ANNEX G

MANILA DOCTORS HOSPITAL PULMONARY THERAPY DEPARTMENT PROCEDURE ON SARS

MANILA DOCTORS HOSPITAL PULMONARY SECTION

Pulmonary Biosafety for Diagnostic Services from Patient with Severe acute Respiratory Syndrome (SARS)

A. Objective

1. To provide a set of infection control or biological safety procedures for Respiratory Care Practicioner tp prevent transmission of SARS to Themselves, their co-workers, and other patients and clients of the hospital.

B. Scope

1. This procedure covers the collection, handling processing and transport of specimens, assembling, hooking of ventilators from patients who are under surveillance for SARS, suspect for SARS or probable SARS patient.

C. Case Definitions

1. Patients under surveillance for SARS- patients with history of travel to high-risk places and or exposure to persons with possible SARS but without symptoms.

2. SARS suspect patients- patients with history of travel to high –risk places and or exposure to persons with possible SARS but with symptoms of high fever, respiratory syndrome, dry cough.

3. probable SARS patients- patients described under SARS suspect patients with laboratory findings and radiologic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome on chest X-ray that increased the suspicion of SARS.

4. Confined SARS patients-patients with a positive confirmatory test for the SARS virus.

D. Procedure

1. Collection of specimen (Blood for Arterial Blood Gas Analysis)

1.1. All Respiratory Care Practioner are required to observed standard precautions in collection and handling of potentially infectious pulmonary specimens.

Respiratory Care Practitioner should wear personal Protective Equipment (PPE) including disposable gloves, disposable gowns,

1.2. goggles for close patient contact, N95 mask, cap, cover shoes tom provide a barrier to mucosal surface exposure. The PPE can be obtained from the nursingservice supervisors in the wards/floors and the ward clerk at the ER.

1.3. A single Respiratory Care Practitioner wearing personal protective equipment should handle the request from collection to processing and disposal of the specimen.

1.4. Careful attention should be given to hand hygiene after removal of gloves especially before touching the eyes or mucosal surfaces.

1.5. After collection, specimen are properly labeled and should be placed in a plastic bag or receptacle which is furthet enclosed in a clean plastic resealble bag with biohazardsticker. The box and bag serves to prevent leakage of contents in case there is spillage.

1.6. The specimens with accompanying request forms are to be brought immediately to the pulmonary section after collection

2. Specimen Reception, Handling and Processing

2..1. Minimize the number of personnel in the ABG room. If possible

only 1 RCP within the room.

2.2. The same RCP verifies the identification on the request forms and

logs it in a separate logbook for SARS /other hazardous specimen.

2.3. Procedure for arterial Blood Gas

Inhalation 2.3.1. Remove the heparinized synringe with blood sample from the

ABG kit.

2.3.2. Inject the blood sample on the blood gas analyzer.

3.Post Analytical Handling and Waste Disposal

3.1. Decontaminate Blood Gas Analyzer at the end of the test. Inject 0.3

ml hypochlorite solution for protein removal and decontamination. Press rinse mode twice.

3.2. Degown and decontaminate accordingly.

3.3. Autoclave all specimen and place in the yellow bag.

3.4. Decontaminate all working surface

4. Transport of Specimen to referral Hospital Laboratory

4.1. Coordinate by the phone with referral laboratory (San Lazro or RITM)

4.2. Specimen is packaged as descriobed after collection (refer 1.4)

4.3. Specimen is bought as soon as possible tomreferral Laboratory

5. Infection Control in the Use of Ventillators for SARS patients

5.1. Mechanical Ventillators for SARS patient transport should provide HEPA A filters or equivaqlent filtration of airflow exhaust.

Discard all ventilators circuits and other gadgets and place in a clear plastic and sealed it properly before placed in biohazard bag for proper

5.2. disposal as regulated medical waste in accordance with local requirements at destination hospital

5.3. Ventillator machine should be airing inside the room for at least 1 day.

5.4. Decontaminate the machine with 0.1 % hypochlorite by wiping the surfaces area after and before returning to service.

6. Therapy is not available for SARS patients due to spreading of aerosol particles during exhalation.