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SARS on CNN 8:30pm 4/22

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

Thank you.

debbyed

Specializes in ER, Hospice, CCU, PCU.

ON the news tonight...New possible case in Baltimore...A visitor from Hong Kong or China I believe...This is definately much to close to home.

did you all hear the report on Toronto's SARS on the ABC News tonight?? They said 25 % of the cases in Toronto were

health care workers ! And, that the health care workers had been gowning, masking, goggles, gloving, the whole 9 yards...Now, being asked to double gown-double glove-wear face shield with mask.....

scary for the Toronto folks...

Originally posted by debbyed

ON the news tonight...New possible case in Baltimore...A visitor from Hong Kong or China I believe...This is definately much to close to home.

Ack. I live in Baltimore.

Passing thru wrote:

>

This from the Toronto Star:

>

From:

Apr. 21, 2003. 01:00 AM

Doctors look at flu for answers

Like it, illness could mutate

TANYA TALAGA

MEDICAL REPORTER

http://thestar.com/NASApp/cs/ContentServer?GXHC_gx_session_id_=1b83347d54758bcc&pagename=thestar/Layout/Article_Type1&c=Article&cid=1035781086877&call_pageid=1049194989222&col=1049194988383

______________________________

Percentage of SARS patients who are HCWs (Health Care Workers):

Mainland China - currently being reported as 23% (456 HCWs/2001 total cases). The accuracy of the Chinese statistics is questionable.

Hong Kong - reported as 24-25%

.

Toronto - reported as 45% by the Toronto Star, now apparently as 25% by ABC News Tonight.

Singapore - 90% of SARS cases are reported as contracted in the health care setting, but this lumps together HCWs, patients, and visitors. I have not been able to tease out HCW stats separately on Singapore.

U.S. - 3% (CDC)

Good night,

Epaminondas

Just some facts re SARS: out of the 261 probable and suspect cases of SARS in Ontario, 73 have been health care workers. Now the question is how many of those health care workers became ill before isolation precautions were imposed and how many have become ill since?

I don't know how this breaks down, but the first group of nurses and doctor and other personel that became ill from contact at Scarbourough Grace Hospital were not using isolation precautions initially because they didn't know what they were dealing with. Now that precautions are being used, health care workers continue to become ill with SARS related to patient contact despite wearing protective gear. Just this week somewhere between 6-10 nurses, doctors and RTs are either probable or suspect SARS.

I am also curious to see if any immunity exists after having SARS and recovering from it. Can someone get it again if re-exposure occurs? Time will tell.

I am also curious to see if any immunity exists after having SARS and recovering from it.

SARS is a virus isn't it?

I don't think you can stimulate memory B-cell production from viral infections(been awhile since A&P though).

This disease has caught my attention since I live in an international area of the country(Baltimore-D.C.-New York) and it appears to have the capability to be pandemic. I'm in an Army medical unit as well, for the National Guard. During our annual drill in June I'll be in an acute care type position. Knowing what it is, how it's spread, and the S&S will be critical.

My "ear is to the rail" and I will be posting as I find news-worthy information.

BTW: I don't think SARS can get through proper precautions, such as double gloves, mask, goggles, gown.

I do think that a hospital would be reluctant to properly report working conditions though.

Peeps

SARS is a virus.

As to the matter regarding SARS "getting through" masks, double gloves ect... the problem has been with the way we are using the equipment. Example- taking the mask off, as you do, the outer edge of the large N95 touches your cheek, the outer edge of the mask has been on the outside, exposed to the SARS virus and now it is on your cheek. You then rub your eyes........ no one counted on it being so virulent...I don't think.

Another problem has been with nurse exhaustion.... all that garb, plus the masks ...plus the stress and the fatique factor and the personal strive, all it takes is one time you forget to remove your gloves the right way...... any breakdown at all and it can lead to transmission.

At the same time you are dealing with sick patients, worried families calling since they can not visit and families of your own at home worried since you are in the eye of the storm.

BTW ....Toronto has now been added by WHO as places to avoid for unnecessary travel.

