POLICY & PROCEDURE
MANUAL:
NO.
PAGE 1 OF 2
DATE: Oct. 2003
REV. DATE
INFECTION CONTROL
SECTION:
VI - Significant Organisms
APPROVED BY:
POLICY 
PROCEDURE 
MANAGEMENT OF SEVERE ACUTE RESPIRATORY
SYNDROME (SARS)
PREAMBLE:
Severe Acute Respiratory Syndrome (SARS) is an illness that causes fever, followed
by symptoms such as cough, shortness of breath or difficulty breathing. The exact
cause of the disease is unknown, however, a newly identified coronavirus is
currently believed to be the organism responsible for Severe Acute Respiratory
Syndrome (SARS). It is not yet certain whether other organisms may also play a role
in the illness. Diagnosis relies on epidemiologic links, a clinical case definition and
the absence of an alternative disease-producing agent.
Current information indicates that transmission is by respiratory droplets coming
from a person who is symptomatic with SARS. The virus may be transmitted to
people who have close contact with the SARS patient by:


Breathing in the respiratory droplets that have the virus in them, or
contact of droplets with the eyes, nose or mouth.
Touching the immediate environment that may have become contaminated
with respiratory droplets, then touching their eyes, nose or mouth.
It has not been ruled out whether the virus is spread by airborne particles. Rapid
identification of any case and appropriate isolation precautions are critical.
The following policy and procedures will likely undergo further revisions and
updates will be provided when new information is made available.
1.0
POLICY:
1.1
All direct admit patients and those presenting for care in ER, critical
care or ambulatory care areas, will be screened for SARS by a
Registered Nurse using the SARS Patient Screening Tool (see Appendix
1).
1.2
For patients who experience unit to unit transfers, the form will be
completed in the initial patient care area/unit.
1.3
When a patient is assessed and fits the SARS case definition of Persons
Under Investigation (PUI), Suspect or Probable Severe Acute Respiratory
Syndrome (SARS), specific precautionary and infection control
measures (Enhanced Contact/Droplet/Airborne Precautions) will be
followed by all hospital staff in order to prevent or contain the
transmission of this organisms within the patient care setting (see
Procedure)
POLICY & PROCEDURE
MANUAL:
INFECTION CONTROL
SECTION:
NO.
PAGE 2 OF 2
DATE: Oct. 2003
REV. DATE
VI - Significant Organisms
APPROVED BY:
POLICY 
PROCEDURE 
MANAGEMENT OF SEVERE ACUTE RESPIRATORY
SYNDROME (SARS)
1.4
During an outbreak of SARS*, all High Risk Patients** will be
managed with Enhanced Contact/Droplet/Airborne Precautions
when providing direct care until such time a Physician rules out SARS
(another diagnosis is confirmed) and Infection Control deems it
appropriate to discontinue such precautionary measures.
* An outbreak is defined as local transmission of SARS. The local
Medical Officer of Health is responsible for declaring a SARS outbreak.
An outbreak may be setting-specific (e.g. a hospital with transmission)
or health unit wide (e.g. transmission in more than one setting or
significant community exposure).
** The following are considered High Risk Patients:
-
patients who are transferred from a Level 2 or 3 hospital
-
Any person who presents in the ER or is directly admitted with
undiagnosed febrile respiratory symptoms (fever > 38◦ C or
new onset or worsening cough or new onset or worsening
shortness of breath)
-
Any in-patient who develops new onset of symptoms
(unexplained cough, unexplained high fever, hypoxia,
shortness of breath or difficulty breathing)
DISTRIBUTION:
Administration (Master)
Nursing
Infection Control
Pharmacy
Cardiorespiratory
Food & Nutrition Service
DI
Environmental Service
Laboratory
LUK:aa
POLICY & PROCEDURE
MANUAL:
INFECTION CONTROL
SECTION:
NO.
