BACKGROUND: On March 11, 2003, a
World Health Organization (
WHO )
physician was admitted to Bamrasnaradura Institute, after alerting the world to the dangers of
severe acute respiratory syndrome (SARS) in
Vietnam and developing a
fever himself. Specimens from the first day of his admission were among the first to demonstrate the novel
coronavirus , by
culture ,
reverse transcription -
polymerase chain reaction (RT-PCR), and rising of specific antibody, but proper protective
measures remained unknown. The authors instituted airborne, droplet and contact precautions from the
time of admission, and reviewed the
efficacy of these
measures . MATERIAL AND
METHOD: A specific unit was set up to care for the
physician , beginning by roping off an isolated room and using a window fan to create negative
pressure , and later by constructing a
glass -walled antechamber, designated changing and
decontamination areas, and adding high-
efficiency particulate
air (HEPA)
filters . The use of
personal protective equipment (PPE) was consistently enforced by
nurse managers for all the staff and visitors, including a minimum of
N95 respirators ,
goggles or
face shields, double gowns, double gloves, full
head and
shoe covering, and full Powered
Air Purifying
Respirator (PAPR) for
intubation . To assess the adherence to PPE and the possibility of
transmission to exposed staff a structured
questionnaire was administered and
serum samples tested for
SARS coronavirus by
enzyme-linked immunosorbent assay (
ELISA ). Exposure was defined as presence on the SARS ward or contact with
laboratory specimens, and close contact was presence in the
patient 's room.
RESULTS: The
WHO physician died from
respiratory failure on day 19. 112 of 129 exposed staff completed
questionnaires , and the 70
who entered the
patient 's room reported a mean of 42 minutes of exposure (range 6 minutes-23.5 hours). 100% reported consistent
handwashing after exposure, 95% consistently used a fit-tested N95 or greater
respirator , and 80% were fully compliant with strict institutional PPE protocol. No staff developed an illness consistent with SARS.
Serum samples from 35 close contacts obtained after day 28 had a
negative result for
SARS coronavirus antibody.
CONCLUSIONS: Hospitalization of one of the earliest SARS
patients with documented
coronavirus shedding provided multiple opportunities for spread to the
hospital staff, but strict enforcement of conservative
infection control recommendations throughout the
hospitalization was associated with no
transmission .