Elective and emergency surgery in patients with severe acute respiratory syndrome (SARS).

Abstract

On Mar. 12, 2003, the World Health Organization issued a global health alert for severe acute respiratory syndrome (SARS), a new illness that originated in Guangdong Province, China. It is known to be caused by a coronavirus. Its spread to Toronto, Canada, occurred in late February 2003. The spectrum of illness ranges from fever, muscle aches and mild respiratory symptoms to severe respiratory distress requiring mechanical ventilation. The SARS epidemic introduced essential infection control considerations. SARS' respiratory-droplet route of transmission and the organism's potential to remain infectious on surfaces for long periods mandate extraordinary precautions. For this reason, the Centers for Disease Control and Prevention (CDC) have published recommendations for the personal protective equipment (PPE) appropriate as precautions, both standard and against contact and airborne infection.1 These recommendations included the use of caps, goggles, N95 masks, gowns and gloves (Fig. 1), hereinafter referred to as standard PPE. FIG. 1. Standard personal protective equipment: cap, goggles, N95 mask, gown and gloves. We found only 2 reports in the literature on the conduct of operations upon patients known to have SARS, which describe 1 emergency and 3 elective tracheostomies.2,3 The staff involved used essentially the standard PPE recommended by the CDC; 2 weeks after the operations, they remained healthy. In our institution 9 health care workers, after being involved with a difficult airway situation in a patient with SARS, were infected despite wearing standard PPE.4 As a result, the Ontario Ministry of Health and Long-Term Care published a directive mandating the use of additional personal protection for high-risk airway management situations.5 In our institution, additional protection consisted of wearing the Stryker T4 Personal Protection System® (hereafter referred to as T4 PPS), consisting of a helmet, a short hood with visor and a long toga-style gown (Fig. 2), over standard PPE. In this report, we describe the effect of our use of these additional precautions on the conduct of 3 elective tracheostomies and 1 emergency laparotomy on 3 patients with SARS. FIG. 2. The Stryker T4 Personal Protection System, which is worn over standard personal protective equipment.