Biomedical Engineering Reference
In-Depth Information
all matters related to the outbreak. Daily meetings
of HCE in HAHO made major policy decisions to
manage the outbreak, followed by OMT meeting
in the hospital to ensure swift communication of
important corporate messages among all parties
involved. Meeting minutes were sent by electronic
means to ward managers, department managers
and unit heads and posted in the hospital intranet.
In addition, weekly summaries of developments
were sent to update all Hospital Governing Board
members.
23.6.1 Visiting Policy
Visitors to the cohort wards were prohibited,
but patients were allowed to freely use their
mobile phones for communications with families
and responding to enquiries from epidemiologists.
Videophones were later installed for visitors in
the Patient Resource Center. Visitors were only
allowed into the cohort wards under exceptional
circumstances, during which their contact informa-
tion was recorded and the Department of Health
notified for medical surveillance. Visitors to acute
general wards were similarly prohibited, since
rapid diagnosis of SARS was not feasible until
very late in the outbreak, and atypical presentation
[30] could occur especially in the elderly [31,32].
Visitors were only allowed into the two non-acute
wards in which patients had negligible likelihood
of SARS. With additional security installed at a
single point of entry for the public, surveillance
with temperature-taking and completion of desig-
nated questionnaires were enforced to facilitate
contact tracing. Further security was installed at the
entrance to all wards to prevent inadvertent entry
of the public from other hospital entrances. Volun-
teer services and clinical training attachments for
medical, nursing and allied health students were
suspended.
Figure 23.7
Protective device for resuscitation: Bag-valve
apparatus with viral-bacterial filter between the bag and the
face mask, with plastic shield to cover face shield and patient's
face to direct expired air downwards and away from the face
of healthcare workers.
ventilation within a few days of the outbreak [42].
We submit that the (still current) recommendations
from Canada [27] and the United Kingdom [28] to
avoid the use of NIV had not taken into account
the utility of improved environmental ventilation
in markedly reducing the chance of SARS trans-
mission to HCW.
During resuscitation, we added viral and bacte-
rial filters to ventilator tubings and the bag-valve
apparatus, and draped a plastic bag opened on two
sides above the face mask to direct expired air to
below the patient's face to avoid direct its inhala-
tion by HCW (Figure 23.7) [29]. The department
continued a close liaison with the Microbiology
Department of the University of Hong Kong,
whose team successfully isolated and grew the
SARS-CoV [19], and benefited from fruitful advice
while also contributing valuable specimens for
research.
23.6 Response at Hospital
Management Level
Unified command was achieved through an
Outbreak Management Team (OMT) headed by the
Hospital Chief Executive (HCE), with members
comprising General Managers and COS, to oversee
23.6.2 Reporting Mechanism and e-SARS
Registry
In the last week of March 2003, the ICT was
assigned by OMT to conduct daily rounds of cohort
wards to collect epidemiological and clinical data.
All suspected cases fulfilling the case definition
