Possible SARS coronavirus transmission during cardiopulmonary resuscitation.
Christian-MD; Loutfy-M; McDonald-LC; Martinez-KF; Ofner-M; Wong-T; Wallington-T; Gold-WL; Mederski-B; Green-K; Low-DE
Emerg Infect Dis 2004 Feb; 10(2):287-293
Infection of healthcare workers with the severe acute respiratory syndrome-associated coronavirus (SARS-CoV) is thought to occur primarily by either contact or large respiratory droplet transmission. However, infrequent healthcare worker infections occurred despite the use of contact and droplet precautions, particularly during certain aerosol-generating medical procedures. We investigated a possible cluster of SARS-CoV infections in healthcare workers who used contact and droplet precautions during attempted cardiopulmonary resuscitation of a SARS patient. Unlike previously reported instances of transmission during aerosol-generating procedures, the index case-patient was unresponsive, and the intubation procedure was performed quickly and without difficulty. However, before intubation, the patient was ventilated with a bag-valve-mask that may have contributed to aerosolization of SARS-CoV. On the basis of the results of this investigation and previous reports of SARS transmission during aerosol-generating procedures, a systematic approach to the problem is outlined, including the use of the following: 1) administrative controls, 2) environmental engineering controls, 3) personal protective equipment, and 4) quality control.
Infectious-diseases; Infection-control; Health-care-facilities; Health-care-personnel; Pulmonary-system-disorders; Respiratory-system-disorders; Protective-equipment; Protective-measures
Michael D. Christian, Immunodeficiency Clinic University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4
Emerging Infectious Diseases