| High risk procedures, alternatives, and precautions |
| Limit opportunities for exposure: Limit aerosol generating procedures & limit number of HCWs present |
| Effective use of time during patient contact |
| How to ‘gown’ and ‘degown’ without contamination |
| Emphasis on importance of vigilance and adherence to all infection control precautions |
| Emphasis on importance of monitoring own health |
| Dissemination of information on SARS and other prevailing infections as they evolve |
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Personal protection equipment (PPE)
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|
N95 respirator/surgical mask for airborne/droplet precautions |
| Contact precautions: Disposable gloves, gown, cap |
| Eye protection with non‐reusable goggles and face‐shield |
| Powered air purification respirators (PAPR) may be used when performing high‐risk procedures (1, 2) |
| Pens, paper, other personal items and medical records should not be allowed into or removed from the room |
| Immediate removal of grossly contaminated PPE and showering in nearby facility |
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Environment/Equipment
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| Conform to CDC recommendations for environmental control of tuberculosis: Minimum 6 air change per hour (ACH). Where feasible, increase to 3 12 ACH or recirculate air through HEPA filter |
| Preferred: Negative pressure isolation rooms with antechambers, with doors closed at all times |
| Equipment should not be shared among patients |
| Alcohol‐based hand and equipment disinfectants |
| Gloves, gowns, masks and disposal units should be readily available |
| Careful and frequent cleaning of surfaces with disposable cloths and alcohol‐based detergents |
| Use of video camera equipment or windows to monitor patients |
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Transport
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| Avoid patient transport where possible: Balance risks and benefits of investigations which necessitate patient transport |
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Special precautions for ICU
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| Viral/bacterial filter placed in expiratory port of bag‐valve mask |
| Two filters per ventilator: Between expiratory port and the ventilator, and another on the exhalation outlet of the ventilator |
| Closed‐system in‐line suctioning of endotracheal/tracheostomy tubes (Fig. 2a) |
| Heat and moisture exchanger (HME) preferred to heated humidifier: Careful handling of contaminated HME required (Fig. 2a) |
| Scavenger system for exhalation port of ventilator (e.g. Servo Evac 180, Fig. 2b): Optional if negative pressure with high air change (>12/h) is achieved |
| Preoxygenate patient and temporarily switch off machine when ventilator circuit disconnection required (e.g. change of ventilator tubings, HME, etc.) |