PAGE 1 OF 13
DATE: July 2003
REV. DATE
VI - Significant Organisms
APPROVED BY:
POLICY 
PROCEDURE 
MANAGEMENT OF SEVERE ACUTE RESPIRATORY
SYNDROME (SARS)
2.0
PROCEDURE:
2.1
IDENTIFICATION OF PATIENTS AT RISK
Identification of patients at risk for SARS is based on clinical and
epidemiological criteria.
i)
All patients presenting to the Emergency Department will be
screened for SARS within the triage process. This will include
assessment and interview to determine:
a) if clinical signs & symptoms of SARS are present (using Health
Canada's case definition for SARS - refer to Appendix III)
b) his/her travel history to affected areas
c) contact with a person diagnosed with SARS
d) contact with a setting/group associated with a cluster of SARS
cases or a hospital that was closed because of SARS (See
Appendix XVIII for web sites where most current SARS info
can be found and Appendix XVII for Healthcare Facility SARS
Category Definitions).
ii)
Any person who presents in the ER with undiagnosed
respiratory symptoms (unexplained cough, hypoxia, shortness
of breath or difficulty breathing) with or without fever suggestive
of an infectious disease, will be given a surgical mask to apply
and be triaged into a single room (see Procedure 2.2 for SARS
designated rooms) within 10 minutes. Such a patient will be
treated as a SARS case (SARS Infection Control Precautions will
be taken) until another diagnosis has been confirmed.
iii)
All heath care providers who are assessing persons with
symptoms and signs of a respiratory infection suggestive of an
infectious disease must wear an N95 mask, protective eye and
face wear, gown(s) and gloves (see procedure 2.4 - 4 for details).
iv)
Those who come in contact first with persons who have
suspected respiratory infections (e.g. triage RN, an ER clerk)
must have an N95 mask and hand sanitation agent
immediately available for their own use (protective equipment e.g.
eye. Face, head wear, gowns, gloves etc. will also be worn when
care within 3 feet is anticipated)
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
PAGE 2 OF 13
IDENTIFICATION OF PATIENTS AT RISK (con't)
2.2
v)
A medical assessment will be carried out to rule out SARS.
Health Canada's case definition for SARS (refer to Appendix III)
will be used to identify patient's as suspect or probable SARS or
persons under investigation for SARS (PUI).
vi)
Any person(s) accompanying a patient who is determined to
be SARS (suspect, probable or under investigation) must be
assessed for SARS in the ED and sent home with notification of
the Infection Control Co-ordinator and Public Health Unit (see
Appendix IV for Emergency Department SARS Patient Assessment
Guidelines and Appendix XIII for Close Contact Info. Sheet).
vii)
Upon admission to a unit, all direct-admit patients (those who
bypass the ER) will be screened for SARS by the attending
nurse (SARS Screening Tool is used in addition to the completion
of patient data base - see Appendix I)
viii)
Any person(s) accompanying a direct-admit patient who is
determined to be SARS by the nursing admission history, must
be given a surgical mask and sent to ER for assessment for
SARS and dealt with accordingly (see v)
ix)
All in-patients are to be assessed daily by their Attending
Nurse for any NEW onset of symptoms of fever, cough, hypoxia
and shortness of breath and such occurrences must be
reported to the attending physician and Infection Control
immediately.
x)
Any patient developing new onset of symptoms after
admission (unexplained cough, unexplained fever, hypoxia,
shortness of breath or difficulty breathing) will be placed on
SARS infection control precautions (privacy drape closed, N95
mask, gown, gloves, protective eyewear for patient contact,
surgical mask for patient to wear) until assessed by a physician.
xi)
Patient will remain on precautions and be moved to a private
(negative pressure) room if medically indicated or be taken off
precautions if another diagnosis is confirmed.
xii)
The daily Fever/Pneumonia Surveillance Form must also be
filled out when such patients are identified (see Appendix II)
PATIENT PLACEMENT/ROOM DESIGNATION
i)
Any patient who meets the SARS case definition (categories 1- 4)
will be given a surgical mask to wear (if tolerated) and
immediately placed in one of the SARS designated rooms (see
table on next page)
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
ii)
iii)
PAGE 3 OF 13
Any person accompanying the person will also be given a surgical
mask to wear and asked to wait in the same room.
The door to the room will remain closed at all times.
