Adult Sepsis Guidelines Children's Sepsis Guidelines
Adult ICU Liberation Guidelines PANDEM Guidelines for Children and Infants
Log In
Forgot username? Forgot password? New User? Sign Up Free
SCCM is performing maintenance on its websites. For the best browsing experience, please use Microsoft Edge or Safari. Those using Chrome or Firefox may experience access issues at this time.
Concern over the 2019 novel coronavirus (2019-nCoV) is growing. It is vital that those on the frontlines be prepared. This article highlights several strategic goals and special considerations related to caring for a critically ill patient who can transmit a deadly disease to you, your staff, or others in your hospital.
SCCM Resources
Visit sccm.org/disaster for numerous emergency response resources relevant to infectious disease outbreaks and lessons learned from previous outbreaks. Resources include complimentary chapters from SCCM’s Fundamental Disaster Management program.
Download the PDF Print Version
As of January 30, 2020, 14 countries have confirmed cases of the 2019 novel coronavirus (2019-nCoV), and the number of cases has almost tripled.1 Many of us have gone through the process of preparing for serious outbreaks, and some have been in the unfortunate situation of responding to them. It seems that each new outbreak brings a level of chaotic activity rather than implementation of a set of strategies and operational tactics. Concern over the 2019 novel coronavirus (2019-nCoV) is growing. It is vital that those on the frontlines be prepared. This article highlights several strategic goals and special considerations related to caring for a critically ill patient who can transmit a deadly disease to you, your staff, or others in your hospital. Many of the shortfalls in previous responses have occurred in hospitals. The disconnect has generally been in marrying infection control guidance with the myriad clinical activities necessary to care for a critically ill infected patient. Why should we pay attention to an outbreak that seems small and is in other regions? Human-to-human transmission of a potentially deadly pathogen, even in small numbers relative to the population health burden of other critical illnesses, is an existential threat to even the most sophisticated facilities, as was demonstrated by the severe acute respiratory syndrome (SARS) outbreak of 2002-2004. Despite the limited relative burden of disease compared to everyday conditions, it is crucial that we protect our hospitals from unrecognized exposure, since such an event can devastate an entire hospital and community. Emergency departments (EDs) and critical care units are major locations for disease transmission for both healthcare workers and patients. A 21-hour period of unprotected exposure in the first impacted hospital in Toronto ultimately led to 128 nosocomial cases in this facility and sparked additional transmission in two other hospitals due to transfers of two critically ill patients with unrecognized disease.2 The challenges of caring for a relatively small number of patients (375 confirmed and suspected cases in Ontario) resulted in the cumulative closure of nearly one-third of Toronto’s critical care beds during the response.3 About 37% of the secondary cases at the initial hospital were healthcare workers, 14% were hospitalized patients, and 14% were hospital visitors.4 This facility closed to new admissions, closed its outpatient clinics, and quarantined its discharge patients to gain control of the outbreak. SARS ultimately led to more than 8,000 cases and 800 deaths. The importation of a case of MERS-CoV to South Korea led to similar outcomes. A businessperson who traveled to several Middle Eastern countries and then back to Seoul sought treatment in multiple hospitals, leading to more than 180 cases and 30 deaths.4 Both the Toronto and Seoul initial cases occurred at a time when no cases had been identified in their respective countries. However, even when risk perception is high, countering disease transmission in modern hospitals is very difficult. In 2014, an outbreak of 255 MERS-CoV cases led to 93 deaths in Jeddah, Saudi Arabia. An investigation suggested that the event was a result of human-to-human transmission in healthcare facilities, rather than an uptick in primary cases in the community, despite MERS-CoV already being endemic in the country and region.5 What are the initial strategic steps in preparing to care for patients who are ill from 2019-nCoV infection? Clinical facility leaders must define and disseminate strategic goals and use the best available science to develop risk-based objectives and tactics. Strategic Goals:
Posted: 1/31/2020 | 0 comments
Log in to Comment