Illness in Intensive Care Staff after Brief Exposure to Severe Acute Respiratory Syndrome

acute respiratory syndrome (SARS) is a threat to healthcare workers. After a brief, unexpected exposure to a patient with SARS, 69 intensive-care staff at risk for SARS were interviewed to evaluate risk factors. SARS developed in seven healthcare workers a median of 5 days (range 3–8) after last exposure. SARS developed in 6 of 31 persons who entered the patient's room, including 3 who were present in the room >4 hours. SARS occurred in three of five persons present during the endotracheal intubation, including one who wore gloves, gown, and N-95 mask. The syndrome also occurred in one person with no apparent direct exposure to the index patient. In most, but not all cases, developing SARS was associated with factors typical of droplet transmission. Providing appropriate quarantine and preventing illness in healthcare providers substantially affects delivery of health care. S evere acute respiratory syndrome (SARS) is a disease that consists of fever and respiratory symptoms that can progress to respiratory failure and death (1). SARS is most likely to develop in healthcare workers and household or family contacts of infected persons (2–4). Unprotected exposure to SARS in hospitals has several potential consequences, which include the following: illness in persons and healthcare workers; transmission of SARS from ill healthcare workers and patients to visitors and household contacts; and reduced ability of the health-care system to deliver care because of illness in or quarantine of healthcare workers. In addition, the psychological impact of isolation and quarantine can be substantial (5). As a result, understanding factors associated with SARS transmission after exposure to SARS patients is important and would assist with formulating appropriate quarantine procedures. We describe our experience with a large number of healthcare workers who were exposed to a patient in an intensive-care unit (ICU) with undiagnosed SARS. a 74-year-old immunocompro-mised man was transferred to our ICU from a hospital where the original cluster of Toronto's SARS cases occurred (2). The patient originally had signs and symptoms consistent with a presumptive diagnosis of community acquired pneumonia. Before transfer, SARS was excluded from the differential diagnosis because the patient had not traveled, had never left the emergency department of the referring hospital, and had only had a single recent outpatient visit to an area of the original hospital in which SARS had not been identified. Upon arrival in our ICU, the patient was placed in precautions for methicillin-resistant Staphylococcus aureus (MRSA) pending …