Case Definition
SARS Designated Rooms
Probable
Or
Suspect
Take patient directly to
1st - ICU (Rm 124, negative pressure room)
2nd - Medical Unit (Rm 165, negative pressure)
3rd - Obs/Surg. Unit (Rm 264, negative
pressure)
4th - SARS Unit (outbreak situation)
If bed unavailable, place directly in :
1st - Room 8 (negative pressure room)
2nd - Room 10 (closed door)
until one of the above rooms are available
Persons Under Investigation
Or
Community Acquired
Pneumonia & Other febrile
respiratory illness
Place directly in the following for Assessment:
1st - Room 8 (negative pressure room)
2nd - Room 10 (closed door)
If admission is required, take patient from above
to:
1st - ICU (Rm 124, negative pressure room)
2nd - Medical Unit (Rm 165, negative pressure)
3rd - Obs/Surg. Unit (Rm 264, negative
pressure)
4th - SARS Unit (outbreak situation)
2.3
COMMUNICATION AND NOTIFICATION
SARS is a reportable communicable disease. Public Health must be
notified of any case that fits the "Probable", "Suspect" or "Person Under
Investigation" case definitions.
i)
The triage RN will immediately inform the ER physician and the
ER charge nurse of any suspected case of SARS so that
arrangements can be made to assess the patient in the required
environment with the necessary protection.
ii)
Between 0830 - 1630 hr, the Attending Nurse of the patient will
notify the Infection Control Co-ordinator (or designate) who in
turn will notify Simcoe County Public Health.
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
2.4
2.5
PAGE 4 OF 13
NOTIFICATION (con't)
iii)
Off hours and Weekends, the Attending Nurse will phone and
provide a report to the Public Health Duty Officer (734-8804) and
notify the Infection Control Co-ordinator by voicemail.
iv)
The following information must be provided:
 date and time of call
 Patient's name and MO#
 Any epidemiological links
 Symptoms
 Diagnostic tests performed (results)
 Precautions implemented
 Name of person reporting
iv)
Contact tracing will be initiated by the assessing Physician in
collaboration with the Attending Nurse and the Infection Control
Co-ordinator for patients with suspect or probable SARS or
patients under investigation for SARS.
v)
Should unprotected SARS exposure or evidence of SARS
transmission occur in the hospital, the Medical Officer of Health
will be notified and the guidelines for Risk Identification and
Management of New SARS Occurrences will be followed (see
Appendix V).
DIAGNOSTIC TESTING
Aside from routine investigation required to manage the patient, it
is recommended that all patients with respiratory illness or
prodromal symptoms with no known cause should undergo the
investigations outlined in the table below to determine the cause
of their symptoms.
Test to Order
Rapid influenza A and B
Rapid RSV
Rapid parainfluenza 1, 2, and 3
Rapid adenovirus
Viral cultures
IgM for Mycoplasma - order STAT
Urine for Legionella antigen
Bacterial cuture and sensitivity
Specimen to Collect
Nasopharyngeal swab or tracheal
aspirate
Blood in Red top tube
Urine Bottle
Tracheal aspirate or sputum
SARS specific testing is only to be ordered in consultation
with public health who can help expedite the testing if it is felt to
be indicated. Refer to Appendix VI for current recommended
diagnostic testing.
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
2.6
PAGE 5 OF 13
TREATMENT
At the moment, there is no vaccine or cure for SARS. Patients are
treated with antibiotics and antiviral agents and receive
supportive care (e.g. oxygen, hydration by IV fluids, placed on a
ventilation etc)
2.7
INFECTION CONTROL PRECAUTIONS
In addition to following Routine Practices for each and every patient,
all patients with suspected or confirmed SARS will be placed on
ENHANCED CONTACT/ DROPLET/AIRBORNE PRECAUTIONS.
1. Patient Placement
i)
Patients will be placed in a single, negative pressure room
(Negative pressure rooms are located in ER - Rm 8, ICU - Rm #124,
Medical - Rm. #165, Obs/Surg - Rm. # 264 or SARS isolation Unit
in case of outbreak)
ii) The door to the room must remain closed at all times.
Note: If patient is placed in a room with an anteroom, one door
must remain closed at all times (eg. Exit into the anteroom and
make sure the door is closed prior to opening the next door)
iii) All unnecessary items are to be removed from the room. This
includes bed curtains and window curtains (when not required
for patient privacy), upholstered furniture, extra tables, chairs etc.
Note: With individual patient rooms, drapes around beds are not
necessary and should not be used.
iv) Patients will remain in their rooms except for test, treatments or
therapy which are medically necessary or urgent which can not
be provided in the room.
Note: Whenever possible, diagnostic procedures (e.g. X-rays) or
therapies (e.g. physiotherapy, chiropody) should be performed
in the patient's room.
v)
A Daily Contact Sheet will be placed and maintained on the door
of any patient with suspected or probable SARS (see Appendix XII).
