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SARS TRANSMISSION DURING INTUBATION: CAREGIVERS’ EXPERIENCES

¹ Department of Anesthesia, Sunnybrook & Women’s College Health Science Centre (SWCHSC), 2075 Bayview Avenue, Toronto Ontario, M4N 3M5
² Depts. of Anesthesia and Mechanical and Industrial Engineering, University of Toronto, Fitzgerald Building Rm. 132, 150 College Street, Toronto Ontario, M5S 1A8

INTRODUCTION

The purpose of the study was to identify factors that contributed to the infection of Health Care Workers (HCWs) who intubated SARS patients. We sought recommendations from "front-line" HCWs regarding the future care of SARS patients. Based on these recommendations, a risk analysis tool was created to identify common factors across disease outbreaks. This information will be used to improve the guidelines for caring for highly infectious patients and strategies for risk management.

METHODS

The study was approved by the SWCHSC Ethics Committee and formed a subsection of a larger public health SARS investigation. HCWs who performed intubations were identified by a chart audit. Anesthesiologists administered a questionnaire that was comprised of three sections: patient information (demographics, clinical history, drugs and intubation procedure), HCW information (demographics, personal protection, SARS infection and its clinical history) and HCW recommendations for future outbreaks. Recommendations were collated and iteratively grouped to create a broadly applicable risk management framework.

RESULTS

We interviewed 31 HCWs who performed 36 intubations of 32 SARS patients in 10 Toronto-area hospitals. Of the HCWs, 23(74%) were anesthesiologists, 4(13%) were respiratory therapists, 3(10%) were internists and 1(3%) was a surgeon. 3(10%) HCWs, all anesthesiologists, acquired SARS (Figure 1). The recommendations directed the development of a high level framework consisting of three broad categories: Process, People and Technology & Infrastructure. Process recommendations relate to infection control and airway management protocols, education, new knowledge and communication. People recommendations relate to experience or availability of HCWs while Technology & Infrastructure recommendations relate to patient equipment, HCW equipment and hospital infrastructure.

View larger version (13K): [in this window] [in a new window]   Figure 1: Results a. >15 years clinical experience b. Impending respiratory arrest c. Both with Succinylcholine d. 14 Succinylcholine and 11 Rocuronium

All infected intubators (10%) were anesthesiologists. Ad-hoc, consensus-based guidelines were clearly insufficient. Management requires a framework that rapidly integrates experience into guidelines for the treatment of infectious patients.

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