Abstract
BackgroundIn the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission.MethodsA retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE) logistic regression models and classification and regression trees (CART) were used to identify risk factors for SARS transmission.Results45 laboratory-confirmed intubated SARS patients were identified. Of the 697 HCWs involved in their care, 624 (90%) participated in the study. SARS-CoV was transmitted to 26 HCWs from 7 patients; 21 HCWs were infected by 3 patients. In multivariate GEE logistic regression models, presence in the room during fiberoptic intubation (OR = 2.79, p = .004) or ECG (OR = 3.52, p = .002), unprotected eye contact with secretions (OR = 7.34, p = .001), patient APACHE II score ≥20 (OR = 17.05, p = .009) and patient Pa02/Fi02 ratio ≤59 (OR = 8.65, p = .001) were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients.ConclusionClose contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV. Rates of transmission of SARS-CoV varied widely among patients.
Highlights
On March 7, 2003, a son of Canada’s index SARS case was admitted to a hospital in Toronto with a diagnosis of communityacquired pneumonia. Because he and other family members were not identified as infected with SARS CoV until March 13, infection was transmitted to patients, volunteers, visitors and health care workers in this community hospital, and subsequently in other hospitals and the community throughout Greater Toronto Area (GTA)
We conducted a retrospective cohort study designed to identify risk factors associated with transmission of SARS-CoV from patients requiring intubation to HCWs involved in their care
Two statistical methods were used to identify factors associated with SARS-CoV transmission: Classification and regression trees (CART) [12] and Generalized Estimating Equation (GEE) models
Summary
On March 7, 2003, a son of Canada’s index SARS case was admitted to a hospital in Toronto with a diagnosis of communityacquired pneumonia. Because he and other family members were not identified as infected with SARS CoV until March 13, infection was transmitted to patients, volunteers, visitors and health care workers in this community hospital, and subsequently in other hospitals and the community throughout Greater Toronto Area (GTA). During and after the outbreak, considerable controversy evolved regarding how HCWs using precautions became infected, and what care activities and/or behaviours posed the greatest risk of transmission. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission
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