Biomedical Engineering Reference
In-Depth Information
a week to transmit important information from
HAHO and hospital management, to keep staff up-
to-date on the clinical aspects of SARS, progress of
outbreak, changing infection control requirements,
and clinical and radiographic information toward
early identification of this disease. Staff feed-
back on suggestions and concerns were encour-
aged and reflected to hospital management where
appropriate. The COS frequently appealed to the
staff's professionalism and duty of care to patients
while assuring them that the risk they were taking
for the good of their patients and society were
well recognized by the hospital and the depart-
ment, and all that was possible would be done
to protect them and their families [20]. It was
later found that anxiety levels were high among
front-line HCW in our hospital as in other parts
of the world [21]. We have thus learned that,
should similar outbreaks ever return, experts must
be recruited to the response team to attend to the
mental well-being of HCW and supporting staff
as well as their family members. Towards this
end, integration of mental health care into public
health preparedness for infectious outbreaks has
been proposed [22].
The department also maintained close contact
with HAHO and other hospitals to exchange views
about this disease. Training programs and meet-
ings were organized for department staff on infec-
tion control and clinical management of SARS,
psychosocial care of patients, and communica-
tion skills with patients/relatives at times of stress.
Meticulous real-time or retrospective documenta-
tion was kept at every stage, which facilitated
subsequent review for research, reporting, account-
ability and medico-legal purposes.
conducted rounds in each cohort ward twice
daily, and the Team discussed patient manage-
ment together every day to expedite learning and
accumulation of experience. A multi-disciplinary
team comprising PCCT, ICT, FMT, and adminis-
trators was convened and met regularly to plan and
monitor different aspects of outbreak response in
the light of continuously updated clinical knowl-
edge. Psychiatrists were recruited to manage SARS
patients when they developed anxiety and depres-
sion and to provide training to staff caring for
them.
To keep HCW abreast about the rapidly
changing scenario, PCCT developed information
sheets containing clinical features, investigation
methods, treatment, and prognostic factors, which
were frequently updated and distributed to SARS
and medical wards. This exercise required PCCT to
integrate knowledge gained from various channels
in a timely manner, and contributed toward the
formulation of a standardized treatment protocol
for SARS at an early stage [12]. Our satis-
factory treatment outcomes were duly published
[23] and efficacy of the protocol was subse-
quently supported by similar outcomes reported
from Taiwan [24].
Encouraged by our observation that non-
invasive ventilation (NIV) did not cause SARS
transmission when applied in an isolation room
with 8 ACH to the index case, we continued to use
this ventilatory mode in the early stages of SARS-
related ARF. At the same time and unbeknown to
us, NIV was totally banned in all other Hong Kong
hospitals for fear of nosocomial transmission of
SARS. Satisfactory patient outcome was achieved
in most of our patients with ARF, however, and
no SARS transmission had occurred in over 100
exposed HCW [25]. The efficacy of NIV with
avoidance of intubation could be related to two
equally beneficial effects: it reduced prevented
secondary infection as patients were not intubated,
and reduced the chance of SARS transmission to
HCW during intubation [26]. The safety of NIV
use in our hospital and the possibility that air-borne
transmission of SARS could have been possible
[14,16] lent full support to the establishment of
negative pressure and unidirectional environmental
23.5.4 Clinical Management
Five members of the Pulmonary and Critical Care
team (PCCT, of which the COS was head) took
up supervisory roles in SARS wards and SARS
ICU throughout the outbreak, assisted later by
a geriatrician-cum-pulmonologist. Rotating senior
and junior physicians from other medical sub-
specialties took up front-line roles in the SARS
wards. At
least
two members of
the PCCT
