Management of Suspect SARS Patients: An Opportunity To Redesign Isolation Protocol

ISSUE: Between March and May 2003, 12 patients with symptoms and travel history consistent with the SARS case definition were transported to Oakwood facilities from the Detroit Wayne County International Airport. Existing isolation protocols quickly proved inadequate to meet the challenges raised by the uncertainty of transmission and frequent revisions to CDC-recommended practices. PROJECT: Over a 90-day period, four suspect SARS patients were transferred to Oakwood Annapolis Hospital. Infection control and patient care staff faced numerous challenges maintaining sound isolation procedure as new CDC recommendations were issued and subsequently revised. This prompted development of a new isolation category. Frequent revisions to the recommended precautions caused confusion, distrust, and reduced faith in the integrity of the infection control program. Issues of patient confidentiality, staff fit testing, and N95 availability presented further challenges. RESULTS: The integrity of the SARS management process required round-the-clock attention to and support of staff and visitorsʹ awareness and utilization of prescribed infection control practices. Multiple staff inservice programs and one-on-one counseling of staff and visitors were executed. Fact sheets and isolation instructions with pictures to reinforce donning and removal of PPE were distributed. Flexibility and stamina were in order as infection control staff struggled to reassure patients, staff, physicians, and visitors of risk-reduction efforts. LESSONS LEARNED: A complete needs assessment of isolation practice and protocol was initiated to identify and assess performance gaps. Lessons from patient care and infection control personnel have prompted the revision of Oakwoodʹs isolation, fit testing, and education procedures.