I. Rationale and Goals

Supplement I: Infection Control in Healthcare, Home, and Community Settings

Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2

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Transmission of SARS-CoV appears to occur predominantly through close interactions with infected persons. Infectious respiratory secretions are the most likely source of infection, although fecal/oral transmission may have occurred in some settings. Contact with contaminated body substances, either directly (e.g., shaking hands) or indirectly (e.g., touching objects contaminated with respiratory secretions or stool), can lead to exposure. SARS-CoV may also be transmitted through close contact with respiratory droplets expelled when a patient coughs or sneezes. In some instances, however, true airborne transmission (i.e., via droplet nuclei) cannot be excluded as a possible mode of SARS-CoV transmission.

SARS-CoV has been transmitted in healthcare settings (e.g., inpatient settings, emergency departments, nursing homes) to and from patients, healthcare workers, and visitors. Transmission to healthcare workers has occurred primarily after close contact with symptomatic persons before implementation of infection control precautions. During the 2003 outbreaks, multiple hospitals reported cases of SARS-CoV disease among healthcare workers who were present during aerosol-generating procedures performed on patients with SARS-CoV disease, suggesting that aerosol-generating procedures may pose an increased risk of SARS-CoV transmission. Special precautions during these procedures are recommended.

Infection control guidance to prevent SARS-CoV transmission is necessary to help ensure the protection of healthcare workers and healthcare facilities. In addition, as hospitalization of patients with SARS-CoV disease is recommended only if medically indicated, patients with less severe disease will likely be isolated in personal residences and designated community facilities. Therefore, appropriate infection control measures will be required to prevent transmission of SARS-CoV in these facilities. The goals for all settings are to:

• Ensure early recognition of patients at risk for SARS-CoV disease.
• Prevent transmission of SARS-CoV by implementing appropriate infection control precautions.