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Early containment of severe acute respiratory syndrome (SARS); experience from Bamrasnaradura Institute, Thailand.
J Med Assoc Thai. 2004 Oct; 87(10):1182-7.JM

Abstract

BACKGROUND

On March 11, 2003, a World Health Organization (WHO) physician was admitted to Bamrasnaradura Institute, after alerting the world to the dangers of severe acute respiratory syndrome (SARS) in Vietnam and developing a fever himself. Specimens from the first day of his admission were among the first to demonstrate the novel coronavirus, by culture, reverse transcription-polymerase chain reaction (RT-PCR), and rising of specific antibody, but proper protective measures remained unknown. The authors instituted airborne, droplet and contact precautions from the time of admission, and reviewed the efficacy of these measures.

MATERIAL AND METHOD

A specific unit was set up to care for the physician, beginning by roping off an isolated room and using a window fan to create negative pressure, and later by constructing a glass-walled antechamber, designated changing and decontamination areas, and adding high-efficiency particulate air (HEPA) filters. The use of personal protective equipment (PPE) was consistently enforced by nurse managers for all the staff and visitors, including a minimum of N95 respirators, goggles or face shields, double gowns, double gloves, full head and shoe covering, and full Powered Air Purifying Respirator (PAPR) for intubation. To assess the adherence to PPE and the possibility of transmission to exposed staff a structured questionnaire was administered and serum samples tested for SARS coronavirus by enzyme-linked immunosorbent assay (ELISA). Exposure was defined as presence on the SARS ward or contact with laboratory specimens, and close contact was presence in the patient's room.

RESULTS

The WHO physician died from respiratory failure on day 19. 112 of 129 exposed staff completed questionnaires, and the 70 who entered the patient's room reported a mean of 42 minutes of exposure (range 6 minutes-23.5 hours). 100% reported consistent handwashing after exposure, 95% consistently used a fit-tested N95 or greater respirator, and 80% were fully compliant with strict institutional PPE protocol. No staff developed an illness consistent with SARS. Serum samples from 35 close contacts obtained after day 28 had a negative result for SARS coronavirus antibody.

CONCLUSIONS

Hospitalization of one of the earliest SARS patients with documented coronavirus shedding provided multiple opportunities for spread to the hospital staff, but strict enforcement of conservative infection control recommendations throughout the hospitalization was associated with no transmission.

Authors+Show Affiliations

Bamrasnaradura Institute, Ministry of Public Health, Thailand.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

15560695

Citation

Chaovavanich, Achara, et al. "Early Containment of Severe Acute Respiratory Syndrome (SARS); Experience From Bamrasnaradura Institute, Thailand." Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 87, no. 10, 2004, pp. 1182-7.
Chaovavanich A, Wongsawat J, Dowell SF, et al. Early containment of severe acute respiratory syndrome (SARS); experience from Bamrasnaradura Institute, Thailand. J Med Assoc Thai. 2004;87(10):1182-7.
Chaovavanich, A., Wongsawat, J., Dowell, S. F., Inthong, Y., Sangsajja, C., Sanguanwongse, N., Martin, M. T., Limpakarnjanarat, K., Sirirat, L., Waicharoen, S., Chittaganpitch, M., Thawatsupha, P., Auwanit, W., Sawanpanyalert, P., & Melgaard, B. (2004). Early containment of severe acute respiratory syndrome (SARS); experience from Bamrasnaradura Institute, Thailand. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 87(10), 1182-7.
Chaovavanich A, et al. Early Containment of Severe Acute Respiratory Syndrome (SARS); Experience From Bamrasnaradura Institute, Thailand. J Med Assoc Thai. 2004;87(10):1182-7. PubMed PMID: 15560695.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early containment of severe acute respiratory syndrome (SARS); experience from Bamrasnaradura Institute, Thailand. AU - Chaovavanich,Achara, AU - Wongsawat,Jurai, AU - Dowell,Scott F, AU - Inthong,Yaowarat, AU - Sangsajja,Chariya, AU - Sanguanwongse,Natpatou, AU - Martin,Michael T, AU - Limpakarnjanarat,Khanchit, AU - Sirirat,Likanonsakul, AU - Waicharoen,Sunthreeya, AU - Chittaganpitch,Malinee, AU - Thawatsupha,Pranee, AU - Auwanit,Wattana, AU - Sawanpanyalert,Pathom, AU - Melgaard,Bjorn, PY - 2004/11/25/pubmed PY - 2005/1/26/medline PY - 2004/11/25/entrez SP - 1182 EP - 7 JF - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JO - J Med Assoc Thai VL - 87 IS - 10 N2 - BACKGROUND: On March 11, 2003, a World Health Organization (WHO) physician was admitted to Bamrasnaradura Institute, after alerting the world to the dangers of severe acute respiratory syndrome (SARS) in Vietnam and developing a fever himself. Specimens from the first day of his admission were among the first to demonstrate the novel coronavirus, by culture, reverse transcription-polymerase chain reaction (RT-PCR), and rising of specific antibody, but proper protective measures remained unknown. The authors instituted airborne, droplet and contact precautions from the time of admission, and reviewed the efficacy of these measures. MATERIAL AND METHOD: A specific unit was set up to care for the physician, beginning by roping off an isolated room and using a window fan to create negative pressure, and later by constructing a glass-walled antechamber, designated changing and decontamination areas, and adding high-efficiency particulate air (HEPA) filters. The use of personal protective equipment (PPE) was consistently enforced by nurse managers for all the staff and visitors, including a minimum of N95 respirators, goggles or face shields, double gowns, double gloves, full head and shoe covering, and full Powered Air Purifying Respirator (PAPR) for intubation. To assess the adherence to PPE and the possibility of transmission to exposed staff a structured questionnaire was administered and serum samples tested for SARS coronavirus by enzyme-linked immunosorbent assay (ELISA). Exposure was defined as presence on the SARS ward or contact with laboratory specimens, and close contact was presence in the patient's room. RESULTS: The WHO physician died from respiratory failure on day 19. 112 of 129 exposed staff completed questionnaires, and the 70 who entered the patient's room reported a mean of 42 minutes of exposure (range 6 minutes-23.5 hours). 100% reported consistent handwashing after exposure, 95% consistently used a fit-tested N95 or greater respirator, and 80% were fully compliant with strict institutional PPE protocol. No staff developed an illness consistent with SARS. Serum samples from 35 close contacts obtained after day 28 had a negative result for SARS coronavirus antibody. CONCLUSIONS: Hospitalization of one of the earliest SARS patients with documented coronavirus shedding provided multiple opportunities for spread to the hospital staff, but strict enforcement of conservative infection control recommendations throughout the hospitalization was associated with no transmission. SN - 0125-2208 UR - https://www.unboundmedicine.com/medline/citation/15560695/Early_containment_of_severe_acute_respiratory_syndrome__SARS_ L2 - http://www.diseaseinfosearch.org/result/6415 DB - PRIME DP - Unbound Medicine ER -