Severe acute respiratory syndrome :Guidelines were drawn up collaboratively to protect healthcare workers in British ColumbiaBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7403.1394-b (Published 19 June 2003) Cite this as: BMJ 2003;326:1394
- Annalee Yassi, executive director (, )
- Michael A Noble, infection control officer,
- Patricia Daly, medical health officer,
- Elizabeth Bryce, director
- Occupational Health and Safety Agency for Healthcare, 301–1195 West Broadway Avenue, Vancouver, BC, Canada V6H 3X5
- Vancouver Coastal Health, 899 West 12th Avenue, Room JPN 1112, Vancouver General Hospital, Vancouver, BC V5Z 1M9
- Vancouver Coastal Health, #800-601 West Broadway, Vancouver, BC V5Z 4C2
- infection control Vancouver Hospital and Health Science Centre, 899 West 12th Avenue, Room JPN 1111, Vancouver General Hospital, Vancouver, BC V5Z 1M9
EDITOR—Detailed measures to protect healthcare workers from severe acute respiratory syndrome (SARS) are paramount. The equipment of choice for respiratory protection is thought to be the disposable N95 respirator. However, without testing the fit, a poor facial seal may result in a reduction to only 33% of ambient levels.1
Guidelines were developed through a collaborative process involving the Workers' Compensation Board of British Columbia (the state's regulatory agency), the Occupational Health and Safety Agency for Healthcare (jointly governed by healthcare unions and employers), and provincial experts in public health, infection control, and infectious disease.2 An important component was a risk assessment designed to reduce the exclusive use of fit tested N95 respirators without diminishing worker safety.
At initial presentation all patients with respiratory symptoms are considered potentially to have SARS, and healthcare workers are required to wear a fit tested N95 respirator and protective eyewear until risk assessment is completed and reasons for admission are ascertained. During the initial period of greatest risk, full personal protective equipment is required (table). As the patient recovers and the risk of aerosolisation reduces, the requirement for a fitted respirator and face protection declines.
Throughout, critical emphasis is placed on hand hygiene and careful use and removal of personal protective equipment to prevent accidental autoinoculation. Staffing must be adequate to meet the increased workload that occurs with SARS patients, to allow healthcare workers to maintain vigilance.
Seto et al noted that transmission of infection was equal among workers wearing either surgical masks or N95 respirators, when high risk of aerosolisation was excluded.3 On the other hand, a review of cases of SARS in Toronto found that some healthcare workers who acquired SARS were not fit tested and had not been trained to use personal protective equipment, which potentially results in accidental autoinoculations.4 This supports the need for a formal programme including fit testing, education on use, and removal of personal protective equipment, as well as a risk assessment approach with full equipment for high risk activities.
Detailed documents on how to apply a risk based approach are now circulating throughout the province along with a programme to train the trainer.5 We hope that lessons learnt from SARS will strengthen our ability to protect healthcare workers and the public from other pathogens.
Important contributions are being made to the control of SARS in British Columbia by numerous organisations and individuals. In addition to the organisations of the authors, special acknowledgement goes to the Workers' Compensation Board of British Columbia for their enormous work in this area, and to the British Columbia Nurses Union, Health Sciences Association, the Health Employers Association, the Hospital Employees Union, British Columbia Centre for Disease Control, and the various health authorities across the province.