Thanks, Peeps for the info, my A&P is rusty as well. We have been revising isolation protocols almost daily as new information is released. Now we use an N-95 mask covered by a face mask with full face shield, double glove, double cap, double gown and booties with each entrance into SARS isolation rooms. Like JMP mentioned, taking off the protective gear is the worry. We take off the first layer- outer gloves first, followed by outer gown and cap in the patient room, then remove last set of gloves, go out of the room to the antiroom and wash hands remove shield and wash hand and then lastly remove mask and put on a new one, the outer shield protects the inner mask and always washing hands in between touching any part of your body protects contamination........I hope.

I know all the top notch scientists are looking at this and doing their best to come up with the best way to deal with this virus and the people who must be in contact with it. I finally have a few days off and I hope things are a little less stressful when I return.

Another death yesterday, unfortunately it looks like more to come before this is under control.

I was wondering if weak link could be a fellow worker that might be infectious without being symptomatic. They are using the same bathrooms as the rest of the staff and no one knows for sure who is contageous until they are really, really sick.

I did some brief research on Infotrac but most of the articles I saw are from newsmagazines. The reputable on-line material that I've found so far is $12 per article.

I need to get a subsciption to a good source ( I'm too lazy to go to the med library downtown).

Anyone have a good on-line, or hardcopy source for epidemiology?

I did see an interesting comment in a summary that should be considered.

Of all the contact that lab techs have had in studying this paticular virus, none of them have reported being infected.

I think you are all on the right track with the idea that procedure for donning and removing protective gear may be at fault.

I say find out how the lab techs do it.

Posted by Oramar

I was wondering if weak link could be a fellow worker that might be infectious without being symptomatic. They are using the same bathrooms as the rest of the staff and no one knows for sure who is contageous until they are really, really sick.

Very good point Oramar.

We all know those people that think handwashing is optional, or it is not important to follow a certain procedure when doing it. :devil: While they're asymptomatic, it could be traveling mass transit.

I think enough patients of the "typhoid Mary" would be infected as to cause a link to them though.

I really don't think that there are any asymptomatic carriers, although that was typhoid mary wasn't it!, So far all the potential and suspect SARS victims can be traced back to the initial outbreak in some way- all but one. The people have all had contact with someone exibiting symptoms or exposed to someone who had contact with someone ect ect. The virus is still contained primarily within the medical setting, no reports of scattered cases with no contact arising yet, unlike China.

The staff are all screened before even entering the hospital- temperatures taken, symptoms report asked and questionaire re contacts and other hospitals you may have been in. Several staff have been quarantined as a result of screening failure. Although most times it is just a cold or other illness. But the fearful part is indeed not knowing if someone is contagious, We have had several patients who initially didn't appear to be SARS but later proved to be.

4/21/03

NYS Nurses Association -

Nursing Practice Information: Severe Acute Respiratory Syndrome (SARS)

Severe Acute Respiratory Syndrome (SARS) is an emerging infectious disease that healthcare officials believe is caused by a new strain of coronavirus, a virus responsible for such upper respiratory illnesses as the common cold. Most individuals who have been affected by SARS have experienced a rapidly developing pneumonia. About 10 percent have required mechanical ventilation, and nearly 4 percent have died.

Although SARS appears to be well contained in the United States to date, the New York State Department of Health has just issued a second update. Additional information on SARS can be found online at the Centers for Disease Control:

see NYS Department of Health SARS Update and link to Centers for Disease Control at:

http://www.nysna.org/programs/nps/sars_update.htm

###

Dear toronto rn, I based what I said about transmission via bathroom use on the case in Hong Kong. It is said that a person used a bathroom twice in one apartment complex and everyone in the complex that used the bathroom came down with it even though most had never met him.

debbyed

Specializes in ER, Hospice, CCU, PCU.

First case in Baltimore probably not SARS...Second case however probably is. A doctor who was in Toronto and flew home (2 or 3 different planes) knowing he was ill. Even went into work the next day and was sent home. Classic case of denial.

Excellent JT!

Thanks for the link.

The symptom of 'dry cough' is interesting. This mutation attacks the first line of defense right from the start.

I couldn't get into the CDC site. I imagine there are more than a few people on-line to the server there.

Even went into work the next day and was sent home. Classic case of denial.

I'm sure that a noticeble percentage of the known healthcare worker risk is due to denial, by both the employee and their direct supervisor.

Everyone should carry a mask and gloves and don them at the first symptom, wherever they might be and consider it SARS until shown otherwise.

Employees of hospitals have access to these items which the Damage Control administrators should be strongly encouraging.

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