Supplement C: Preparedness and Response In Healthcare Facilities

Footnote *

The current version of Supplement C emphasizes that SARS preparedness and response planning in healthcare facilities should not occur in a vacuum but rather should build on existing preparedness activities and relationships with the public health community. Although healthcare facilities will likely play a key role in the follow-up of exposed patients and healthcare workers, it will be important to coordinate these activities with the local health department, especially for patients being discharged and for healthcare workers who live in the community. Supplement C now recommends that healthcare facilities work with health departments to coordinate this follow-up. Because activity restrictions for healthcare workers who have been exposed to SARS-CoV might depend on the level of SARS-CoV transmission in the community, Supplement C now recommends coordinating decisions on these restrictions with the health department, in accordance with the guidance in Supplement D.

The recommendations for surveillance in healthcare settings have been revised for consistency with the recommendations in Supplement B. The guidance clarifies that, in patients who have epidemiologic links to SARS-CoV, the presence of either fever or lower respiratory symptoms should prompt further evaluation. In addition, in accordance with the new SARS case definition, when persons have a high risk of exposure to SARS-CoV (e.g., persons previously identified through contact tracing or self-identified as close contacts of a laboratory-confirmed case of SARS-CoV disease; persons who are epidemiologically linked to a laboratory-confirmed case of SARS-CoV disease), the clinical criteria should be expanded to include, in addition to fever or lower respiratory symptoms, the presence of two or more other early symptoms of SARS-CoV disease.

The term "universal respiratory etiquette" has been changed to "respiratory hygiene/cough etiquette." Because patients with respiratory infections may not present with fever, the document clarifies that the recommended practices apply to all patients with symptoms of a respiratory infection.

The section on staffing emphasizes that healthcare workers will need logistical and emotional support to help them cope with the challenges of responding to a SARS outbreak.