SARS in hospital emergency room

Abstract

Thirty-one cases of severe acute respiratory syndrome (SARS) occurred after exposure in the emergency room at the National Taiwan University Hospital. The index patient was linked to an outbreak at a nearby municipal hospital. Three clusters were identified over a 3-week period. The first cluster (5 patients) and the second cluster (14 patients) occurred among patients, family members, and nursing aids. The third cluster (12 patients) occurred exclusively among healthcare workers. Six healthcare workers had close contact with SARS patients. Six others, with different working patterns, indicated that they did not have contact with a SARS patient. Environmental surveys found 9 of 119 samples of inanimate objects to be positive for SARS coronavirus RNA. These observations indicate that although transmission by direct contact with known SARS patients was responsible for most cases, environmental contamination with the SARS coronavirus may have lead to infection among healthcare workers without documented contact with known hospitalized SARS patients.

Figure 1

Time course during which patients with febrile illnesses were screened for severe acute respiratory syndrome (SARS) (vertical bars) and patients with SARS were detected at the emergency room of National Taiwan University Hospital, March 15–May 12, 2003. The numbers of patients with SARS who were admitted to this hospital is shown in black lines. The number of patients who temporarily stayed in the emergency room or were transferred to other hospitals is shown in red and blue lines, respectively.

Figure 2

Epidemic curves showing three clusters of cases of severe acute respiratory syndrome (SARS) during the outbreak at the emergency room of the National Taiwan University Hospital. The first two clusters (open lines) consisted of patients, family members, and nursing aids. The third cluster (solid lines) consisted entirely of healthcare workers.

Figure 3

Allocation of bed numbers in the observation unit of patients involved in the first cluster (squares) and the second cluster (stars) of severe acute respiratory syndrome at the emergency room (ER) of National Taiwan University Hospital.

Figure 4

Contact history and temporal relationships among contacts according to the date of fever for 19 cases of severe acute respiratory syndrome (SARS) during the first two clusters of SARS at the emergency room of National Taiwan University Hospital. On April 27, fever and pneumonia developed in the index patient (patient 1) of the first cluster. The second cluster from an unknown source was identified on May 8. P, patients. Unlabeled numbers indicate family members or nursing aids. Location in the emergency room is shown in gray bars and in general wards by black bars. Numbers within the gray bar represent bed numbers in the observation unit of the ER. The dates of onset of fever are shown in arrows.