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 Biological Controls Inc. - Information on SARS  

This is a compilation of information culled from numerous Web sites relating to SARS.  The information presented only relates to those issues and references that directly involve the products manufactured by Biological Controls and how our products can be of benefit in a program of risk reduction based upon those recommendations.

It is highly recommended that anyone requiring more detailed information about SARS contact any of the organizations or government agencies that are referenced in this article, such as CDC, World Health Organization (WHO), State and local health agencies, and news agencies such as BBC, UPI, Reuters, CNN, etc. 

THE DISEASE

What is SARS?

Severe acute respiratory syndrome (SARS) is a viral respiratory illness that was first reported in Asia in February 2003.  In early March, the World Health Organization (WHO) issued a global alert about SARS.  Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia.  By late July, however, no new cases were being reported and the illness was considered contained.  According to WHO, 8437 people worldwide became sick with SARS during this outbreak;  of these, 813 died.  For more information check the WHO SARS Web site or visit other pages on CDC's SARS Web site.

     What causes the infection?

The scientists, from the US Centers for Disease Control, believe it is Corona virus (SARS-CoV) - a family of viruses well known as a cause of the common cold.

The WHO (World Health Organization)  believes this is a new strain which has mutated to become more dangerous to humans.

 How is SARS spread?

The primary way that SARS appears to spread is by close person-to-person contact.  The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes.  Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to 3 feet) through the air and deposited on the mucous membranes of the mouth, nose or eyes of persons who are nearby.  The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eye(s).  In addition, it is possible that SARS-CoV might be spread more broadly through the air (airborne spread) or by other ways that are not now known.

If there is another outbreak of SARS, how can I protect myself?

If SARS were to re-emerge, there are some common-sense precautions that you can take that apply to many infectious diseases.  The most important is frequent hand washing with soap and water or use of alcohol-based hand rubs (see Guideline for Hand Hygiene in Health-Care Settings).  You also should avoid touching your eyes, nose, and mouth with unclean hands and encourage people around you to cover their nose and mouth with a tissue when coughing sneezing.  In hospitals, staff have been instructed to use "barrier nursing" to try to prevent more infections. 

SARS and Isolation

During the February and July, 2003 SARS outbreak, patients in the United States were isolated until they were no longer infectious.  This practice allowed patients to receive appropriate care, and it helped contain the spread of the illness.  Those who were more severely ill were cared for in hospitals.  Those whose illness was mild were cared for at home.  Individuals being cared for at home were asked to avoid contact with other people and to remain at home until 10 days after the resolution of fever, provided respiratory symptoms were absent or improving. (For more information on SARS infection precautions, visit the CDC website). 

EXECUTIVE ORDER 13295:  REVISED LIST OF QUARANTINABLE COMMUNICABLE DISEASES

By the authority invested in me as President by the Constitution and the laws of the United States of America, including section 361 (b) of the Public Health Service Act (42 U.S.C. 264(b)), it is hereby ordered as follows: 

Section 1.  Based upon the recommendation of the Secretary of Health and Human Services (the 'Secretary'), in consultation with the Surgeon General, and for the purpose of specifying certain communicable diseases for regulations providing for the apprehension, detention, or condition release of individuals to prevent the introduction, transmission, transmission , or spread of suspected communicable diseases, the following communicable diseases are hereby specified pursuant to section 361 (b) of the Public Health Service Act: 

Severe Acute Respiratory Syndrome (SARS), which is a disease associated with fever an signs and symptoms of pneumonia or other respiratory illness, is transmitted from person to person predominantly by the aerosolized or droplet route, and if spread in the population, it would have severe public health consequences. 

Interim Domestic Infection Control precautions for Aerosol-Generating procedures on Patients with Severe Acute Respiratory Syndrome (SARS) 

Worldwide, several healthcare workers (HCWs) have been reported to develop severe acute respiratory syndrome (SARS) after caring for patients with SARS.  Multiple hospitals have reported cases among HCWs who were present during aerosol-generating procedures performed on patients with SARS, suggesting that aerosol-generating procedures may increase the risk of SARS transmission. 

Procedures capable of stimulating cough and promoting the generation of aerosols include:  administration of aerosolized medication treatment; diagnostic sputum induction;  bronchoscopy airway suctioning;  endotracheal intubation;  positive pressure ventilation via facemask (e.g.,BPAP, CPAP), during which air may be forced out around the facemask;  and high frequency oscillatory ventilation (HFOV).   CDC is recommending healthcare facilities to review their strategies to protect HCWs during these procedures, including the use of personal protective equipment and safe work practices, and to alert HCWs performing such procedures that there may be an increased risk for transmission of SARS. 

 Limit opportunities for exposure.

  • Limit the use of aerosol-generating procedures on SARS patients to those that are deemed medically necessary.  Use clinically appropriate sedation during intubation and bronchoscopy to minimize resistance and coughing during the procedure.

  • Limit the number of HCWs present in the room during an aerosol-generating procedure to those who are essential for patient care and support.

 Perform aerosol-generating procedures in an airborne isolation environment

  • If patient is in an airborne isolation room, perform the procedure in that environment.

  • If an airborne isolation room is not available, the procedure should be performed in a private room, away from other patients.  If possible, steps should be taken to increase air exchanges, create a negative pressure relative to the adjacent room or hallway, and avoid recirculation of the room air.  If recirculation of air from such rooms is unavoidable, the air should be passed through a HEPA filter before recirculation as recommended for Mycobacterium tuberculosis.  Air cleaning devices such as portable HEPA filtration units may be used to further reduce the concentration of contaminants in the air.  Doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized during the procedure.

For the inpatient setting:

If a suspect SARS patient is admitted to the hospital, infection control personnel should be notified immediately.  Infection control measures for inpatients (www.cdc.gov/ncidod/hip/isolat/isolat.htm) should include:

  • Airborne precautions (e.g., an isolation room with negative pressure relative to the surrounding area and use of an N-95 filtering disposable respirator for persons entering the room)

If airborne precautions cannot be fully implemented, patients should be placed in a private room, and all persons entering the room should wear N-95 respirators.  Where possible, a qualitative fit test should be conducted for N-95 respirators;  detailed information on fit testing can be accessed at http://www.osha.gov/SLTC/etools/respiratory/oshafiles/fittesting1/htmlIf N-95 respirators are not available for healthcare personnel, then surgical masks should be worn.  Regardless of the availability of facilities for airborne precautions, standard and contact precautions should be implemented for all suspected SARS patients. 

For the outpatient setting:

  • Persons seeking medical care for an acute respiratory infection should be asked about possible exposure to someone with SARS or recent travel to an area with SARS.  If SARS is suspected, provide and place a surgical mask over the patient's nose and mouth.  If masking the patient is not feasible, the patient should be asked to cover his/her mouth with a disposable tissue when coughing, talking or sneezing.  Separate the patient from others in the reception area as soon as possible, preferably in private room with negative pressure relative to the surrounding area.

 

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