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Intubation of SARS patients: infection and perspectives of healthcare workers

Ľintubation de patients atteints du SRAS: infection et perspectives des travailleurs de la santé

Abstract

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.

Résumé

Objectif

Ľéclosion du syndrome respiratoire aigu sévère (SRAS) en 2003 a présenté des défis importants à la sécurité des anesthésiologistes et des autres travailleurs de la santé (TS). Ľétude a déterminé ľincidence de transmission du SRAS aux TS qui ont intubé des patients et a analysé les préoccupations des TS concernant la sécurité du personnel et des patients.

Méthode

Nous avons repéré les TS qui ont réalisé des intubations dans 10 hôpitaux de Toronto grâce à la base de données sur la santé publique de ľOntario. Un questionnaire a été utilisé pour recueillir les informations des TS. Pour vérifier si les modèles de protection individuelle et les préoccupations avaient changé avec le temps, ľanalyse a tenu compte des intubations réalisées pendant les phases I ou II du SRAS: du 23 février au 21 avril ou du 22 avril au premier juillet.

Résultats

Nous avons interrogé 33 travailleurs qui ont fait 39 intubations sur 35 patients atteints de SRAS. Pendant la phase I, 3 /23 TS (13 %) ont contracté le SRAS et pendant la phase II, aucun (0/10) n’a été atteint. La protection du personnel s’est améliorée ďune phase à ľautre et les inquiétudes ont changé avec le temps. Pendant la phase I, on se préoccupait davantage de la nécessité ďun équipement de protection individuelle tandis qu’à la phase II, ľattention a été centrée sur la formation rigoureuse et le respect des protocoles de soins. Les TS ont eu ľimpression que leurs expériences avaient été mal intégrées aux protocoles de gestion du risque.

Conclusion

Les directives sur la protection n’ont pas permis ďempêcher complètement la transmission du SRAS aux TS. Parmi les TS qui ont intubé des patients, 9 % ont contracté le SRAS. Un cadre ďanalyse du risque est présenté pour faciliter ľintégration rapide des expériences des TS en directives cliniques.

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Correspondence to Karen M. Caputo or Robert Byrick or Martin G. Chapman or Barbara J. Orser or Beverley A. Orser.

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Caputo, K.M., Byrick, R., Chapman, M.G. et al. Intubation of SARS patients: infection and perspectives of healthcare workers. Can J Anesth 53, 122 (2006). https://doi.org/10.1007/BF03021815

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