SARS among Critical Care Nurses, Toronto
Open accessAbstract
To determine factors that predispose or protect healthcare workers from severe acute respiratory syndrome (SARS), we conducted a retrospective cohort study among 43 nurses who worked in two Toronto critical care units with SARS patients. Eight of 32 nurses who entered a SARS patient's room were infected. The probability of SARS infection was 6% per shift worked. Assisting during intubation, suctioning before intubation, and manipulating the oxygen mask were high-risk activities. Consistently wearing a mask (either surgical or particulate respirator type N95) while caring for a SARS patient was protective for the nurses, and consistent use of the N95 mask was more protective than not wearing a mask. Risk was reduced by consistent use of a surgical mask, but not significantly. Risk was lower with consistent use of a N95 mask than with consistent use of a surgical mask. We conclude that activities related to intubation increase SARS risk and use of a mask (particularly a N95 mask) is protective.
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A study of nurses using respiratory protection during the SARS epidemic in Canada showed that N95 respirators were more protective than surgical masks.
“One study evaluated the health risk of nurses using respiratory protection during the severe acute respiratory syndrome (SARS) epidemic in Canada (12) and showed that N95 respirators were more protective than the SMs.”
From A Quantitative Assessment of the Total Inward Leakage of NaCl Aerosol Representing Submicron-Size Bioaerosol Through N95 Filtering Facepiece Respirators and Surgical Masks (2014) · cites this paper as [12]
The Discussion reports a lower estimated SARS risk with N95 masks than with surgical masks, but says the difference was not statistically significant because of the small sample. The authors say their data “suggest” greater protection, so “showed” overstates the comparison. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe inverse relationship between filter efficiency and TIL provides a better explanation for the higher levels of respiratory protection offered by N95 FFRs than SMs reported previously.
“The inverse relationship between filter efficiency and TIL provides a better explanation for the higher levels of respiratory protection offered by the N95 FFRs than the SMs reported previously. (12,14,15)”
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- Authors
- Loeb, M., McGeer, A., Henry, B., Ofner, M., Rose, D., Hlywka, T., Levie, J., McQueen, J., Smith, S., Moss, L., Smith, A., Green, K., & Walter, S. D.
- Affiliations
- McMaster University (CA)
- Mount Sinai Hospital (CA)
- Toronto Public Health (CA)
- Health Canada (CA)
- Scarborough Grace Hospital, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Corresponding author
- Loeb, Mark
- ORCID
- Venue
- Emerging Infectious Diseases
- Published
- 2004-02
- Volume
- 10
- Issue
- 2
- Pages
- 251-255
- ISSN
- 1080-6040 (ISSN-L)
- 1080-6059
- PMC
- PMC3322898
- OpenAlex
- W1973418860
- Cited by
- 345
- References
- 9
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 3 · 2023: 8 · 2022: 34 · 2021: 51 · 2020: 95 · 2019: 7 · 2018: 3 · 2017: 4 · 2016: 7 · 2015: 4 · 2014: 2 · 2013: 7 · 2012: 13
- FWCI
- 14.68
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Emerging infectious diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- McMaster University
- Ontario Ministry of Health and Long-Term Care
- 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 › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- SARS, intensive care unit nurses, occupational infection risk, healthcare worker infection, N95 respirators, surgical masks, personal protective equipment, intubation, aerosol-generating procedures, infection control
- MeSH terms
- Critical Care, Disease Outbreaks, Female, Humans, Male, Masks, Nurses, Occupational Diseases, Ontario, Retrospective Studies, Risk Factors, Cohort Studies, Occupational Exposure, Infectious Disease Transmission, Patient-to-Professional, Severe Acute Respiratory Syndrome
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