All persons entering the room must sign this contact tracking
sheet. Upon discharge, the Contact Sheet(s) will be filed with the
patient's chart and become part of the medical record.
2. Signage
i)
Place a "CONTACT/DROPLET/AIRBORNE" sign on the patient's
door advising all persons to check in at the nursing station before
entering the room.
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
2.8
PAGE 6 OF 13
INFECTION CONTROL PRECAUTIONS (con')
3. Handwashing
HANDWASHING IS THE MOST IMPORTANT HYGIENE MEASURE FOR
PREVENTING THE SPREAD OF HOSPITAL-AQUIRED INFECTIONS.
i)
Hands will be washed with alcohol hand rinse (e.g. Cida Rinse)
using friction for 15 seconds before and after patient contact, after
touching contaminated equipment or surfaces, after gloves are
removed and before leaving the room.
ii) Patients and visitors will be offered the opportunity to review the basic
principles of handwashing. Use the pamphlet on "Handwashing" to
assist with teaching.
4. Personal Protective Equipment
(See Appendix VIII for summary of PPE to be worn)
i)
All staff assigned to a SARS room/unit will wear a clean surgical
scrub suit provided by the hospital (to be put on each shift upon
arrival and removed before leaving the hospital).
ii) When providing direct care to any SARS patient, all health care
providers must wear:
a) an N95 mask
b) gown * (double gown if gown may be soiled during care)
c) gloves pulled over the sleeves (2 pairs, double glove - if gross
contamination of hands is likely, outer gloves may be removed
after completing one task and before proceeding to the next task)
d) protective eye and face covering (use either safety glasses and
full-face shield OR goggles and full face shield
Note: should a full-face shield be temporarily unavailable, a
surgical mask with attached face shield ("fluid shield") is
acceptable - worn over the N95 mask.
e) protective hair/head cover cap *
f) shoe booties
Note: * gown and hair cover may be replaced by hooded coverall
iii) For any changing of clothes, staff must continue to wear N95 mask
and take all efforts to minimize aerosolization.
iv) All staff are to follow the written routine procedures provided for
applying and removing personal protective equipment (see Appendix
IX)
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
PAGE 7 OF 13
5. Patient Care Equipment
Meticulous cleaning of patient equipment must be carried out
by all staff.
i)
Every effort should be made not to share patient care equipment.
If any equipment must be shared (oxygen saturation probes,
glucometers, Doppler, etc.) the equipment will be thoroughly wiped
down after each use with a cloth well-saturated with hospital
approved disinfectant (e.g. Enviro 256) prior to leaving the room.
ii) Leave non critical items to be used only for the patient in the room
e.g. stethoscopes, flashlight, portable blood pressure cuffs,
commode chairs etc. and store them in a designated place. This
equipment must also be wiped down after each use with a cloth
well-saturated with hospital approved disinfectant.
Note: disinfectants that may be used include stabilized accelerated
hydrogen peroxide products, quaternary ammonium
compounds, phenolics, and 1/100 dilution of household bleach.
iii) Ensure adequate supplies are maintained in the room (e.g. gloves,
patient surgical masks, cloths well-saturated with disinfectant);
however, do not over stock supplies in the patient's room.
iii) Any supplies which cannot be surface wiped and disinfected must
be discarded at the time of discharge.
iv) All equipment which is to be put back into general use for other
patients such as IV poles, blood pressure cuffs, oximetry machines
etc. must be thoroughly cleaned and disinfected with hospital-grade
disinfectant
v) Any equipment that must be sent to CSR for reprocessing will be
double-bagged (outside bag will be yellow biohazard bag)
vi) Use of floor tubs and showers is restricted.
6. Patient Care Activities
Minimize patient contact at all times with no direct contact that is
not absolutely necessary.
i)
ii)
Patients are to wear surgical mask at all times (unless medically
contraindicated) when anyone else is in the room. Ensure patient
has mask supply in room.
Staff will position themselves to avoid being exposed to droplets
(e.g. not directly in front of patient if coughing, rather standing off
to the side).
iii)
Staff will stay a minimum of 2 meters away from the patient
whenever possible.
