Identification and containment of an outbreak of SARS in a community hospital

Abstract

Background: Severe acute respiratory syndrome (SARS) is continuing to spread around the world. All hospitals must be prepared to care for patients with SARS. Thus, it is important to understand the transmission of this disease in hospitals and to evaluate methods for its containment in health care institutions. We describe how we cared for the first 2 patients with SARS admitted to our 419-bed community hospital in Richmond Hill, Ont., and the response to a SARS outbreak within our institution.

Methods: We collected clinical and epidemiological data about patients and health care workers at our institution who during a 13-day period had a potential unprotected exposure to 2 patients whose signs and symptoms were subsequently identified as meeting the case definition for probable SARS. The index case at our hospital was a patient who was transferred to our intensive care unit (ICU) from a referral hospital on Mar. 16, 2003, where he had been in close proximity to the son of the individual with the first reported case of SARS in Toronto. After 13 days in the ICU, a diagnosis of probable SARS was reached for our index case. Immediately upon diagnosis of our index case, respiratory isolation and barrier precautions were instituted throughout our hospital and maintained for a period of 10 days, which is the estimated maximum incubation period reported for this disease. Aggressive surveillance measures among hospital staff, patients and visitors were also maintained during this time.

Results: During the surveillance period, 15 individuals (10 hospital staff, 3 patients and 2 visitors) were identified as meeting the case definition for probable or suspected SARS, in addition to our index case. All but 1 individual had had direct contact with a symptomatic patient with SARS during the period of unprotected exposure. No additional cases were identified after infection control precautions had been implemented for 8 days. No cases of secondary transmission were identified in the 21 days following the implementation of these precautions at our institution.

Interpretation: SARS can easily be spread by direct personal contact in the hospital setting. We found that the implementation of aggressive infection control measures is effective in preventing further transmission of this disease.

Fig. 1: Timeline of the SARS outbreak at York Central Hospital (YCH), Richmond Hill, Ont., from Mar. 7, 2003, to Apr. 11, 2003. The period of unprotected exposure extends from the admission of the first SARS case to YCH on Mar. 16, 2003, to the implementation of hospital-wide respiratory isolation and barrier precautions. That index patient's exposure and first and second admission to hospital were at Scarborough Hospital, Grace Division, Toronto. Photo: Myra Rudakewich

Fig. 2: Interventions taken to contain a SARS outbreak at York Central Hospital, Richmond Hill, Ont. SARS = severe acute respiratory syndrome, ICU = intensive care unit, HEPA = high efficiency particulate air.