Severe Acute Respiratory Syndrome Another Challenge for Critical Care Nurses Karen M. Williamson RN, MScN, PhD(c) Maher M. El-Masri RN, PhD Susan M. Fox-Wasylyshyn RN, PhD

What is SARS? Viral Disease Primarily airborne Contracted by exposure to a new form of coronavirus Symptoms are common: fever; non-productive cough No vaccine or definitive treatment Epidemic is NOT over: It is CONTAINED

Historical Background First case of SARS: November 2002 Started in China Nurses, particularly ICU and ER nurses were at risk for contracting the disease

SARS Statistics: 2004 Total probable/suspected China: 2889 cases USA: 220 cases Canada: 438 cases In Canada: 100 of these were HCWs HCWs contracted SARS d/t: caring for undiagnosed SARS patients who were not isolated; contact with ill family members

Etiology and Transmission SARS viral in origin; contracted by exposure to a novel coronovirus Transmitted: droplet spread; surface contamination; close contact

Prognosis Greatest in patients aged 65 years and older (50%) Risk factors: older age, diabetes, tachycardia, elevated creatinine kinase and LDH levels Predictors of mortality: HTN, diabetes, age, smokers, immunosuppression, respiratory infections

Case Definition Clinical: Temp: 100.4°F Cough, SOB, dyspnea, hypoxia, pneumonia ARDS

Case Definition (cont’d) Epidemiologic: Travel Close contact Laboratory: Detection SARS-CoV Detection SARS-CoV RNA by RT-PCR Isolation SARS-CoV

Clinical Manifestations Fever greater than 100.4°F Non-productive cough Dyspnea Radiologic infiltrates: O2 sat. on room air < 95% No alternative diagnosis can fully explain the illness

Diagnostic Criteria Testing of SARS-CoV based on detection of virus or antibody response to viral infection RT-PCR (nasopharangeal and stool) ELISA or IFA (serum)

The Inter-epidemic period 2004/2005 Definition of SARS alert is based on clinical evidence in the following situations: A. Individual contact/travel B. 2 or more HCWs exhibiting S&S C. 3 or more persons (HCWs and others) with symptoms

Current and Future of Treatment for SARS Antibiotics (not successful) Anti-virals Corticosteroids Supportive intensive care Immunization: in the beginning phase

Clinical Management Infection Control+++ Early identification and patient isolation Patients and HCWs should wear masks/HCWs wear eye protection, gloves, long sleeved gowns, respirator masks, wash hands with ETOH-based skin disinfectants,

Clinical Management (cont’d) Highly recommended: SARS patients should be placed in a room with negative pressure ventilation Lower tidal volumes during mechanical ventilation Continuity of care

Implications for Critical Care Nurses Be viligant for any non-ordinary reports of acute respiratory illnesses Full infection control Become involved in collaborative policy and research efforts to understand SARS and effective clinical management

Conclusion SARS is highly contagious The SARS epidemic has only been contained! Adherence by critical nurses to optimal infection control procedures is MANDATORY!