Possible SARS coronavirus transmission during cardiopulmonary resuscitation.
Infection of healthcare workers with the severe acute respiratory syndrome-associated coronavirus (SARS-CoV) is thought to occur primarily by either contact or large respiratory droplet transmission. However, infrequent healthcare worker infections occurred despite the use of contact and droplet precautions, particularly during certain aerosol-generating medical procedures. We investigated a possible cluster of SARS-CoV infections in healthcare workers who used contact and droplet precautions during attempted cardiopulmonary resuscitation of a SARS patient. Unlike previously reported instances of transmission during aerosol-generating procedures, the index case-patient was unresponsive, and the intubation procedure was performed quickly and without difficulty. However, before intubation, the patient was ventilated with a bag-valve-mask that may have contributed to aerosolization of SARS-CoV. On the basis of the results of this investigation and previous reports of SARS transmission during aerosol-generating procedures, a systematic approach to the problem is outlined, including the use of the following: 1) administrative controls, 2) environmental engineering controls, 3) personal protective equipment, and 4) quality control.
Christian
Michael D
MD
Immunodeficiency Clinic, University Health Network, University of Toronto, Toronto, ON, Canada. Michael.Christian@utoronto.ca
Loutfy
Mona
M
McDonald
L Clifford
LC
Martinez
Kennth F
KF
Ofner
Mariana
M
Wong
Tom
T
Wallington
Tamara
T
Gold
Wayne L
WL
Mederski
Barbara
B
Green
Karen
K
Low
Donald E
DE
D000336:Aerosols; D000368:Aged; D000391:Air Microbiology; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D009864:Ontario / Q000453:epidemiology; D010564:Personnel, Hospital; D011482:Protective Devices / Q000592:standards; D011786:Quality Control; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*
D000336:Aerosols