Intubation of SARS patients: infection and perspectives of healthcare workers
Open accessAbstract
Purpose The outbreak of severe acute respiratory syndrome (SARS) in 2003 presented major challenges to the safety of anesthesiologists and other healthcare workers (HCWs). This study determined the incidence of SARS transmission to HCWs who intubated patients and analyzed the concerns of HCWs regarding personal and patient safety. Methods Healthcare workers who performed tracheal intubation in 10 Toronto hospitals were identified using the Ontario Public Health database. A questionnaire was used to collect information from the HCWs. To determine if the patterns of personal protection or concerns changed over time, data were analyzed according to whether the intubation occurred during SARS 1 (February 23 to April 21) or SARS 2 (April 22 to July 1). Results Thirty-three HCWs who performed 39 intubations on 35 SARS patients were interviewed. Three of 23 HCWs (13%) acquired SARS during SARS 1 whereas none (0/10) acquired SARS during SARS 2. Personal protection increased from SARS 1 to SARS 2 and HCWs' concerns changed over time. During SARS 1, concerns focused on the need for personal protective equipment whereas during SARS 2, concerns focused on the need for strict training and patient care protocols. HCWs perceived that their experiences were ineffectively integrated into risk management protocols. Conclusions Protection guidelines failed to completely prevent the transmission of SARS to HCWs. Nine percent of the interviewed HCWs who intubated patients contracted SARS. A Risk Analysis Framework is presented to facilitate the rapid integration of HCWs' experiences into practice guidelines.
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Supportive evidence for the interaction between mask type and protection was seen in within-study comparisons, including that N95 had a stronger protective association compared with surgical masks or 12-16-layer cotton masks, and that both N95 and surgical masks had a stronger association with protection versus single-layer masks.
“Supportive evidence for this interaction was also seen in within-study comparisons (eg, N95 had a stronger protective association compared with surgical masks or 12–16-layer cotton masks); both N95 and surgical masks also had a stronger association with protection versus single-layer masks.”
In 13 unadjusted studies and two adjusted studies, eye protection was associated with lower risk of infection (unadjusted n=3713, RR 0·34, 95% CI 0·22 to 0·52; AR 5·5% with eye protection vs 16·0% with no eye protection, RD −10·6%, 95% CI −12·5 to −7·7; adjusted n=701, aOR 0·22, 95% CI 0·12 to 0·39; low certainty).
“In 13 unadjusted studies and two adjusted studies,34, 37, 38, 39, 47, 49, 51, 54, 58, 60, 61, 65, 75 eye protection was associated with lower risk of infection (unadjusted n=3713, RR 0·34, 95% CI 0·22 to 0·52; AR 5·5% with eye protection vs 16·0% with no eye protection, RD −10·6%, 95% CI −12·5 to −7·7; adjusted n=701, aOR 0·22, 95% CI 0·12 to 0·39; low certainty; figure 6; table 2; appendix pp 16–”
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- Authors
- Caputo, K. M., Byrick, R., Chapman, M. G., Orser, B. J., & Orser, B. A.
- Affiliations
- University of Toronto (CA)
- Venue
- Canadian Journal of Anesthesia/Journal canadien d'anesthésie
- Published
- 2006-02
- Volume
- 53
- Issue
- 2
- Pages
- 122-129
- ISSN
- 0832-610X (ISSN-L)
- 1496-8975
- OpenAlex
- W159957110
- Cited by
- 110
- References
- 15
- Citations by year
- 2023: 2 · 2022: 7 · 2021: 32 · 2020: 56 · 2015: 1 · 2013: 1 · 2012: 1
- FWCI
- 2.06
- Type
- journal article
- Language
- fr
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- SARS, healthcare worker infection, endotracheal intubation, occupational exposure, personal protective equipment, infection control, risk management, risk analysis framework, patient safety, 2003 SARS outbreak
- MeSH terms
- Adult, Aged, Aged, 80 and over, Disease Outbreaks, Humans, Intubation, Intratracheal, Middle Aged, Ontario, Protective Devices, Infectious Disease Transmission, Patient-to-Professional, Severe Acute Respiratory Syndrome
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