title: Possible SARS coronavirus transmission during cardiopulmonary resuscitation.
abstract: 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.
authors.affiliation: Immunodeficiency Clinic, University Health Network, University of Toronto, Toronto, ON, Canada. Michael.Christian@utoronto.ca
authors.forename: Michael D
authors.initials: MD
authors.lastname: Christian
authors.forename: Mona
authors.initials: M
authors.lastname: Loutfy
authors.forename: L Clifford
authors.initials: LC
authors.lastname: McDonald
authors.forename: Kennth F
authors.initials: KF
authors.lastname: Martinez
authors.forename: Mariana
authors.initials: M
authors.lastname: Ofner
authors.forename: Tom
authors.initials: T
authors.lastname: Wong
authors.forename: Tamara
authors.initials: T
authors.lastname: Wallington
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Gold
authors.forename: Barbara
authors.initials: B
authors.lastname: Mederski
authors.forename: Karen
authors.initials: K
authors.lastname: Green
authors.forename: Donald E
authors.initials: DE
authors.lastname: Low
mesh_terms: 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*
chemical_list: D000336:Aerosols