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DISPATCHES Severe Acute Respiratory Syndrome Lessons from.pdf

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DISPATCHES Severe Acute Respiratory Syndrome Lessons from

Severe Acute Respiratory Syndrome: Lessons from Singapore Kamaljit Singh,* Li-Yang Hsu,? Jorge S. Villacian,? Abdulrazaq Habib,* Dale Fisher,* and Paul A. Tambyah* An outbreak of severe acute respiratory syndrome (SARS) occurred in Singapore in March 2003. To illustrate the problems in diagnosing and containing SARS in the hospital, we describe a case series and highlight changes in triage and infection control practices that have resulted. By implementing these changes, we have stopped the nosocomial transmission of the virus. An outbreak of severe acute respiratory syndrome(SARS) was first recognized in Singapore on March 12, 2003. The index patient was hospitalized at Tan Tock Seng Hospital, which has since become the country’s des- ignated SARS hospital. The patient infected 20 other peo- ple (including patients and healthcare workers), who sub- sequently became the sources for secondary spread of the infection (1). As of June 12, 2003, a total of 206 cases and 31 deaths attributed to SARS had been reported in Singapore. We describe the important lessons learned during the triage and containment of SARS at the National University Hospital, Singapore. Both involved expanding isolation criteria to include all patients with undifferentiated fever (even in the absence of respiratory symptoms or chest x- ray changes), improving contact-tracing methods, enforc- ing the use of fit-tested personal protective equipment in all patient-care areas, avoiding aerosol-generating proce- dures, and carefully monitoring all healthcare workers for fever or respiratory symptoms. We also highlight the impact of these measures on preventing the entry and nosocomial spread of infection. The Study From March 13 to May 5, 2003, we identified all epi- demiologically linked patients whose disease met the Centers for Disease Control and Prevention’s case defini- tion of SARS issued on April 29, 2003 (2). Initial investi- gations included a complete blood count (with a differen- tial co