Biomedical Engineering Reference
In-Depth Information
cohort ward in the hospital, with each of the cubicle
and isolation room clearly defined for the screening
of new cases with respiratory infection or cohorting
of atypical pneumonia cases. With further influx of
suspected cases, ward B5 (another medical ward)
was designated to be a female cohort ward, with
A5 accepting male patients only. Eventually, a
total of seven wards were designated for cohorting:
five medical wards (two for screening, two for
confirmed SARS, and one for convalescent SARS
patients to complete the standard course of treat-
ment [12]); as well as one pediatric ward and one
SARS ICU.
65
60
number of SARS in-patients
number of SARS patients admitted
55
50
Day 1 = March 9, 2003
Day 97 = June 13, 2003
45
40
35
30
25
20
15
10
5
0
10
20
30
40
50
60
70
80
90
100
Day of hospital outbreak
Figure 23.2
The number of new SARS patients admitted over
time (Total 90 patients) and the number of confirmed SARS
patients in cohort wards each day (peaking at 60 on April 15)
during the outbreak.
23.5.1.2 Personal protective
equipment (PPE)
HCW in ward A5 initially wore surgical masks
only, but as soon as the high infectivity of SARS
was recognized, protective gowns, gloves, and
N95 respirators were worn during patient care.
Hand hygiene was emphasized and safety in the
handling of clinical specimens reinforced. The ICT
set up different levels of PPE requirements for
different clinical areas according to risk stratifica-
tion (Table 23.1). These rules were enforced until
the end of the outbreak. In the early stages, demand
on PPE was very high. For peace of mind, some
staff further added on their own versions of PPE.
To enforce strict infection control policies and
to ensure staff safety, HAHO appointed relevant
experts to review all PPE with ICT from all hospi-
tals, and only those found to be suitable for the
purpose were allowed. Among those rejected were
the “barrier man suit” designed against chemical
contamination, and the “Stryker T4 protective
system” used in operation rooms (OR). A personal
air purified particulate respirator (PAPR) system
(Airmate
®
) was used after mid-April during high-
risk aerosol generating procedures such as intuba-
tion and resuscitation. Consumption and supply of
PPE and other essential equipment were closely
monitored by administrative services. Two “PPE
Complaint Coordinators,” a doctor and an admin-
istrative staff, were appointed to receive staff
feedback.
and the number of confirmed SARS patients in
cohort wards each day (peaking at 60 on April 15)
during the outbreak. Our strategies to deal with this
sudden surge of patients harboring an unknown
and highly infectious disease are described.
23.5.1 Infection Control Measures
HAHO has established Infection Control Offi-
cers (ICO) in each hospital to head the Infec-
tion Control Team (ICT), formulate and enforce
the implementation of infection control policies
in line with prevailing standards. Guidelines for
control against droplet infections have been well-
established in Hong Kong hospitals before the
occurrence of SARS, in particular for infections
which were specified or suspected by ICT to be
highly infectious. In general, patients with respi-
ratory tract infections were routinely nursed in
general medical wards together with those with
other medical problems.
23.5.1.1 Patient cohorting
On receiving the information about the outbreak
in ward A5, ICT immediately advised droplet and
contact precautions to be implemented. On March
14, 2003, A5 ward became the only pneumonia
