15. INFECTION CONTROL IN THE INPATIENT SETTING

This section is meant to guide health facilities who would be admitting patients suspected to have SARS or with Probable SARS.

15.1. PHYSICAL REQUIREMENTS OF SARS ISOLATION ROOM/WARD

· All DOH-designated SARS referral hospitals should identify rooms or wards beforehand, which will be dedicated solely for SARS in-patients.

· In choosing the rooms or wards for the purpose of SARS in-patient care, consider transport route from the ER to these designated rooms (i.e. need to use elevators). The shortest possible route should be taken.

· The door of isolation rooms must be closed at all times.

· SUSPECT SARS must be admitted ONLY TO SINGLE ISOLATION ROOMS.

· PROBABLE SARS should preferably be admitted to single isolation rooms also.

· If single private rooms will not be possible, cohort placement (putting several patients with the same diagnosis in one area) of Probable SARS in one room is an acceptable alternative. Place a screen or other forms of barriers between patients.

· Do not mix SARS suspects and Probable SARS patients in the same room.

· Do not cohort SARS Suspects together as some suspects may be reassessed as non-SARS after work-up.

· The designated single rooms or wards for SARS should be equipped with negative-pressure devices. If negative-pressure rooms are not available, single air-supply or air-conditioning unit with independent exhaust is acceptable. If still not possible, well-ventilated private rooms with windows that open away from public areas should suffice. Exhaust and windows must not open to any area with public access. The single isolation rooms and wards must have their own sink and bathrooms.

· A separate area strategically located within the isolation room or ward must be designated to serve as an area for HCWs to change and dispose PPE (i.e. changing room).

15.2. PERSONNEL REQUIREMENTS OF SARS ROOM/WARD

· If possible, only HCWs with defined patient care-related activities should be allowed to enter these areas.

· All persons entering the room should wear an N95 mask. Observe standard precautions (hand hygiene) as well as airborne (masks), droplet (masks and gloves) and contact (gloves, gowns, eye protection) precautions.

· Paramedical staff such as X-ray technicians, janitors, food tray handlers and the like must be equally protected with PPE when they enter these rooms.

15.3. CONTAINMENT PROCEDURES FOR SARS ROOM/WARD

· Exposure to the SARS-infected patient must be kept to the absolute minimum according to the level of care required.

· HCWs must disinfect hands and change PPE in the designated areas within the Isolation Room/Ward before moving to the next patient.

· Hand washing with soap and water should be practiced after contact with any SARS suspect. Alcohol-based hand rubs can also be used.

· Solely the patient should use utilities used by the SARS patient. These include eating utensils, thermometers, BP cuff, tourniquet and the like.

· Discard wastes soiled with body fluids of SARS patients including facial tissues, gloves and surgical masks in the yellow (Infectious wastes) trash bags.

· Trained personnel must collect the linen with the minimum handling, shaking or sorting to minimize generation of contaminated aerosols. Used linen must be properly put into yellow plastic bags before transport to the laundry area. Linen used by SARS patients must be disinfected with 0.1% sodium hypochlorite for at least 30 minutes before washing with soap and water. Other SARS patients can reuse disinfected and washed linen.

15.4. ROUTINE AND TERMINAL CLEANING OF SARS ISOLATION ROOMS

OR WARDS

· The personnel assigned to do cleaning and disinfecting tasks in SARS-designated areas must be properly trained and supervised.

· The recommended PPE must be worn and includes gown, apron, utility gloves, eye protection and N95 masks.

· If the volume of patients is high, the hospital may consider dedicating cleaning personnel for these areas alone.

· Daily routine cleaning should include all horizontal surfaces such as floors, tables and nightstands; and all surfaces that are frequently touched by the patient and the HCWs such as bedrails, call buttons, telephones, and the toilet and lavatory in the bathroom.

· Terminal cleaning after patient discharge or transfer must include:

o All of the horizontal surface covered in routine cleaning PLUS

o Obviously soiled vertical surfaces

o Surfaces frequently touched by the patient or HCWs such as doorknobs,switches

o All other durable equipments in the room such as bed, wheelchair, commode.

· Equipment such as mechanical ventilators, pulse oximeter and BP cuff must be

cleaned and disinfected according to manufacturer’s instructions.

· There is no need to disinfect walls, window drapes and other vertical surfaces unless

obviously soiled.

· Disinfectant solutions for this purpose are chemical germicides used in hospital

infection control, which provide low to intermediate level disinfection of hospital equipment. These agents include 0.1% sodium hypochlorite (1part bleach in 100 parts water) or phenolic agents.

· Discard all leftover solutions used for cleaning the SARS-designated areas and do

not use anymore in other hospital areas. The housekeeping equipment such as mops and rugs must be washed thoroughly and allowed to dry.