Outbreak preparedness & control PPHSN Guidelines For the Preparedness, Surveillance And Response To Severe Acute Respiratory Syndrome (SARS) in Pacific Island Countries And Territories 9 April 2003 SARS is a new disease syndrome. Our knowledge about the best way to prevent and treat it is constantly evolving. These guidelines will be continuously updated. Please regularly check PPHSN website for the most up to date guidance. These guidelines have also been ‘harmonised’ with the WHO WPRO guidelines published on 4th April. PREPAREDNESS - INITIAL ACTION AND RESPONSIBILITIES (Updated 09.04.03) Staff responsibilities for the various actions For the purpose of proper SARS control in hospital environment, this task force and expert committee should include a member experienced in hospital infection control, and who can advise on isolation and barrier nursing issues.
Priority functions of the task force are to: o identify the facility(ies) where suspected and probable cases of SARS can be nursed. o perform an inventory of supplies required for nursing such patients (using WPRO SARS Preparedness Kit contents list). o plan how contacts of suspect/probable cases will be managed o liaise with customs/immigration authorities on the best way to provide information to arriving passengers, record travel details for surveillance and plan of action if an individual arrives ill on a plane with suspected SARS. |
The task force should be responsible for all the issues concerning SARS including establishing good communications. The expert committee should be responsible for making a decision on the public health response to reported cases. An urgent task of this task force will be establishing a national surveillance system. The surveillance system should also include private hospital and clinics. Information should be provided for the media and general public. Designate at least one hospital to isolate cases and one laboratory responsible for managing clinical samples. Good communications should be established between the national focal point and the designated hospital and the designated laboratory. (see Figure 2) The tasks at national level includes development of inventory of barrier nursing supplies, community infection control, quarantine at port of entry, and public awareness (avoiding panic).
>> Figure 2: Information Flows Clinical assessment of suspected patients Clinicians must be aware of the symptoms and signs of SARS. Patients with symptoms of SARS and a history of travel from an affected area or contact with a case of SARS should be triaged immediately to designated examination rooms or wards to minimize exposure to other patients and staff. Where feasible, separate specific reception areas for triaging patients who may have SARS should be established. Patients with suspected SARS should be issued with surgical masks. Medical and nursing staff must take precautions when examining the patient ie barrier nursing. Where material resources for barrier nursing are scarce, available supplies should be used sparingly in triage settings (such as by limiting the number of staff working in this area), so in the event of a SARS admission supplies will not have been exhausted. Obtain and record detailed clinical, travel and contact history including occurrence of acute respiratory diseases in contact persons during the last 10 days. Obtain chest X-ray (CXR) and full blood count (FBC).
(See example patient management flow chart in ANNEX 4) Enhanced surveillance Complete PPHSN reporting form and send immediately to National Health Authorities, with a cc to PPHSN-CB Focal Point or WHO Suva (through local WHO Office if present). Also send immediately the form WITHOUT reporter and patient details (i.e. page 2) to PacNet or PacNet-restricted. Identify close contacts and give information to contacts. Screen any contacts with compatible symptoms as for suspected cases.
Communications (between members of team and with outside bodies, media etc.) Ensure that lines of communication are clear. Identify spokesperson for the team who will be the focal point for media briefings and will liaise with international agencies eg WHO/SPC (this could be the EpiNet team Focal Point or another person).
Laboratory diagnosis The agent causing SARS remains to be established. There are no specific diagnostic tests at this stage. For suspected cases where the diagnosis of SARS is by exclusion and the patient is not very ill (ie no chest X-ray changes compatible with SARS). It is reasonable to take specimens for diagnostic purposes. However health care workers must take full barrier nursing precautions to protect themselves from aerosols or splashing/splattering of blood or other body fluids. For probable cases where the diagnosis of SARS is very likely and particularly if the patient has significant respiratory symptoms. The clinicians must perform a risk/ benefit analysis. There have been documented cases of transmission to HCWs during diagnostic/therapeutic procedures, particularly those prone to the generation of aerosols. Therefore the priority should be for tests likely to influence the clinical management of the patient. If specimens are collected for diagnostic testing (rather than clinical management), they should be stored under appropriate conditions. At this stage, the three laboratories in our region that have agreed to receive specimens are:
o Institute Pasteur, New Caledonia o WHO Collaborating Centre for Reference and Research on Influenza, Australia o Clinical Virology, Communicable Disease Programme, Institute of Environmental Science and Research (ESR), New Zealand (See Contact List in ANNEX 1 for addresses) Initial community interventions Provide suitable information to arriving passengers (particularly those who have traveled through affected countries) about the risks of SARS and where they can go to for advice and assistance (as example, see Advice to Arriving Travelers in ANNEX 5). Simple health education messages should be communicated to the public via appropriate media (see Health Advices from Hong Kong in ANNEXES 6 and 7 for examples). WHO has introduced new travel advice on 4th April advising against travel to the worst affected areas (Hong Kong and Guandong Province in China), unless essential. The PPHSN SARS Task force has also produced a travel advisory that goes further than WHO (see ANNEX 3). This careful attitude helps to avoid SARS long-distance spread through travel to and from infected zones and prevents the importation of SARS "home" (lots of close contacts...). This is particularly important in places where control measures may not be easy to implement (and SARS importation may have serious public health consequences).
External (international) reporting, requests for support, and coordination among agencies Report all suspect and probable cases to PPHSN/WHO using the PPHSN reporting form, Contact PPHSN-CB Focal Point or WHO South Pacific if additional information or assistance is required (see contact list in ANNEX 1).
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