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Severe Acute
Respiratory Syndrome (SARS) |
Health-care
workers caring for patients with Severe Acute Respiratory Syndrome (SARS)
are at risk for acquiring SARS. Although the infectivity of SARS is currently
uncertain, transmission to health-care workers appears to have occurred
after close contact with symptomatic individuals (e.g., persons with fever
or respiratory symptoms), particularly before implementation of recommended
infection control precautions for SARS (i.e., unprotected exposures).
Personal protective equipment appropriate for standard, contact, and airborne
precautions (e.g., hand hygiene, gown, gloves, and N95 respirators) in
addition to eye protection, have been recommended for health-care workers
to prevent transmission of SARS in health-care settings (see the Infection
Control and Exposure Management page).
The transmission
of SARS appears to occur predominantly by direct contact with infectious
material, including dispersal of large respiratory droplets. However,
it is also possible that SARS can be spread through the airborne route.
Accordingly, CDC has recommended the use of N95 respirators, consistent
with respiratory protection for airborne diseases, such as tuberculosis.
SARS, unlike
tuberculosis, also appears to spread by direct contact with respiratory
secretions, which makes touching contaminated objects a potential concern.
Although reaerosolization of infectious material is unlikely under normal
use conditions, infectious material deposited on a respirator may cause
it to become a vehicle for direct or indirect transmission. Therefore,
additional infection control measures applicable to this specific situation
are needed.
This interim
guidance provides information on the selection and handling of respirators
for SARS and includes guidance for when respirators are either not available
or in short supply.
- A NIOSH-certified,
disposable N95 respirator is sufficient for routine airborne isolation
precautions. Use of a higher level of respiratory protection may be
considered for certain aerosol-generating procedures (see Infection
Control Precautions for Aerosol-Generating Procedures on Patients Who
Have SARS).
- Respirators
should be used in the context of a complete respiratory protection
program in accordance with OSHA regulations. This includes training
and fit testing to ensure a proper seal between the respirator’s
sealing surface and the wearer’s face. Detailed information
on respirator programs, including fit test procedures can be accessed
at www.osha.gov/SLTC/etools/respiratory.
- Once
worn in the presence of a SARS patient, the respirator should be
considered potentially contaminated with infectious material, and
touching the outside of the device should be avoided. Upon leaving
the patient’s room, the disposable respirator should be removed
and discarded, followed by hand hygiene.
- If a
sufficient supply of respirators is not available, healthcare facilities
may consider reuse as long as the device has not been obviously soiled
or damaged (e.g., creased or torn). Data on reuse of respirators for
SARS are not available. Reuse may increase the potential for contamination;
however, this risk must be balanced against the need to fully provide
respiratory protection for healthcare personnel.
If N95 respirators are reused for contact with SARS patients, implement
a procedure for safer reuse to prevent contamination through contact
with infectious droplets on the outside of the respirator.
- Consider
wearing a loose-fitting barrier that does not interfere with fit
or seal (e.g., surgical mask, face shield) over the respirator.
- Remove
the barrier upon leaving the patient’s room and perform hand
hygiene. Surgical masks should be discarded; face shields should
be cleaned and disinfected.
- Remove
the respirator and either hang it in a designated area or place
it in a bag. (Consider labeling respirators with a user’s
name before use to prevent reuse by another individual.)
- Use
care when placing a used respirator on the face to ensure proper
fit for respiratory protection and to avoid contact with infectious
material that may be present on the outside of the mask.
- Perform
hand hygiene after replacing the respirator on the face.
- When
elastomeric (rubber) or powered air purifying respirators (PAPRs) are
used, their reusable elements should be cleaned and disinfected after
use, in accordance with manufacturer’s recommendations. When half-
or full-facepiece elastomeric negative pressure respirators are used
by more than one individual, filters should be replaced between individual
users. When PAPRs are used, the filters should be replaced following
manufacturer’s recommendations. All used filters must be safely
discarded.
- Respiratory
protective devices with a filter efficiency of 95% or greater (e.g.,
N95, N99, N100) may not be available in some settings due to supply
shortages or other factors. In this situation, a surgical (procedure)
mask should be worn. Surgical masks will provide barrier protection
against large droplets that are considered to be the primary route of
SARS transmission. However, surgical masks may not adequately protect
against aerosol or airborne particles, primarily because they allow
for leakage around the mask and cannot be fit tested. The mask should
resist fluid penetration and fit tightly around the mouth and nose when
properly applied to the face.
- Hand
hygiene is urged for all contact with suspect SARS patients or objects
that may be contaminated with the virus that causes SARS, including
hand washing with soap and water; if hands are not visibly soiled, alcohol-based
hand rubs may be use as an alternative to hand washing.
- For additional technical information regarding respirators, see the web site of the NIOSH National Personal Protective Technology Laboratory, or call 1-412-386-4000.
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