11. INFECTION CONTROL IN THE TRIAGE AREA

• All health care facilities MUST prepare for a triage area where patients with possible SARS can be screened.

• The triage area must be separate from the general Emergency Room to prevent transmission of the SARS infection to other patients and hospital staff.

• This area will be utilized to screen for SARS Suspect according to the algorithm presented in the triage section. The minimum number of appropriate hospital personnel required to perform the screening should be assigned to this Triage Area.

• Personnel assigned to this area must be trained and properly protected with the PPE (N95 mask).

• Innovative barriers may be implemented by individual hospitals to reduce further the risk of transmission to HCWs and other patients without compromising initial screening procedure.

· Clean and disinfect the triage area regularly. The horizontal surfaces especially the table where the patient is interviewed should be disinfected at least once daily. The General Cleaning Procedures above should be followed.

11.1. INFECTION CONTROL IN THE HOLDING AREAS, WHICH ARE USED FOR

SCREENING AND INITIAL HANDLING OF SARS

SARS suspects should be directed to the designated holding area before transfer to a SARS referral hospital.

As soon as a patient is assessed to be a SARS suspect, he or she must wear at least a plain surgical mask.

11.2. PHYSICAL REQUIREMENTS OF THE SARS HOLDING AREA

· SARS patients must not be mixed with the patients in the general Emergency Room

· A separate room should be provided to accommodate SARS patients before transfer to the SARS referral hospital

· The room for this use should ideally be a closed area with negative pressure relative to surrounding areas.

· This room should have a door that can be closed.

· If negative pressure is not available for this area, the room must have its own independent air-conditioning unit/air supply with own exhaust and must not be part of the centralized air-conditioning system of the building.

· If single air conditioning unit with exhaust is still not possible, adequate ventilation should still be ensured by opening windows. Windows must open away from public places.

· This area should also have its own sink and bathroom facilities for use of the SARS patient.

11.3. PERSONNEL PROTECTION REQUIREMENTS OF THE SARS HOLDING

AREA

· All personnel in these areas should be properly protected with N95 masks.

· Barriers for contact precaution such as disposable solid-front gowns, gloves and eye protection are highly recommended.

· As mentioned above, in the event that N95 masks cannot be made available to all HCWs in a facility, the available masks must be prioritized to HCWs who would have the highest risk of direct contact with the SARS patients. A plain surgical mask with snug fit is an alternative while awaiting N95 supplies. Plain masks will act as physical barriers to transmission (versus no mask) but will not be as protective as N95 masks.

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

· Appendages of healthcare workers such as CELLULAR PHONES and PAGERS should be left outside these SARS designated areas. If this cannot be arranged, cover all cellular phones, pagers and telephones with yellow disposable plastic cover. Covers should be disposed before leaving SARS areas.

11.4. CONTAINMENT PROCEDURES of SARS INFECTION WITHIN THE SARS

HOLDING AREA

· SARS patients must remain within the SARS holding area until ready for admission or transport.

· SARS patients must wear a surgical mask at all times.

· HCWs entering this area must be kept to a minimum number essential for the care of the patient.

· Family members and other visitors MUST NOT be allowed to enter the SARS Holding Area.

· All materials such as stethoscope, writing pens, BP cuff, tourniquet etc. must be left within the SARS-designated holding area and not used in other hospital areas.

· Personnel leaving these areas should do careful hand hygiene before opening the exit door.

· All disposable PPE must be removed according to the sequence discussed above and disposed into the appropriate yellow-colored infectious waste bins.

· In addition, change of scrub suits into a different set of clothing is highly recommended.

11.5. ROUTINE CLEANING IN THE SARS HOLDING AREA

· After discharge or transfer of a suspect or probable SARS patient, the Holding Area must be cleaned and disinfected before the next patient is seen. Horizontal surfaces such as the examining table and side tables, and other surfaces, which are frequently touched, by patients and HCWS, and the floors, bathrooms and sinks must be cleaned with disinfectants.

· 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 chlorox in 100 parts water) or phenolic agents.

· Details of cleaning procedures recommended by the WHO are listed in the GENERAL CLEANING PROCEDURES above.

· Leftover solutions used for cleaning the SARS-designated areas must be discarded and not used anymore in other hospital areas. The housekeeping equipment such as mops and rugs must be washed thoroughly and allowed to dry.