SARS Management: Lessons Learned at the University of North Carolina Health Care System

BACKGROUND: University of North Carolina Health Care System (UNCHCS) provided care for the eighth laboratory-confirmed case of SARS and a CDC special interest case (clinical symptoms without epidemiological link). The confirmed case was managed on an outpatient basis. The special interest case was critically ill and died with all laboratory tests negative for SARS, including autopsy studies. PROJECT: Hospital Epidemiology Department (ED) was responsible for the implementation of the CDC SARS recommendations. This required the coordinated effort of multiple hospital and university departments and daily contact with the local and state health departments. Due to heightened concern by coworkers of the confirmed case, a special SARS screening clinic was provided for 42 “exposed” people. RESULTS: No SARS transmission occurred. Three employees were exposed to the confirmed SARS case. One was a physician who did not wear protective eyewear during an exam, and two were environmental service workers who failed to wear appropriate protective equipment. Four employees removed their protective eyewear during a code of the special interest case and were considered exposed. LESSONS LEARNED: Use sitters to ensure correct PPE use, provide anti-fog goggles, organize SARS laboratory test kits, provide SARS reference notebook for ED, identify alternative site for outpatient screening with an outside entrance that leads directly to exam rooms, identify ventilation system of emergency transport vehicles, plan for emergency fit-testing, use telephone triage for medical referral/information combined with signs and monitors at entrances regarding SARS alert, consider use of a special SARS precautions sign, use isolation rooms with anterooms, and designate a SARS coordinator for the facility.