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Intubation of SARS patients: infection and perspectives of healthcare workers

[L’intubation de patients atteints du SRAS: infection et perspectives des travailleurs de la santé]

Karen M. Caputo, BASc^*, Robert Byrick, MD^*, Martin G. Chapman, MD^*, Barbara J. Orser, PhD and Beverley A. Orser, MD PhD^*

^* From the Department of Anesthesia, University of Toronto, Toronto; and the
School of Management, University of Ottawa, Ottawa, Ontario, Canada.

Address corresponding to: Dr. Beverley A. Orser, Department of Anesthesia, Room 200-M3, Sunnybrook and Women’s College Health Science Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. Phone: 416-978-0574; Fax: 416-978-4940; E-mail: beverley.orser{at}utoronto.ca

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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