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Epidemiologic Study and Containment of a Nosocomial Outbreak of Severe Acute Respiratory Syndrome in a Medical Center in Kaohsiung, Taiwan

Published online by Cambridge University Press:  21 June 2016

Jien-Wei Liu
Affiliation:
Committee of Infection Control and Division of Infectious Diseases, Chang Gung University College of Medicine, Taiwan
Sheng-Nan Lu
Affiliation:
Division of Hepatogastroenterology, Chang Gung University College of Medicine, Taiwan
Shun-Sheng Chen
Affiliation:
Department of Internal Medicine, Department of Neurology, Chang Gung University College of Medicine, Taiwan
Kuender D. Yang
Affiliation:
Department of Pediatrics, Chang Gung University College of Medicine, Taiwan
Meng-Chih Lin
Affiliation:
Division of Pulmonary and Critical Care, Chang Gung University College of Medicine, Taiwan
Chao-Chien Wu
Affiliation:
Division of Pulmonary and Critical Care, Chang Gung University College of Medicine, Taiwan
Peter B. Bloland
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Sarah Y. Park
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
William Wong
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Kuo-Chien Tsao
Affiliation:
Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Clinical Virology Laboratory, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Lin-Kou, Chang Gung University College of Medicine, Taiwan
Tzou-Yien Lin
Affiliation:
Department of Pediatrics, Chang Gung Children's Hospital, Kweishan, Chang Gung University College of Medicine, Taiwan
Chao-Long Chen*
Affiliation:
Department of General Surgery, Chang Gung University College of Medicine, Taiwan
*
Chang Gung Memorial Hospital, Kaohsiung Medical Center, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 833, Taiwan

Abstract

Objective.

We conducted an epidemiologic investigation at the beginning of a nosocomial outbreak of severe acute respiratory syndrome (SARS) to clarify the dynamics of SARS transmission, the magnitude of the SARS outbreak, and the impact of the outbreak on the community.

Methods.

We identified all potential cases of nosocomially acquired SARS, linked them to the most likely infection source, and described the hospital containment measures.

Setting.

A 2,300-bed medical center in Kaohsiung, Taiwan.

Results.

A total of 55 cases of SARS were identified, and 227 hospital workers were quarantined. The index patient and neighboring patients were isolated. A chest physician team reviewed medical charts and chest radiographs and monitored the development of SARS in patients staying in the ward. The presence of underlying lung disease and immunocompromise in some patients made the diagnosis of SARS difficult. Some cases of SARS were diagnosed after the patients had died. Medical personnel were infected only if they cared for patients with unrecognized SARS, and caretakers played important roles in transmission of SARS to family members. As the number of cases of nosocomial SARS increased, the hospital closed the affected ward and expedited construction of negative-pressure rooms on other vacated floors for patient cohorting, and the last case in the hospital was identified 1 week later.

Conclusions.

Timely recognition of SARS is extremely important. However, given the limitations of SARS testing, possible loss of epidemic links, and the nonspecific clinical presentations in hospitalized patients, it is very important to establish cohorts of persons with low, medium, and high likelihoods of SARS acquisition. Rapid closure of affected wards may minimize the impact on hospital operations. Establishment of hospitals dedicated to appropriate treatment of patients with SARS might minimize the impact of the disease in future epidemics.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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