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. 2003;50(10):989–997. doi: 10.1007/BF03018361

Infection control and anesthesia: Lessons learned from the Toronto SARS outbreak

La lutte anti-infectieuse et l’anesthésie : les leçons de l’éclusion du SRAS à Toronto

Philip W H Peng 1,✉, David T Wong 1, David Bevan 1, Michael Gardam 3,4
PMCID: PMC7091083  PMID: 14656775

Abstract

Purpose

To describe the outbreak of severe acute respiratory syndrome (SARS) in Toronto, its impact on anesthesia practice and the infection control guidelines adopted to manage patients in the operating room (OR) and to provide emergency intubation outside the OR.

Clinical features

The SARS outbreak in Toronto was the result of a single index patient. The causative virus, SARS-CoV, is moderately contagious, and is spread by droplets and contact. The virus gains access to host through the mucosa of the respiratory tract and the eyes. It can affect both healthy and compromised patients. The use of several precautionary measures such as goggles, gloves, gowns and facemasks and the application of various infection control strategies designed to minimize the spread of the virus are discussed.

Conclusion

In containing the spread of SARS, vigilance and strict infection control are important. This results in the rediscovery of standards of infection control measures in daily anesthesia practice.

Keywords: Health Care Worker, Severe Acute Respiratory Syndrome, Severe Acute Respiratory Syndrome, Anesthesia Machine, Severe Acute Respiratory Syndrome Patient