Patients should be asked to turn their head away as necessary
e.g. when in close proximity such as when blood is being taken
and when coughing, sneezing, etc.
iv)
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
PAGE 8 OF13
6. Patient Care Activities (con't)
v)
Tympanic temperature probes should be used where possible and
if not possible, adult patients should take own oral electronic
temperature and report to nurse.
vi)
If the patient requires a nasal culture (nasopharyngeal
swab/aspirate or nasal swab as per hospital procedure)or throat
swab, their surgical mask should be removed to expose only the
mouth or nose as required.
vii)
Optimal use of anti-emetics to minimize vomiting is essential
viii) Bed linens should be changed in ways that minimize dust
generation i.e. DO NOT SHAKE sheets, rather gently fold or roll
sheets and place in linen hamper.
ix)
Minimize air turbulence when emptying linen and garbage bags.
x)
Use disposable bedpans and urinals when possible. If reusable
ones must be used, do not rinse bedpans with a spray wand.
While wearing all personal protective equipment described above,
carefully pour out urinals and bedpans into toilet. Place soiled
urinals, bedpans and washbasins in a leak-proof sealable bin
with cover or a biohazard bag. Arrange for transport to CSR for
low-level disinfection by an automated cleaning process.
xi)
Dispose of or replace reusable urinals / bedpans after each use.
xii)
When performing aerosol-generating procedures (e.g. intubation)
follow the guidelines for high risk procedures (refer to Policy and
Procedure " Guidelines for High Risk Procedures when dealing
with Patients in Critical Care Areas)
7. Linen and Laundry
i)
ii)
All linens will be placed in the laundry hamper provided in
the patient's room. Double bag the linen when taking it out of
the patients room (refer to Appendix XI for proper double
bagging procedure).
No special laundering is required. Normal washing (at 22°C 55°C) and drying cycles are sufficient.
8. Dietary
i)
ii)
Although regular dishwashing cycles will clean dishes and
cutlery sufficiently for reuse, disposable dishes and eating
utensils will be provided to all SARS patients in order to make
their disposal easier and more efficient.
Notify Nutrition and Food Services of the isolation to ensure
the use of disposable dishes.
iii)
Food trays are not disposable and are NOT to enter the
patient's room.
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
PAGE 9 OF 13
9. Housekeeping
Because there is a potential role for the environment in the
transmission of SARS, procedures for the routine cleaning and
disinfection of environmental surfaces must be diligently followed by
housekeeping personnel (See Appendix X for detailed procedure).
10.Waste Handling
To ensure safe storage, handling, transportation and disposal of all
waste generated in the case of a probable, suspect or under
investigation SARS patient, all waste will be handled in the following
manner:
i)
ii)
iii)
iv)
Each waste container in the isolation room will be lined with a
green garbage bag.
Routine sharps precautions will be followed (e.g. sharps
disposed of in biohazard box).
All garbage is to be double-bagged on leaving the patient's
room (refer to Appendix XI for technique)
Housekeeping Service staff will pick up garbage/waste
containers, according to their normal pick up schedule, and
transport them to the loading area for pick up by the
contracted licensed medical waste disposal company.
11.Handling of Specimens
It is imperative that specimens from suspected or confirmed
SARS patients be handled with utmost care to minimize risk to
clinical, transport and laboratory personnel.
i)
ii)
ii)
iii)
iv)
Only necessary items for collection of a specimen are to be
taken into the patient's room.
All specimens are to be removed from the room by placing the
container into a biohazard bag held by a person on the outside
of the patient's room.
Any "SARS" specimen must NOT be sent by the pneumatic
tube. They should be hand-delivered to the laboratory in the
appropriate specimen container in a biohazard bag.
Gloves must be worn when transporting specimens and taken
off after delivery before leaving the lab.
Any "SARS" patient specimen that has been contaminated on
iii)
v)
the outside of the specimen container by any bodily secretion
(including respiratory secretions, blood splashes or droplets)
should be wiped down with alcohol prior to enclosing in the
plastic biohazard bag and sending to the lab.
All specimens from a patient with suspected or probable SARS
must have "SARS" clearly noted on each order entry
requisition (to ensure quicker processing of samples and
appropriate infection control precautions in the lab).
Any testing on "SARS" patients should be limited to tests
absolutely required for patient care.
12. Transporting the Patient within the Hospital
i)
When a test, treatment or therapy is medically necessary or
urgent and can not be provided in the patient's room,
individual assessment of each patient should be done to
determine the risk posed in the hospital of transporting the
patient.
