title: Early containment of severe acute respiratory syndrome (SARS); experience from Bamrasnaradura Institute, Thailand.
abstract: BACKGROUND
  On March 11, 2003, a World Health Organization (WHO) physician was admitted to Bamrasnaradura Institute, after alerting the world to the dangers of severe acute respiratory syndrome (SARS) in Vietnam and developing a fever himself. Specimens from the first day of his admission were among the first to demonstrate the novel coronavirus, by culture, reverse transcription-polymerase chain reaction (RT-PCR), and rising of specific antibody, but proper protective measures remained unknown. The authors instituted airborne, droplet and contact precautions from the time of admission, and reviewed the efficacy of these measures.
  
  
  METHODS
  A specific unit was set up to care for the physician, beginning by roping off an isolated room and using a window fan to create negative pressure, and later by constructing a glass-walled antechamber, designated changing and decontamination areas, and adding high-efficiency particulate air (HEPA) filters. The use of personal protective equipment (PPE) was consistently enforced by nurse managers for all the staff and visitors, including a minimum of N95 respirators, goggles or face shields, double gowns, double gloves, full head and shoe covering, and full Powered Air Purifying Respirator (PAPR) for intubation. To assess the adherence to PPE and the possibility of transmission to exposed staff a structured questionnaire was administered and serum samples tested for SARS coronavirus by enzyme-linked immunosorbent assay (ELISA). Exposure was defined as presence on the SARS ward or contact with laboratory specimens, and close contact was presence in the patient's room.
  
  
  RESULTS
  The WHO physician died from respiratory failure on day 19. 112 of 129 exposed staff completed questionnaires, and the 70 who entered the patient's room reported a mean of 42 minutes of exposure (range 6 minutes-23.5 hours). 100% reported consistent handwashing after exposure, 95% consistently used a fit-tested N95 or greater respirator, and 80% were fully compliant with strict institutional PPE protocol. No staff developed an illness consistent with SARS. Serum samples from 35 close contacts obtained after day 28 had a negative result for SARS coronavirus antibody.
  
  
  CONCLUSIONS
  Hospitalization of one of the earliest SARS patients with documented coronavirus shedding provided multiple opportunities for spread to the hospital staff, but strict enforcement of conservative infection control recommendations throughout the hospitalization was associated with no transmission.
authors.affiliation: Bamrasnaradura Institute, Ministry of Public Health, Thailand.
authors.forename: Achara
authors.initials: A
authors.lastname: Chaovavanich
authors.forename: Jurai
authors.initials: J
authors.lastname: Wongsawat
authors.forename: Scott F
authors.initials: SF
authors.lastname: Dowell
authors.forename: Yaowarat
authors.initials: Y
authors.lastname: Inthong
authors.forename: Chariya
authors.initials: C
authors.lastname: Sangsajja
authors.forename: Natpatou
authors.initials: N
authors.lastname: Sanguanwongse
authors.forename: Michael T
authors.initials: MT
authors.lastname: Martin
authors.forename: Khanchit
authors.initials: K
authors.lastname: Limpakarnjanarat
authors.forename: Likanonsakul
authors.initials: L
authors.lastname: Sirirat
authors.forename: Sunthreeya
authors.initials: S
authors.lastname: Waicharoen
authors.forename: Malinee
authors.initials: M
authors.lastname: Chittaganpitch
authors.forename: Pranee
authors.initials: P
authors.lastname: Thawatsupha
authors.forename: Wattana
authors.initials: W
authors.lastname: Auwanit
authors.forename: Pathom
authors.initials: P
authors.lastname: Sawanpanyalert
authors.forename: Bjorn
authors.initials: B
authors.lastname: Melgaard
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D045169:Severe Acute Respiratory Syndrome / Q000517:prevention & control* / Q000635:transmission; D013785:Thailand