| 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:
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/html. If
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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