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The most common source of transmission of SARS-CoV has been healthcare
facilities. Consequently, control of spread in healthcare facilities
is critical to controlling SARS. The keys to quickly controlling SARS
are rapid and appropriate decision making and rapid and effective implementation
of response activities. The need for rapid and effective responses requires
that planning and preparedness activities precede SARS-CoV activity.
The following checklist is a planning tool for healthcare providers.
The checklist format is not intended to set forth mandatory requirements
or establish national standards for healthcare preparedness. Rather,
each healthcare facility should determine for itself whether it is adequately
prepared for disease outbreaks in accordance with its own procedures.
Structure for planning and decision making
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Designate
a planning and response committee that includes representatives
from a variety of departments (e.g., administration, infection
control, hospital epidemiology, etc.) |
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Identify
the local or state health department contact who will serve as
liaison for SARS preparedness planning and response. |
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Identify
a SARS coordinator to serve as the facility's point of contact
for communication of information internally and externally. |
Written SARS preparedness and response plan
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Develop
written policies and work practices for SARS patients that minimize
the risk of transmission to other patients, healthcare workers,
and visitors. |
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Define
a system to review and update the plan as new information and strategies
develop. |
Function and capacity of the facility to respond to SARS
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Test
the facility's SARS response capabilities of the facility by using "table
top" or other exercises. |
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Identify
criteria and methods for measuring compliance with the implementation
of response activities. |
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Develop
strategies to quickly correct deficiencies in implementation of
response activities. |
Surveillance, screening, triage, and evaluation in healthcare
facilities
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Ensure
that clinicians can promptly detect, report, and manage potential
SARS patients. |
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Identify
a local or state health department contact to coordinate surveillance
for cases of SARS. |
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Develop
measures for symptom monitoring and reporting of healthcare workers
and patients potentially exposed to SARS-CoV, in accordance with
public health recommendations. |
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Educate
clinical healthcare providers about signs and symptoms of and risk
factors for SARS-CoV disease. |
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Be
prepared to recognize and report unusual clusters of pneumonia. |
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Know
where and how to promptly report a potential SARS case to hospital
and public health officials. |
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Develop
procedures for rapidly implementing appropriate isolation and infection
practices for potential SARS patients. |
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Develop
procedures to perform an appropriate and safe evaluation of patients
with SARS-like illnesses that accounts for level of SARS-CoV transmission. |
Infection control, isolation, and cohorting measures, and environmental
controls
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Develop
comprehensive isolation and infection control guidelines and strategies
for patient-related activities in the hospital and optimal overall
safety of staff, patients, and visitors. |
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Develop
a patient placement and transport plan that ensures appropriate
isolation and infection control strategies to minimize the risk
of transmission to staff, patients, and visitors. |
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Develop
a plan to formally monitor and reinforce compliance with PPE measures
and to update those measures as needed as a SARS outbreak progresses. |
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Develop
optimal patient placement strategies that account for the availability
of AIIRs. |
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Review
and ensure that air-handling capacity of rooms is adequate for
isolation and infection control needs of SARS patients. |
Exposure reporting and evaluation of risk Educate staff regarding:
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Modes
of SARS-CoV transmission |
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Risks
associated with different patient-care procedures |
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Risks
to healthcare workers, patients, and visitors |
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Importance
of reporting exposures and illness |
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How
and to whom to report SARS-CoV exposures and illness |
Administrative and organizational activities
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Determine
the minimum number and categories of personnel needed to care for
a single patient or small group of patients on a given day. |
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Determine
whether a small group of staff, including ancillary staff, could
be assigned responsibility for providing initial care for SARS
patients. |
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For
teaching hospitals, determine what role, if any, students and other
trainees (e.g., residents, fellows) will play in the care of SARS
patients. |
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Develop
a strategy to meet the staffing needs as the number of SARS patients
increases and/or personnel become ill or are quarantined. |
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Develop
a strategy to ensure the availability of a sufficient number of
infection control practitioners (ICPs) to allow for daily monitoring
and assessment of all patient-care areas. |
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Develop
a plan for healthcare workers that includes criteria for furloughs
and work restrictions, appropriate measures to help healthcare
workers comply with restrictions
(including access to mental health professionals), follow-up after unprotected
exposures to SARS patients, and notification of multiple facilities
at which
they work. |
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Establish
criteria and protocols for controlling access to hospitals, including
admissions, transfers, discharges, and visitors. |
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Develop
a plan that determines when and how to involve security services
to enforce access limitations. |
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Establish
criteria and protocols to determine when to close the facility
to new admissions and transfers. |
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Assess
anticipated needs for consumable and durable resources required
to provide care for various numbers of SARS patients, and develop
a plan to meet the extra need. |
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Develop
a back-up plan to deal with the possibility of limited supplies. |
Communication and reporting
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Establish
a mechanism and contacts for regular communications with the state
and local health departments. |
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Develop
a plan to communicate with and report to health departments information
on SARS activity in the healthcare facility and information on
exposed visitors. |
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Develop
a plan for discharge of SARS patients and appropriate follow-up
and case management in the community. |
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Address
jurisdictional and procedural issues for the investigation of nosocomial
SARS outbreaks. |
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Develop
a plan to provide daily updates to the infection control staff
and the hospital administration regarding SARS activity in the
facility and the community. |
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Develop
a plan for the flow and release of information related to SARS
patient care or SARS-CoV transmission in the facility. |
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Develop
criteria to determine whether and how the facility will establish
a SARS hotline for public inquiries. |
Community healthcare delivery
Determine how the healthcare facility will participate in and be affected
by community-level healthcare-related issues such as:
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Community
management of SARS patients |
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Expansion
of AIIR facilities |
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Training
of first responders to safely manage SARS patients |
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Development
of community-wide strategies to meet healthcare worker shortages
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PPE supplies |
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Funding
needs |
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Legal
regulations |
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Liability
issues related to healthcare personnel |
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