SARS presents containment, garment conundrum

07/01/2003

TORONTO—Nurses caring for SARS patients here want garments ranging from facemasks to full-body "moon suits" at their disposal throughout all shifts, now that even well-protected hospital workers are still being infected with the deadly respiratory virus.

Peter Birt, manager of public relations for the Ontario Nurses Association, says there are several factors contributing to widespread concern among nurses, many of whom have either contracted or been quarantined in a second outbreak of SARS (severe acute respiratory syndrome).

At press time, two of the three latest cases involved nurses contracting SARS while performing intubation (inserting a breathing-tube) on a dying patient during a frantic operation.

In addition, Birt says the effectiveness of the N-95—a respirator mask that is said to trap 95 percent of particles one-tenth the size of Anthrax—has also come into question, while new provincial guidelines call for using a Papr—a head-and-shoulders hood with a battery-operated air filter attached—or a full-body Stryker suit during such high-risk procedures as intubation.

Meanwhile, a memorandum from the Ministry of Health suggests that Ontario hospitals (namely, the four hospitals where SARS wards have been condensed) have not been following containment directives, including: Failure to follow the transfer protocols as outlined in the Updated Provincial Inter-Facility Patient Transfer Directrive, May 12, 2003.

"[That's] a big one because they have been moving patients around," Birt adds, saying that may have contributed to the second outbreak.

During the first outbreak, he explains, many healthcare workers did not wear face shields "because it did not seem to be an issue." Now, it seems the N-95 is not adequate enough. Says Birt: "Very few are getting the training they need to affix the masks to their faces properly. Even if you scratch yourself and dislodge the mask, you could disrupt the fitting and it could become less effective in preventing the transmission of SARS."

Healthcare workers are now demanding "moon suits," which are ultra-protective garments outfitted with respirators, commonly worn by biological lab personnel.

But some believe wearing the full-body moon suits or other heavy-duty protective garments full-time is not the answer. Dr. Donald Low, chief microbiologist at Mount Sinai Hospital, says nurses and doctors wearing just masks, goggles, face shields and gowns face no risks working around stable SARS patients. But in taking off the full-body equipment or hoods, workers could inadvertently expose themselves to the virus on the outside of the suits, he adds.