Epidemiologic study and containment of a nosocomial outbreak of severe acute respiratory syndrome in a medical center in Kaohsiung, Taiwan.
OBJECTIVE
We conducted an epidemiologic investigation at the beginning of a nosocomial outbreak of severe acute respiratory syndrome (SARS) to clarify the dynamics of SARS transmission, the magnitude of the SARS outbreak, and the impact of the outbreak on the community.


METHODS
We identified all potential cases of nosocomially acquired SARS, linked them to the most likely infection source, and described the hospital containment measures.


METHODS
A 2,300-bed medical center in Kaohsiung, Taiwan.


RESULTS
A total of 55 cases of SARS were identified, and 227 hospital workers were quarantined. The index patient and neighboring patients were isolated. A chest physician team reviewed medical charts and chest radiographs and monitored the development of SARS in patients staying in the ward. The presence of underlying lung disease and immunocompromise in some patients made the diagnosis of SARS difficult. Some cases of SARS were diagnosed after the patients had died. Medical personnel were infected only if they cared for patients with unrecognized SARS, and caretakers played important roles in transmission of SARS to family members. As the number of cases of nosocomial SARS increased, the hospital closed the affected ward and expedited construction of negative-pressure rooms on other vacated floors for patient cohorting, and the last case in the hospital was identified 1 week later.


CONCLUSIONS
Timely recognition of SARS is extremely important. However, given the limitations of SARS testing, possible loss of epidemic links, and the nonspecific clinical presentations in hospitalized patients, it is very important to establish cohorts of persons with low, medium, and high likelihoods of SARS acquisition. Rapid closure of affected wards may minimize the impact on hospital operations. Establishment of hospitals dedicated to appropriate treatment of patients with SARS might minimize the impact of the disease in future epidemics.
Liu
Jien-Wei
JW
Committee of Infection Control and Division of Infectious Diseases, Chang Gung Memorial Hospital, Kaohsiung Medical Center, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 833, Taiwan.
Lu
Sheng-Nan
SN
Chen
Shun-Sheng
SS
Yang
Kuender D
KD
Lin
Meng-Chih
MC
Wu
Chao-Chien
CC
Bloland
Peter B
PB
Park
Sarah Y
SY
Wong
William
W
Tsao
Kuo-Chien
KC
Lin
Tzou-Yien
TY
Chen
Chao-Long
CL