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Letter

Severe acute respiratory syndrome

Private hospital in Singapore took effective control measures

Hospitals are most vulnerable to outbreaks of SARS. Every patient is a potential risk, and everywhere must be secured against this disease. Prerequisites for containment include prompt implementation of specific infection control measures as seen at the private Mount Elizabeth Hospital and Medical Centre.

All visitors underwent temperature checks before entering buildings bcause SARS is infective in the febrile phase. Triage disclosed people who were well, and they wore colour coded stickers. People at risk of developing SARS were escorted to "fever" facilities in the emergency department for further assessments. People with suspected SARS waited in a separate facility before transfer to Tan Tock Seng Hospital.

As healthcare workers have been unwitting victims and amplifiers of SARS,¹ each one was required to wear a fitted N95 mask in all patient care settings. Hand washing and other hygiene measures were reinforced. Gowns, gloves, and goggles were added in higher risk situations (such as dealing with febrile patients and emergencies and working in intensive care units, operating theatres, and maternity departments). Positive air purifying respirators were used over the masks during tracheal suction and intubation. Healthcare workers monitored their temperatures twice daily.

Since the initial symptoms of SARS may be non-specific, all febrile patients were admitted to single rooms in a fever ward, with strict barrier nursing protocols. Transfer of patients between hospitals was proscribed, and elective procedures were postponed for 10 days in those who had been in contact with SARS. Other measures included prohibition of nebulisation treatment,⁵ restriction of staff movements, and logging of visitors.

We conclude that knowledge and ready availability of protective equipment are critical in successfully containing SARS.

S C Yeoh, consultant obstetrician and gynaecologist, E Lee, consultant anaesthetist

Mount Elizabeth Medical Centre and Mount Elizabeth Hospital, 3 Mount Elizabeth, Singapore 228510

B W Lee, consultant paediatrician

paeleebw@nus.edu.sg Mount Elizabeth Medical Centre and Mount Elizabeth Hospital, 3 Mount Elizabeth, Singapore 228510

D L Goh, assistant professor

Department of Paediatrics, National University of Singapore, Lower Kent Ridge Road, Singapore 119074

References

1. World Health Organization. Outbreak news—Severe acute respiratory syndrome (SARS). Wkly Epidemiol Rec 2003;78: 81-3.[Medline]
2. Fouchier RA, Kuiken T, Schutten M, van Amerongen G, van Doornum GJ, van Den Hoogen BG, et al. Aetiology: Koch's postulates fulfilled for SARS virus. Nature 2003;423: 240.[CrossRef][ISI][Medline]
3. Hsu LY, Lee CC, Green JA, Ang B, Paton NI, Lee L, et al. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg Infect Dis [serial online] 2003;9. www.cdc.gov/ncidod/EID/vol9no6/03-0264.htm (accessed 9 Jun 2003).
4. Fisher DA, Lim TK, Lim YT, Singh KS, Tambyah PA. Atypical presentations of SARS. Lancet 2003;361: 1740.[CrossRef][ISI][Medline]
5. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348: 1986-94.[Abstract/Free Full Text]

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