Mount Sinai Hospital Critical Care Unit

SARS Resources

Ontario Ministry of Health Directives

• These standards have been established in order to prevent the transmission of respiratory and other pathogens to health care workers. It is necessary to review these standards against existing practices and make changes as required.

SEPTEMBER, 2003 BIOSAFETY AND SARS INCIDENT IN SINGAPORE. REPORT OF THE REVIEW PANEL ON NEW SARS CASE AND BIOSAFETY

• This report outlines a number of issues related to the accidental SARS coronavirus exposure and clinical illness of a laboratory worker in Singapore. It raises a number of issues related to safe handling of specimens, and reinforces the importance of biohazard education in clinical and non-clinical settings. This case is also a stern reminder of the need for continued vigilance for possible SARS. Screening questions for determining risk of SARS should include whether the patient works at or has contact with any microbiology laboratories.

May 13, 2003 DIRECTIVES TO ALL ONTARIO ACUTE CARE HOSPITALS FOR HIGH-RISK PROCEDURES INVOLVING SARS PATIENTS CRITICAL CARE AREAS DURING A SARS OUTBREAK ("the new normal")

• These are revised directives instructing Ontario hospitals how to safely step down precautions within higher risk environments as the Ontario SARS outbreak resolves. Note that the recommendation to place a filter between ventilator circuits and endotracheal tubes remains incorrect; filtration placed in the expiratory limb of the circuit or use of a ventilator with an intrinsic filter is recommended. We emphasize the point that ALL staff in the room during a high-risk procedure should wear adjunct personal protective gear.

May 1, 2003 DIRECTIVES TO ALL ONTARIO ACUTE CARE HOSPITALS FOR HIGH-RISK PROCEDURES IN CRITICAL CARE AREAS DURING A SARS OUTBREAK

• These directives were released by the Provincial Operations Centre to provide guidance to those caring for SARS patients in Critical Care or Emergency environments. Note that the recommendation to place a filter between ventilator circuits and endotracheal tubes is incorrect; filtration placed in the expiratory limb of the circuit or use of a ventilator with an intrinsic filter is recommended. The directives did not mention the use of adjunct protection systems for nurses; it is our opinion that anyone in the room during high-risk procedures should be wearing adjunct protection.

Critically Ill Patients With Severe Acute Respiratory Syndrome

• Robert A. Fowler, MD, MS; Stephen E. Lapinsky, MB, BCh, MSc; David Hallett, et al JAMA 2003;290:367-373

Review article from Intensive Care Medicine: ICU management of severe acute respiratory syndrome by Dr. Stephen Lapinsky and Dr. Laura Hawryluck

• Dr. Stephen Lapinsky from Mount Sinai Hospital and Dr. Laura Hawryluck from the University Health Network present an overview of care for SARS patients in the ICU. This article reviews important issues regarding infection control precautions and treatment.

Crash Course in Intensive Care Medicine for SARS Patients

• This website was created by the Chinese University of Hong Kong to provide education material on care of patients with SARS. Target audience is physicians with no prior experience in Intensive Care. The material is designed to rapidly train physicians to work under supervision of an ICU specialist when usual ICU staff are unavailable or overwhelmed. Multiple powerpoint presentations or webpages are available for download, including:
  • SARS ICU infection control
  • Respiratory failure
  • Basic mechanical ventilation
  • Pressure regulated volume control
  • Ventilation of patients with SARS
  • Arterial Blood Gases
  • Basic management
  • Central venous catheter insertion
  • Haemodynamic monitoring
  • Shock
  • Sedation
  • SARS radiology

May 16 MMWR Report: Cluster of Severe Acute Respiratory Syndrome Cases Among Protected Health-Care Workers --- Toronto, Canada, April 2003

• This report describes the circumstances surrounding transmission of SARS to health care workers in Toronto after exposure during intubation. Important lessons include the need for proper mask fit (have you performed qualitative mask fit testing on your staff?) and safe removal of contaminated personal protective equipment.

See also the sars.medtau.org Literature Review

For further information contact: Dr. Randy Wax, Education Director
Room 1831, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5

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