Severe Acute Respiratory Syndrome SARS suspected case

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					                   Severe Acute Respiratory Syndrome (SARS)
                        Guidance on management of potential cases
                            Presenting at Cardiff and Vale Trust

Note: This document replaces previous guidance issued on SARS dated 18/03/03 and
      was prepared by the NPHS Microbiology Cardiff, Infection Prevention and Control
      Department, the Department of Infectious Diseases and the Emergency Unit
      Cardiff and Vale Trust.
      The document is based on guidance from the World Health Organisation and the
      Health Protection Agency. Further updates and information can be found at the
      websites listed in Appendix 2.

The guidance covers:
    Case definitions
    Notifications to Public Health Authorities
    Infection Prevention & Control procedures
    Laboratory diagnostic sampling

1. Case Definitions

    Suspected case

    A person presenting to a health care facility (hospital or general practice) with all of the

           Sudden onset of high fever (>38oC)
           One or more of the following respiratory symptoms (cough, sore throat, shortness of
            breath, difficulty breathing)

    One or more the following:
        Onset of symptoms within 10 days of travel to one of the areas listed below
        Onset of symptoms within 10 days of close contact with a person with SARS (close
           contact includes having cared for, having lived with, or having had direct contact with
           respiratory secretions and/or body fluids of a person with SARS)

    Countries (or areas within countries) reporting local transmission of SARS up to
    02 April 2003
       1. Hong Kong Special Administrative Region, China
       2. Guangdong province, China
       3. Bejing, China
       4. Shanxi, China
       5. Taiwan Province, China
       6. Vietnam (Hanoi)
       7. Singapore
       8. Canada (Toronto)

   Probable case

           A suspected case with chest x-ray findings of pneumonia or adult respiratory
            distress syndrome

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2. Initial assessment of all POTENTIAL cases

               Cases referred by GP’s and self-referred cases arriving in The Emergency Unit
                should be transferred to a side-room as soon as the diagnosis is suspected and
                referred to the on-take team. Staff contact should be minimized. Advice should
                be sought immediately from a member of the Infectious Diseases team. Advice
                is also available from Medical Microbiology and Infection Prevention and Control
                (contact numbers in Appendix 1).

               All staff must exercise infection control precautions by

                - Wearing a Tecnol PFR95 face mask (duck bill type)
                - A water repellent disposable gown or a disposable gown with plastic aprons
                - Gloves for handling body fluids
                - Eye protection (e.g. visor or goggles) must be worn

               Patients should be fitted with a mask when in transit unless their clinical condition
                precludes this.

               A chest x-ray should be performed in the Emergency Radiology Unit.

3. Action to be taken on identification of a suspected or probable case in any Trust

               All cases should be referred to the Infectious Diseases team both in and out-of-
                hours. The patient should be moved immediately to a single room on the ward
                that the diagnosis was made. Further movement of the patient, if required, will
                be determined by the Infection Prevention and Control Department and the
                relevant clinical teams.

               All cases should be notified to the Consultant in Communicable Disease Control
                (National Public Health Service) immediately including out-of-hours (contact
                numbers Appendix 1)

               The Infection Prevention & Control Department should be informed immediately
                of all cases.

4. Microbiological sampling

               Contact the Clinical Microbiologist or Clinical Virologist for advice on appropriate
                specimens and transport to the laboratory.

               Label all forms and samples as “High Risk/SARS”.

5. Non-microbiological samples

               Inform the laboratory of samples being sent.

               Label all forms and samples as “High Risk/SARS”.

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