"As new issues about safety and health in the workplace evolve, it is important to put information in the hands of people who need it the most," said John L. Henshaw, Assistant Secretary of Labor for Occupational Safety and Health. "There is still much we do not know about SARS, but sharing what we do know helps everyone make informed decisions about assessing risks and taking appropriate precautions."
The information on OSHA's Web site includes a PowerPoint presentation that employers may find useful in discussing the risks of SARS in the workplace, information about precautions to be taken in working with patients with SARS, and links to other agencies' fact sheets, guidance and information on SARS, including the Centers for Disease Control (CDC) and the National Institute for Occupational Safety and Health (NIOSH). Topics include: background on ; information for OSHA staff for public inquiries; information on precautions in healthcare facilities; information for laboratory workers; information for airline flight crew and airport personnel; information for crew cleaning planes that carried suspected SARS cases; information for workers involved in air medical transport of SARS patients; safety and health during handling of human remains of SARS patients; employee training; if a worker experiences symptoms; and updated information from CDC.
The Centers for Disease Control and Prevention (CDC) has defined a suspect case of SARS as an illness of unknown cause that began in February 2003 or later and meets the following criteria:
- Fever of at least 100.5 degrees F;
- One or more clinical findings of respiratory illness, such as cough, shortness of breath, difficulty breathing, hypoxia or x-ray evidence of either pneumonia or acute respiratory distress syndrome; and
- The onset of symptoms occurs within 10 days of either (1) travel to an area with documented or suspected community transmission of SARS; or (2) close contact with either a person with a respiratory illness who traveled to a SARS area or a known suspect SARS case. Close contact means having cared for, lived with or had direct contact with respiratory secretions and/or body fluids.
A list of areas with documented or suspected community transmission of SARS can be found on the Updated Interim U.S. Case Definition of Severe Acute Respiratory Syndrome (SARS) Web site. Suspect cases with radiographic evidence of pneumonia, respiratory distress syndrome or evidence of unexplained respiratory distress syndrome by autopsy are designated "probable" cases by the World Health Organization (WHO) case definition.
In addition to fever, reports indicated that the majority of SARS patients experienced chills, and about half had muscle aches and dry cough. Fewer than half have also shown other symptoms such as dizziness. The incubation period is typically two to seven days, although some reports suggest an incubation period as long as 10 to 12 days. Signs of the illness include a decreased white blood cell count in most patients as well as below normal blood platelet counts, liver enzyme increase, and electrolyte disturbances in a number of patients.
Most people with SARS are adults. Those age 40 and older and those with certain medical conditions appear to be at increased risk of more severe disease and of death. Treatment consists of antibiotics and steroids, with other options being explored. Between 10 and 20 percent of SARS patients have required ventilator support for a period of time. To date, about 4 percent of identified SARS cases have been fatal.
Since the infectivity and route of transmission of SARS are unknown, healthcare workers treating patients known to be infected with SARS should use standard precautions, including good work and hygiene practices and the use of personal protective equipment (PPE) appropriate for bloodborne and airborne exposures. Appropriate PPE includes protective gowns, gloves and N95 respirators, in addition to eye protection. If workers providing care to a SARS patient have potential exposure to blood or other potentially infectious materials, they must use PPE in accordance with OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030. Refer to the Bloodborne Pathogens Technical Links page for information on the standard.
Acute care facilities already should have appropriate ventilation systems (including appropriate exhaust and filtration) to eliminate the potential for exposure to airborne infectious diseases. If appropriate ventilation systems are in place, any airborne SARS exposures should also be controlled. Individuals with suspected SARS should be placed in an isolation room with negative pressure. If air recirculation is unavoidable, infected individuals should be placed in an area that exhausts room air directly to the outdoors or through HEPA filters if recirculation is unavoidable. The CDC's Guidelines for Isolation Precautions in Hospitals provides additional information on isolation rooms.
There are no disinfectant products currently registered by the U.S. Environmental Protection Agency (EPA) for the newly identified viruses associated with SARS. The CDC recommends the use of EPA-registered chemical germicides that provide low- or intermediate-level disinfection during general use because these products are known to inactivate related viruses with physical and biochemical properties similar to the suspected SARS agents.
OSHA recommends all employees with potential occupational exposure to SARS be trained on the hazards associated with that exposure and on the protocols in place in their facilities to isolate and report cases and to reduce exposures. Employers and employees caqn obtain further information on OSHA training regulations and policies including the revised bloodborne pathogen standard 29 CFR 1910.1030 and needlestick prevention information located on the Bloodborne Pathogens Technical Links page. Additional information can also be obtained from the CDC's SARS Web site.
If an employee experiences a fever and respiratory symptoms after contact with a patient known to be infected with SARS, the CDC recommends that the employee be excluded from duty.