References

  • 1.Varia M, Wilson S, Sarwal S, et al. Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ. 2003;169:285–92. [PMC free article] [PubMed] [Google Scholar]
  • 2.World Health Organization Acute respiratory syndrome, China. Wkly Epidemiol Rec. 2003;78:41–41. [Google Scholar]
  • 3.World Health Organization Severe acute respiratory syndrome (SARS) Wkly Epidemiol Rec. 2003;78:81–3. [PubMed] [Google Scholar]
  • 4.World Health Organization. WHO issues a global alert about cases of atypical pneumonia. Available from URL; http://www.who.int/csr/sarsarchive/2003_03_12/en/. [PubMed]
  • 5.Poutanen SM, Low DE, Henry B, et al. Identification of severe acute respiratory syndrome in Canada. N Engl J Med. 2003;348:1995–2005. doi: 10.1056/NEJMoa030634. [DOI] [PubMed] [Google Scholar]
  • 6.Ministry of Health and Long Term Care, Government of Ontario. Fact sheet. Severe acute respiratory syndrome (SARS) update. Available from URL; http://www.health.gov.on.ca/english/public/updates /archives/hu_O 3/sars_stats/stat_050603.pdf.
  • 7.Spurgeon D. Toronto succumbs to SARS a second time. BMJ. 2003;326:1162–1162. doi: 10.1136/bmj.326.7400.1162-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Booth CM, Matukas LM, Tomlinson GA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003;289:2801–9. doi: 10.1001/jama.289.21.JOC30885. [DOI] [PubMed] [Google Scholar]
  • 9.Kamming D, Chung F, Gardam M. Anaesthesia and SARS (Editorial) Br J Anaesth. 2003;90:715–8. doi: 10.1093/bja/aeg173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Ksiazek TG, Erdman D, Goldsmith CS, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;348:1953–66. doi: 10.1056/NEJMoa030781. [DOI] [PubMed] [Google Scholar]
  • 11.Rota PA, Oberste MS, Monroe SS, et al. Characterization of a novel coronovirus associated with severe acute respiratory syndrome. Science. 2003;300:1394–9. doi: 10.1126/science.1085952. [DOI] [PubMed] [Google Scholar]
  • 12.World Health Organization. Updated 47-Studies of SARS virus survival, situation in China. Available from URL; http://www.who.int/csr/sarsarchive/ 2003_05_05/en/.
  • 13.Gerberding JL. Faster … but fast enough? Responding to the epidemic of severe acute respiratory syndrome (Editorial) N Engl J Med. 2003;348:2030–1. doi: 10.1056/NEJMe030067. [DOI] [PubMed] [Google Scholar]
  • 14.Center for Disease Control and Prevention Severe acute respiratory syndrome — Taiwan, 2003. MMWR. 2003;52:461–6. [Google Scholar]
  • 15.Riley S, Fraser C, Donnelly CA, et al. Transmission dynamics of the etiological agent of SARS in Hong Kong: impact of public health intervention. Science. 2003;300:1961–6. doi: 10.1126/science.1086478. [DOI] [PubMed] [Google Scholar]
  • 16.Lipsitch M, Cohen T, Cooper B, et al. Transmission dynamics and control of severe acute respiratory syndrome. Science. 2003;300:1966–70. doi: 10.1126/science.1086616. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Ferguson NM, Mallett S, Jackson H, Roberts N, Ward P. A population-dynamic model for evaluating the potential spread of drug-resistant influenza virus infections during community-based use of antivirals. J Antimicrob Chemother. 2003;51:977–90. doi: 10.1093/jac/dkg136. [DOI] [PubMed] [Google Scholar]
  • 18.Center for Disease Control and Prevention Severe acute respiratory syndrome — Singapore, 2003. MMWR. 2003;52:405–11. [PubMed] [Google Scholar]
  • 19.Parry J. SARS virus identified, but the disease is still spreading. BMJ. 2003;326:897–897. doi: 10.1136/bmj.326.7395.897. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348:1986–94. doi: 10.1056/NEJMoa030685. [DOI] [PubMed] [Google Scholar]
  • 21.World Health Organization. Update 49 — SARS case fatality ratio, incubation period. Available from URL; http://www.who.int/csr/sarsarchive/2003_05_07/en/.
  • 22.Health Canada. SARS epidemiologic summaries: April 26, 2003. SARS among Ontario health care workers. Available from URL; http://www.hc-sc.gc.ca/pphb-dgspsp/sars-sras/pef-dep/sars-es20030426_e.html.
  • 23.Avendano M, Derkach P, Swan S. Clinical course and management of SARS in health care workers in Toronto: a case series. CMAJ. 2003;168:1649–60. [PMC free article] [PubMed] [Google Scholar]
  • 24.Seto WH, Tsang D, Tung RW, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS) Lancet. 2003;361:1519–20. doi: 10.1016/S0140-6736(03)13168-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.World Health Organization. Hospital infection control guidance for severe acute respiratory syndrome (SARS). Available from URL; http://www.who.int/csr/sars/infectioncontrol/en/.
  • 26.Center for Disease Control and Prevention. Updated interim domestic infection control guidance in the health-care and community setting for patients with suspected SARS. Available from URL; http://www.cdc.gov /ncidod/sars/infectioncontrol.htm.
  • 27.Health Canada. Infection control guidance for health care workers in health care facilities and other institutional settings. Severe acute respiratory syndrome (SARS). Available from URL; http://www.hc-sc.gc.ca/pphb-dgspsp/sars-sras/pdf/sarsfactsheetinstitutions06-03-03_e.pdf.
  • 28.Ministry of Health and Long-Term Care, Government of Ontario. SARS. Directive to all Ontario acute care hospitals for high-risk procedures. Available from URL; http://www.health.gov.on.ca/english/providers/program/pubhealth/sars/docs/docs2/dir_acute_care_06 1603.pdf.
  • 29.Health Canada. Recommendations for acute care facilities.In: Routine Practice and Additional Precaution for Preventing the Transmission of Infection in Health Care. 1999; 25S4, Part B: 35. Available from URL; http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ccdrrmtc/99pdf/cdr25s4e.pdf.
  • 30.Arnold JL. CBRNE — Personal protective equipment. Available from URL; http://www.emedicine.com/ emerg/topic894.htm.

Articles from Canadian Journal of Anaesthesia are provided here courtesy of Nature Publishing Group

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