1. 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

2. 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

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

4. 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

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

6. 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

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

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

9. 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

10. 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)

11. 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

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

13. 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,

14. 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

15. 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

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