SEVERE ACUTE RESPIRATORY SYNDROME (SARS) PAGE 10 OF 13
12. Transporting the Patient within the Hospital (con't)
ii)
iii)
v)
vi)
vii)
viii)
For tests or treatments which can be delayed, they should be
scheduled to occur at the end of the day or when other
patient contact is at a minimum.
The receiving department or area must be informed in
advance regarding the special precautions required so
preparations can be taken in order to treat the patient.
Patients will be transported in wheelchairs or stretchers to
other departments for tests wearing a surgical mask.
Staff transporting the patient must wear full personal
protective equipment (N95 mask, gown, double gloves,
protective eye/face wear)
Stretchers and wheelchairs will be covered with a clean sheet.
After use, remove the sheet and wipe down the equipment
with a hospital grade- disinfectant solution.
All equipment in contact with the patient must be disinfected
after contact.
13. Visitors
i)
Visitation will be restricted (no visitors) for patients with
SARS. Exceptions may be made on compassionate grounds
after discussion with Infection Control as well as Medical and
Nursing staff caring for the patient. In such cases, only one
visitor per patient per day.
ii)
Visitors will follow SARS precautions including protective
apparel.
iii)
The Nurse caring for the patient will instruct visitors:
a. how to properly put on and take off protective apparel
and wash hands.
b. not to go into other areas of the unit (e.g. other patient
rooms, kitchenette etc). If they need something, they
should contact the nurse.
c. not to come to the hospital if they or another family
member has flu-like symptoms
iv)
The Nurse caring for the patient will supervise visitors as
they put on and take off protective apparel to ensure strict
adherence to protective protocols.
SEVERE ACUTE RESPIRATORY SYNDROME (SARS) PAGE 11 OF 13
2.9
EDUCATION OF PATIENTS/FAMILIES/VISITORS
Nursing staff will:
i) provide and review SARS information sheet (see Appendix XII) to
patient and family
ii) review and, if required, provide "Handwashing" pamphlet and/or
demonstrate procedure
iii) instruct the patient to cover his/her nose and mouth with a tissue
when coughing or sneezing and to wear a surgical mask when
others are in the room
iv) instruct the patient on the importance of remaining in the isolation
room
v) review Additional Transmission-Based (Contact/Droplet./Airborne
Enhanced) Precautions with patient and family including putting
on and taking off of personal protective equipment and activity
restrictions.
vi) Contact Infection Control Co-ordinator to respond to additional
questions or concerns as needed.
2.10 DISCONTINUATION OF CONTACT/DROPLET/AIRBORNE
ENHANCED PRECAUTIONS
i)
Patients placed on contact/droplet/airborne enhanced
precautions due to undiagnosed fever or respiratory symptoms
will be reassessed on a daily basis. Precautions will continue until
an etiologic agent is found on laboratory testing or the physician's
clinical judgement determines a diagnosis based on clinical
response. If an organism is found, the precautions specific to that
organism will be instituted in consultation with the Infection
Control Co-ordinator.
ii)
The Attending Physician will discontinue contact/droplet
/airborne enhanced precautions on patients admitted with fever
and respiratory symptoms based on the following criteria:
a) afebrile for 48 hours
b) no new infiltrate on a follow up chest x-ray 48 hours
(COPD/Asthma) or 72 hours (Pneumonia) post admission
c) 24 hours of diuresis (Congestive Heart Failure)
d) improved respiratory symptoms
e) improved oxygen saturation
f) physician's clinical judgement
iii)
Patients with probable or suspect SARS or under investigation for
SARS will remain on contact/droplet/airborne enhanced
precautions until 10 days POST respiratory symptoms and fever
resolution (Note: this may be on home quarantine)
iv)
A physician who discontinues contact/droplet/airborne enhanced
precautions must write an order to discontinue these and must
outline the reason(s) for the discontinuation of precautions in the
medical notes.
v)
SARS patients remaining in the hospital will be considered nonactive if ONE of the following criteria are met;
A) a



patient
no longer requires assisted ventilation and
is at least 28 day s post-onset of symptoms and
has been afebrile for at least 10 days while not taking
antipyretic medication (note: fever due to complications
such as deep venous thrombosis should not prolong
isolation)
OR
B) A patient
 who requires on-going mechanical ventilation must be at
least 35 days post-onset of symptoms and
 must have at least one coronavirus PCR test from both
stool and a naso-pharyngeal swab (taken day 21 or later)
which are negative, and
 must have a respiratory status due to SARS (assessed by
an infectious disease physician, internist or respirologist)
which has been stable or improving for 10 days.
vi)
The decision to deem a case non-active and discontinue SARS
precautions will be a consensus decision between the Physician,
the hospital Infection Control Service and Public Health.
