARS patient.

'People can't get SARS out of nowhere. It is spread by droplets, and you have to be within a 1-metre zone of a SARS patient who sneezes or coughs. There is little chance of getting SARS in a common environment which is not crowded.

SARS, which is a strain of the cold-causing Coronavirus, is currently not believed to be airborne, meaning that it cannot float through the air. Instead, it can only be passed by droplet spread, direct contact with an infected person or with an object he has touched’. (http://www.singhealth.com.sg/News/news_load.asp?AnnounceID=77).

The seriousness of the disease and its rate of spread have resulted in global collaboration to arrest its dispersion, develop effective quarantine, isolate and characterize the offending pathogen, treat patients and even find a vaccine.

In the healthcare setting, healthcare workers should adhere to infection control recommendations revised accordingly to negotiate SARS and other interim exposure management protocols.

Precautionary practices for healthcare workers always involve universal precautions such as the wearing of protective apparel (gloves, masks, gowns, etc) and hand hygiene to minimize the risk of infection and cross contamination.

The Barrier Protection of Medical Gloves in the Healthcare Setting

Gloves play the crucial bilateral task of protecting the healthcare worker and patient of contamination from bodily fluids. Ensure that latex and latex-free examination or surgical gloves are medical-grade quality and trusted brands. Examination gloves should meet a pinhole defect level of 2.5% or less (defined as AQL 2.5) and be manufactured in facilities that comply with Good Manufacturing Practice for medical devices. Surgical gloves should meet AQLs of 1.5 or less and be sterilized, preferably by gamma irradiation.

To further minimize risk, gloves should be used once only and discarded accordingly immediately after patient examination. New gloves should always be worn for each patient. Never bring gloved hands to the proximity of the face. Never handle personal items such as pens, etc, with gloves that have been in contact with patients.

The Role of Masks

Although some masks will provide effective filtration of the offending pathogen, contrary to the hospital setting they are unlikely to be required in the home setting. Healthcare workers are constantly being exposed to infectious agents - very different to the outside community’s exposure - hence masks form a critical part of the infection control regime.

The World Health Organization has approved masks which meet the NIOSH 42 CFR84 of N-95 for masks for use by medical staff, as well as patients with confirmed or suspected SARS. Simplified, this means that the mask filters the microorganism at minimum 95% efficiency. The other factor to consider is the particulate exclusion threshold. Most quality masks will exclude small particles of about 0.1 micron in size. Please check with your local mask supplier or visit the websites below for more information on prescribed masks for SARS.

The Crucial Role of Hand Hygiene

Another vital step in the precautionary practice sequence is hand washing. Sometimes overlooked or performed inadequately or ineffectually, hand washing is a proven and effective deterrent to microorganism transmission and the spread of SARS.

Correct hand washing is fundamental to infection control and in killing viruses and other infectious agents. Proficient hand washing involves washing every part of the hand and between finger webs. Use a hospital prescribed soap and disinfectant and ensure that hand jewelry is removed or penetrated by the washing agent.

Links to further information on Effective Infection Control & SARS:

http://www.cdc.gov/ncidod/sars/

http://www.who.int/csr/sars/en/

http://www.singhealth.com.sg/Start/home.asp

http://www.aica.org.au/

http://www.health.gov.au/sars.htm

Ansell can assist you to upgrade your hospital's infection control procedures.

Click here to see the Do's and Don'ts for protection against Sever Acute Respiratory Syndrome (SARS)