11. INFECTION CONTROL IN THE
TRIAGE AREA
·
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.