Biomedical Engineering Reference
In-Depth Information
identified to be the index case and the nurse
admitted was his case nurse.
In response to an urgent consultation by the COS
of the department, the Chair of Clinical Micro-
biology of the University of Hong Kong who
had managed the contacts of the first local SARS
patient (a visiting nephrologist from Guangzhou
in Guangdong Province), gave his expert opinion
on March 13, 2003. He advised on prescribing
levofloxacin to all symptomatic HCW with atyp-
ical CAP, and intravenous ribavirin and corti-
costeroid (to which another HCW contacting the
nephrologist had responded) to the only admitted
HCW, who by then was in ARF. He concurred with
our plan to cohort all pneumonia and suspected
cases in one ward and recommended improve-
ment in environmental ventilation. The Hong Kong
Department of Health and HAHO were informed
of the situation in PYNEH on the same day.
On March 14, all HCW on sick leave plus
two others were admitted with progressive atypical
pneumonia, including his case medical officer, a
nurse, and four supporting staff. Four household
contacts of three of the affected HCW, a patient
and a visitor of another patient in the same cubicle
were admitted over the next two days with the same
problem. Three more nurses, including one inves-
tigating the outbreak, developed similar illnesses
after March 17 and were admitted on March 23-24.
These likely represented secondary infections by
the first affected HCW before institution of strict
droplet and contact precautions [7]. All 16 cases
could be traced to this index case, had positive
SARS serology subsequently and survived without
intubation.
The PYNEH outbreak coincided with a major
outbreak in another local hospital, in which 138
HCW contracted SARS from a young pneumonic
patient (who had visited “Hotel M”) nursed in a
general medical ward [8]. It later transpired that
the origin of that outbreak was the same nephrol-
ogist from Guangzhou who had stayed in this
hotel in Hong Kong [9]. The nephrologist and his
brother-in-law received treatment and died earlier
in another hospital where a smaller nosocomial
outbreak had also occurred. The outbreak of SARS
in Hong Kong had thus started independently in
three hospitals and spread to the community two
weeks later.
23.4 Response at the Emergency
Room Level
Our emergency room (ER) doctors performed
first-line screening and admitting suspected SARS
patients according to the prevailing WHO case
definitions [10], with advice from pulmonary
physicians where indicated. Learning from the
experience in Singapore, the ER could effectively
screen, treat, and safely discharge the majority of
patients using screening questionnaires and a set
of admission criteria [11]. The total number of
patients screened at ER and admitted as in-patients
was 505, including 459 adults and 46 children
(Figure 23.1) [41].
23.5 Response at Ward and
Department Levels
A total of 90 confirmed SARS cases were even-
tually treated in our hospital. The first patient was
admitted on March 9, and the last was diagnosed on
April 28, 2003. By June 13, all SARS patients were
discharged from PYNEH. Figure 23.2 shows the
number of new SARS patients admitted over time
30
25
Day 1
=
March 9, 2003
Day 97
=
June 13, 2003
20
15
10
5
0
0 0 0 0 0 0 0 0 0 0 0
Day of hospital outbreak
Figure 23.1
Daily number of patients (adults and children)
screened at ER and admitted as in-patients to Pamela Youde
Nethersole Eastern Hospital during the 2003 SARS outbreak
(Total
=
505).
