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Learn why respiratory infections such as SARS are so difficult to combat in the healthcare setting

Accreditation Connection, January 6, 2005

Outbreaks of Severe Acute Respiratory Syndrome (SARS) in 2003, provided a dramatic look at the impact respiratory infections could have on healthcare systems and provided valuable lessons for infection control professionals on the delivery of care in situations such as these.

Because healthcare workers were among the highest percentage of all SARS cases, hospitals faced a double challenge: caring for an increased number of new patients with a decrease in the number of staff, according to Arjun Srinivasan, MD, medical epidemiologist at the Centers for Disease Control and Prevention.

The following are the most important reasons why respiratory infections are so problematic within a hospital setting:

• Transmission can occur over distance either by respiratory droplets or in the case of tuberculosis, over great distances via droplet nuclei. Simply going near infected patients without actual contact can infect people.
• Symptoms are nonspecific and, as such, recognition of infection, and more important, isolation of patients, is often delayed.

There are several strategies to curb the spread of respiratory infections based on hard data and expert opinion, including physical separation of patients from each other, hand-hygiene measures, and droplet precautions.

When respiratory infections are widespread, adopting a universal and multifaceted approach that combines all the effective interventions has proven successful, Srinivasan says.

Ten years before SARS appeared, one U.S. hospital experienced an outbreak of pertussis. The measures they used to limit the healthcare-acquired transmission of the infection, could be effective today. The measures include the following:

• provide masks to patients, with suspected respiratory infections, at the triage desk
• usher patients into examination rooms more quickly to prevent waiting room exposure
• insist that healthcare workers wear surgical masks when they are near these patients

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