Thursday � June 5 � 2003 Experts say spacesuit-like gear only way to safely intubate SARS patients HELEN BRANSWELL Canadian Press
Wednesday, June 04, 2003 CREDIT: (CP /Kevin Frayer) Registered respiratory therapist Jacob Krygier displays a Stryker protective suit that is worn when performing any high-risk procedure on SARS patients. (CP /Kevin Frayer) TORONTO (CP) - Intubating SARS patients is such a risky procedure that all hospitals treating SARS patients need to train and specially equip their staff to do them, using protective gear some liken to spacesuits, a variety of experts now insist. Despite using high-level precautions and having had weeks of experience in treating SARS patients, Toronto hospital workers who take part in intubations continue to contract the disease. As recently as the middle of last week, at least two nurses became infected during a relatively easy intubation at North York General Hospital. Given that as many as one in five SARS patients may require intubation, it's a warning hospitals have to take seriously, SARS expert Dr. Donald Low said Wednesday. "You can't have a patient with SARS in your hospital if you're not trained to do this," insisted Low, one of Canada's leading infectious disease experts and the key medical adviser to the SARS containment team. "The message out there is: Look it. It's no longer acceptable for people to go in with normal attire that you would use to manage a patient that was uncomplicated." Low and others are advocating the use of Stryker suits - the spacesuit-type outfits - and headgear called PAPRs for all SARS intubations. The acronym, which is pronounced pap-per, stands for powered air purifying respirator. Intubation is the process of inserting a tube into the lungs so that a patient who is having severe trouble breathing can be hooked up to a ventilator. The procedure can trigger a great deal of coughing and secretions, which are an obvious SARS transmission risk. But even performing the procedure on patients who have gone into cardiac arrest and aren't coughing - which was the case last week - poses high risk. Dr. Alan Tallmeister, an anesthesiologist at Scarborough Grace Hospital who has done close to 10,000 intubations in his career, knows from personal experience the dangers a SARS intubation poses. Tallmeister, 48, contracted SARS after helping intubate a man - later known to be one of the Toronto outbreak's super-spreaders - on March 17. At the time Tallmeister was wearing what was then standard hospital gear: a paper mask, a gown, gloves and hat. He wasn't wearing protective eyewear. "It was actually a fairly quick, straightforward insertion," Tallmeister recalled. He knew the patient was suffering from the new atypical pneumonia the World Health Organization had a few days earlier warned was devastating parts of China and Hong Kong. Concerns about the mysterious new disease played about the edges of his mind, so he took extra trouble scrubbing his face, arms, hands, shoulders and neck after the procedure. "But I was pretty certain that I'd be OK." Three days later, he came down with the fever that is the calling card of SARS. Before he was hospitalized, he infected his 15-year-old daughter. Both have fully recovered. "I really felt miserable - like the worst flu I'd ever had," said Tallmeister, who has been back at work for the past month. "That's the sickest I'd ever been." Ironically, Tallmeister took part in another intubation Wednesday. The patient was an elderly man with a lung problem. The team was fairly certain it wasn't SARS, but decided to take full precautions anyway, given the fact that Toronto's current bout of SARS was triggered by unprotected exposure of staff and patients to an undiagnosed case. "We thought, just to be on the extra safe side . . . we'd try out that new system of those sort of all-encompassing spacesuits types . . . the Strykers. And it was quite tedious just getting them on," he said. Tallmeister found the suit cumbersome and hot. "It really did make it harder to work. The visibility wasn't quite as good. It was hard to hear what other people were saying. Everything's kind of muffled under that hood." Still, that is the reality SARS intubation teams are going to have to get used to, if health-care workers are to remain free of the disease they are fighting, said Dr. Randy Wax, education director for critical care and one of the staff intensive care specialists at Mount Sinai Hospital. Wax is the expert provincial officials turned to to devise guidelines and protocols for protecting health-care workers in the SARS outbreak. He believes Stryker suits are the way to go. "I think for high-risk procedures such as intubations or running cardiac arrests, the health-care workers definitely need an added layer of protection," Wax said. "And just like you want multiple layers of protection if your car gets into an accident . . . when you're intubating a patient with SARS, you don't want to rely on one piece of equipment. You want to have multiple layers of protection in case something goes wrong." Simulation exercises have shown that trained staff can don the protective gear in 60 to 90 seconds, Wax said. But the issue is ensuring they take the time. "Our instinct when somebody is critically ill is to run in immediately and not think about the risk to ourselves," he explained. "And one of the things that's been difficult for all of us is learning how to balance taking care of the patient to the best of our ability and still figuring out a way to protect ourselves." Another problem is learning to take the equipment off safely. The virus particles shed by SARS patients during an intubation can adhere to protective gear, making disrobing potentially the most dangerous part of the whole procedure. For that reason, not everyone is convinced it is the way to go. "Personally, I'm not certain," said Dr. Andrew Simor, head of microbiology at Sunnybrook and Women's College Health Sciences Centre. "There are potential advantages to the Stryker. The Stryker also has potential problems with it. It's a more complicated thing to put on. There is the possibility of contamination on removing the Stryker if it's not removed properly. I honestly do not know if it's the answer." But Low said those problems can be worked around, with staff education. "You not only have to train people how to go into one of these things but how to come out of them," he said. "So it's training, training, training." � Copyright 2003 The Canadian Press __________________________________ Do you Yahoo!? Yahoo! Calendar - Free online calendar with sync to Outlook(TM). http://calendar.yahoo.com --- URG-L Pour modifier votre adresse de courriel sur URG-L, envoyez un avis a [EMAIL PROTECTED] en indiquant votre nouvelle adresse ainsi que l'ancienne et le nom de la liste.
