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.
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.
13, 2003 DIRECTIVES TO ALL ONTARIO ACUTE CARE HOSPITALS FOR HIGH-RISK PROCEDURES
INVOLVING SARS PATIENTS CRITICAL CARE AREAS DURING A SARS OUTBREAK ("the
- 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.
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.
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
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.
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
- Respiratory failure
- Basic mechanical
- Pressure regulated
- Ventilation of
patients with SARS
- Arterial Blood
- Basic management
- Central venous
- Haemodynamic monitoring
- SARS radiology
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
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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