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Cluster of Cases of Severe Acute Respiratory Syndrome Among Toronto Healthcare Workers After Implementation of Infection Control Precautions: A Case Series

Published online by Cambridge University Press:  21 June 2016

Marianna Ofner-Agostini ,
Denise Gravel ,
L. Clifford McDonald ,
Marcus Lem ,
Shelley Sarwal ,
Allison McGeer ,
Karen Green ,
Mary Vearncombe ,
Virginia Roth  and
Shirley Paton
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Marianna Ofner-Agostini*
Affiliation:
Centre for Infectious Diseases Prevention and Control, Public Health Agency of Canada, Ottawa
Denise Gravel
Affiliation:
Centre for Infectious Diseases Prevention and Control, Public Health Agency of Canada, Ottawa
L. Clifford McDonald
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Marcus Lem
Affiliation:
Centre for Infectious Diseases Prevention and Control, Public Health Agency of Canada, Ottawa
Shelley Sarwal
Affiliation:
Centre for Infectious Diseases Prevention and Control, Public Health Agency of Canada, Ottawa
Allison McGeer
Affiliation:
Mount Sinai Hospital, Toronto
Karen Green
Affiliation:
Mount Sinai Hospital, Toronto
Mary Vearncombe
Affiliation:
Sunnybrook and Women's College Health Sciences Centre, Toronto
Virginia Roth
Affiliation:
The Ottawa Hospital, Ottawa
Shirley Paton
Affiliation:
Centre for Infectious Diseases Prevention and Control, Public Health Agency of Canada, Ottawa
Mark Loeb
Affiliation:
Hamilton Health Sciences Corporation, Hamilton, Canada
Andrew Simor
Affiliation:
Sunnybrook and Women's College Health Sciences Centre, Toronto
*
Nosocomial and Occupational Infections Section, Blood Safety and Surveillance, Health-Care Acquired Infections Division, Public Health Agency of Canada, Tunney's Pasture, PL 0601E2, Ottawa, CanadaK1A 0L2 ([email protected])
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Abstract

Objective.

To review the severe acute respiratory syndrome (SARS) infection control practices, the types of exposure to patients with SARS, and the activities associated with treatment of such patients among healthcare workers (HCWs) who developed SARS in Toronto, Canada, after SARS-specific infection control precautions had been implemented.

Methods.

A retrospective review of work logs and patient assignments, detailed review of medical records of patients with SARS, and comprehensive telephone-based interviews of HCWs who met the case definition for SARS after implementation of infection control precautions.

Results.

Seventeen HCWs from 6 hospitals developed disease that met the case definition for SARS after implementation of infection control precautions. These HCWs had a mean age ( ± SD) of 39 ± 2.3 years. Two HCWs were not interviewed because of illness. Of the remaining 15, only 9 (60%) reported that they had received formal infection control training. Thirteen HCWs (87%) were unsure of proper order in which personal protective equipment should be donned and doffed. Six HCWs (40%) reused items (eg, stethoscopes, goggles, and cleaning equipment) elsewhere on the ward after initial use in a room in which a patient with SARS was staying. Use of masks, gowns, gloves, and eyewear was inconsistent among HCWs. Eight (54%) reported that they were aware of a breach in infection control precautions. HCWs reported fatigue due to an increase number and length of shifts; participants worked a median of 10 shifts during the 10 days before onset of symptoms. Seven HCWs were involved in the intubation of a patient with SARS. One HCW died, and the remaining 16 recovered.

Conclusion.

Multiple factors were likely responsible for SARS in these HCWs, including the performance of high-risk patient care procedures, inconsistent use of personal protective equipment, fatigue, and lack of adequate infection control training.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 5 , May 2006 , pp. 473 - 478
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Tsang, K, Ho, P, Ooi, G, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003; 348:1977–1985.CrossRefGoogle ScholarPubMed
2.Ksiazek, T, Erdman, D, Goldsmith, C, et al. A novel Coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003;348:1953–1966.CrossRefGoogle ScholarPubMed
3.Drosten, C, Gunther, S, Preiser, W, et al. Identification of a novel Coronavirus in patients with severe acute respiratory syndrome. N Engl J Med 2003;348:1967–1976.CrossRefGoogle ScholarPubMed
4.World Health Organization (WHO). Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. September 16, 2003. Available at: http://www.who.int/csr/sars/country/table2003_ 09_23/en/. Accessed April 11, 2006.Google Scholar
5.Health Canada. Canadian SARS numbers. Ottawa, Ontario; June 20,2003. Available at: http://www.phac-aspc.gc.ca/sars-sras/cn-cc/20030625_e.html. Accessed April 11, 2006.Google Scholar
6.Dwosh, H, Hong, H, Austgarden, D, Herman, S, Schabas, R. Identification and containment of an outbreak of SARS in a community hospital. CMAJ 2003; 168:1415–1420.Google Scholar
7.Ofner, M, Lem, M, Sarwal, S, Vearncombe, A. Cluster of severe acute respiratory syndrome cases among protected health-care workers—Toronto, Canada. MMWR Morb Mortal Wkly Rep 2003; 52:433–436.Google Scholar
8.Stegenga, J, Bell, E, Matlow, M. The role of nurse understaffing in nosocomial viral gastrointestinal infections on a general pediatrics ward. Infect Control Hosp Epidemiol 2002; 23:133–136.Google Scholar