2.11 TRANSFER/DISCHARGE PROCESS AND FOLLOW-UP
i)
Recovering SARS patients will be assessed for ongoing symptoms or
transmissibility of their infection prior to discharge.
ii) Recovering SARS patients and patients with suspected or probable
SARS will NOT be discharged to non-acute care facilities (including
long-term care facilities, complex continuing care hospitals,
rehabilitation hospitals, provincial psychiatric hospitals and other
residential facilities such as retirement homes, seniors' residences)
in either the acute or convalescent stages (exception: in an outbreak
situation, patients may be sent to a specific facility that has been
designated by the Ministry of Health and Long-Term Care to receive
recovering patients)
SEVERE ACUTE RESPIRATORY SYNDROME (SARS) PAGE 12 OF 13
2.12 TRANSFER/DISCHARGE PROCESS AND FOLLOW-UP (con't)
NOTE: The convalescent stage is considered to be finished 10 days
AFTER the resolution of the fever (without any antipyretic
medication) with resolving (or resolved) cough.
iv) Patients can be discharged as per medical approval.
v)
Prior to discharge (as soon as discharge date is known), the
Attending Nurse will notify the in-house ICC - Infection Control
Co-ordinator (or delegate) who in turn will notify Public Health.
During off hours or weekends, the Attending Nurse will notify the
Public Health Duty Officer on Call (734-8804) and leave a voice mail
message for the ICC.
vi) The Attending Physician and Infection Control /Public Health will
decide, based on new or ongoing symptomatology (or host factors
e.g. the frail elderly, immunosuppressed patient) whether
continuation of isolation beyond the 10-day period is warranted.
vii) Recovering SARS patients will remain on isolation in the home or
designated care facility or in hospital if awaiting placement in a
non-acute facility (as described above in "ii") for a total of 10 days
after the resolution of fever (without antipyretic medication) with
resolving (or unresolved) cough.
viii) If a convalescing SARS patient is to receive in-home services while
on isolation, the attending nurse will review and/or provide the
patient with:
a) written instructions regarding home isolation and self monitoring
requirements and contact information (see Appendix XV)
b) a "SARS Discharge Patient Kit" which contains a 48 hours
supply of surgical masks and a thermometer.
ix) If the patient is being discharged to CCAC, the Attending Nurse
will clearly communicate the patient's SARS status to the Case
Manager during the discharge planning process.
x)
If transfer in any mode of transportation (ambulance, taxi, relative's
car, Wheeltrans, etc.) between any health care facilities is required,
the "Provincial Inter-facility Patient Transfer Directives involving the
completion of the "Patient Transfer Authorization" Form and
process to receive POC Patient Transfer Authorization Number
approval will be followed (see Appendix XVI).
Note: A Patient Transfer Authorization Number is not required from
a health care facility to a medical appointment outside a
health-care facility (dentist, family physician, ophthalmologist,
chiropodist, etc.) or a transfer home.
SEVERE ACUTE RESPIRATORY SYNDROME (SARS) PAGE 13 OF 13
2.13 TRANSFER/DISCHARGE PROCESS AND FOLLOW-UP (con't)
xi) The Attending Nurse will instruct their patients that if they return
to an institution or clinic for any reason, they must advise that
facility if they are still on quarantine for SARS.
xii) The Attending Nurse will notify the receiving agency and ambulance
service in advance by phone and in writing of the patient's SARS
status.
ASSESSMENT:
The Manager of Housekeeping, Nurse Managers and Infection Control Co-ordinator
will monitor activities and review all cases of SARS to ensure 100% compliance.
DISTRIBUTION:
Administration (Master)
Nursing
Infection Control
Cardiorespiratory
Laboratory
LUK:aa
Pharmacy
DI
Environmental Service
Food & Nutrition Service
Reference: SARS Provincial Operations Centre: Directives to All Ontario Acute Care Facilities. May 13
& May 16, October 22nd, 2003.