• Michael D Christian, Mona Loutfy, L Clifford McDonald, Kennth F Martinez, Mariana Ofner, Tom Wong, Tamara Wallington, Wayne L Gold, Barbara Mederski, Karen Green, Donald E Low, and SARS Investigation Team.
• Immunodeficiency Clinic, University Health Network, University of Toronto, Toronto, ON, Canada. Michael.Christian@utoronto.ca
• Emerging Infect. Dis. 2004 Feb 1; 10 (2): 287-93.

AbstractInfection of healthcare workers with the severe acute respiratory syndrome-associated coronavirus (SARS-CoV) is thought to occur primarily by either contact or large respiratory droplet transmission. However, infrequent healthcare worker infections occurred despite the use of contact and droplet precautions, particularly during certain aerosol-generating medical procedures. We investigated a possible cluster of SARS-CoV infections in healthcare workers who used contact and droplet precautions during attempted cardiopulmonary resuscitation of a SARS patient. Unlike previously reported instances of transmission during aerosol-generating procedures, the index case-patient was unresponsive, and the intubation procedure was performed quickly and without difficulty. However, before intubation, the patient was ventilated with a bag-valve-mask that may have contributed to aerosolization of SARS-CoV. On the basis of the results of this investigation and previous reports of SARS transmission during aerosol-generating procedures, a systematic approach to the problem is outlined, including the use of the following: 1) administrative controls, 2) environmental engineering controls, 3) personal protective equipment, and 4) quality control.

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