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Letter

Severe acute respiratory syndrome

Guidelines were drawn up collaboratively to protect healthcare workers in British Columbia

Guidelines were developed through a collaborative process involving the Workers' Compensation Board of British Columbia (the state's regulatory agency), the Occupational Health and Safety Agency for Healthcare (jointly governed by healthcare unions and employers), and provincial experts in public health, infection control, and infectious disease.² An important component was a risk assessment designed to reduce the exclusive use of fit tested N95 respirators without diminishing worker safety.

At initial presentation all patients with respiratory symptoms are considered potentially to have SARS, and healthcare workers are required to wear a fit tested N95 respirator and protective eyewear until risk assessment is completed and reasons for admission are ascertained. During the initial period of greatest risk, full personal protective equipment is required (table). As the patient recovers and the risk of aerosolisation reduces, the requirement for a fitted respirator and face protection declines.

Throughout, critical emphasis is placed on hand hygiene and careful use and removal of personal protective equipment to prevent accidental autoinoculation. Staffing must be adequate to meet the increased workload that occurs with SARS patients, to allow healthcare workers to maintain vigilance.

Seto et al noted that transmission of infection was equal among workers wearing either surgical masks or N95 respirators, when high risk of aerosolisation was excluded.³ On the other hand, a review of cases of SARS in Toronto found that some healthcare workers who acquired SARS were not fit tested and had not been trained to use personal protective equipment, which potentially results in accidental autoinoculations.⁴ This supports the need for a formal programme including fit testing, education on use, and removal of personal protective equipment, as well as a risk assessment approach with full equipment for high risk activities.

Detailed documents on how to apply a risk based approach are now circulating throughout the province along with a programme to train the trainer.⁵ We hope that lessons learnt from SARS will strengthen our ability to protect healthcare workers and the public from other pathogens.

Annalee Yassi, executive director

Occupational Health and Safety Agency for Healthcare, 301-1195 West Broadway Avenue, Vancouver, BC, Canada V6H 3X5 AnnaleeY@aol.com

Michael A Noble, infection control officer

Vancouver Coastal Health, 899 West 12th Avenue, Room JPN 1112, Vancouver General Hospital, Vancouver, BC V5Z 1M9

Patricia Daly, medical health officer

Vancouver Coastal Health, #800-601 West Broadway, Vancouver, BC V5Z 4C2

Elizabeth Bryce, director

infection control Vancouver Hospital and Health Science Centre, 899 West 12th Avenue, Room JPN 1111, Vancouver General Hospital, Vancouver, BC V5Z 1M9

References

1. Centers for Disease Control and Prevention (CDC). Laboratory performance evaluation of N95 filtering facepiece respirators. Morb Mortal Wkly Rep MMWR 1998;47: 1045-9.
2. British Columbia Centre for Disease Control. Guidelines for the acute management of the patient with SARS in the hospital setting. BCCDC, 9 May 2003. http://www.bccdc.org/ (accessed 9 Jun 2003).
3. Seto WH, Tsang D, Yung RWH, Ng TK, Ho M, Ho LM, er al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003;361: 1519-20.[CrossRef][ISI][Medline]
4. Centers for Disease Control and Prevention (CDC) and Health Canada. Cluster of severe acute respiratory syndrome cases among protected health-care workers—Toronto, Canada, April 2003. Morb Mortal Wkly Rep MMWR 2003;52: 433-6.
5. Province of British Columbia. SARS Science Committee. Guidelines for the acute management of the patient with SARS in the hospital setting. PSSC, 7 May 2003. www.ohsah.bc.ca/media/Provincial_SARS_Guidelines_May7.doc (accessed 9 Jun 2003).

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