Control of Hospital Infection during the SARS Outbreak in Ontario, Canada February – August, 2003 2003 Asia Pacific Inter-City SARS Forum Taipei, September 2003 Dr. Colin D’Cunha Commissioner of Public Health, Chief Medical Officer of Health and Assistant Deputy Minister Ontario Ministry of Health and Long-Term Care
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Control of Hospital Infection during the SARS Outbreak in Ontario, Canada February – August, 2003 2003 Asia Pacific Inter-City SARS Forum Taipei, September.
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Control of Hospital Infectionduring the SARS Outbreak
in Ontario, CanadaFebruary – August, 2003
2003 Asia Pacific Inter-City SARS ForumTaipei, September 2003
Control of Hospital Infectionduring the SARS Outbreak
in Ontario, CanadaFebruary – August, 2003
2003 Asia Pacific Inter-City SARS ForumTaipei, September 2003
Dr. Colin D’CunhaCommissioner of Public Health, Chief Medical Officer of Health
and Assistant Deputy MinisterOntario Ministry of Health and Long-Term Care
Presentation Outline
SARS in Ontario
Inter-City Experience: The Greater Toronto Area
Control of Hospital Infection
Preparedness / Protocols
Implications and Lessons Learned
Planning for the Future
Ontario, CanadaOntario, Canada Twice as large as Thailand
and ¼ of India
30 x larger than Taiwan
Population: 12 million
Capital: Toronto
OntarioMap
Michigan New York
QuebecMinnesota
Manitoba
Toronto, Ontario
Largest city in Canada
GTA population 5.1 million Multi-ethnic (about 50% immigrants;
more than 100 languages spoken)
TorontoToronto
Onset of SARS Outbreak in Ontario
Hong KongHong Kong
Toronto HospitalToronto Hospital (Mar. 7/03)
Index CaseIndex Case
HouseholdHousehold
transmissiontransmission
NosocomialNosocomial
transmissiontransmission
SARS Experience in Ontario
Introduced to Toronto bya traveller to Hong Kong
Transmitted to a family member;the latter admitted to Toronto hospital
Household+Nosocomial Transmission
Phase I: 257 cases136 Probable, 121 Suspect
Phase II: 118 cases111 Probable, 7 Suspect
12-Jun Last Onset
Last week of May
Last week of Feb. to first week of Mar.
23-Feb.
Outcome: 331 recovered, 44 died
Nosocomial Transmission
n = 375
Phase 2
Phase 1
SARS Cases in Ontario by Case Status and Phase
SARS Cases Reported by Health Units
SurroundingSurrounding Regions Regions
39%39%
City of Toronto City of Toronto
661%1%
Suspect 128
Probable247
Hospitalization and Case Fatality DataProbable and Suspect SARS Cases
1
18
0
50
100
150
200
250
Phase 1 Phase 2 Phase 1 Phase 2
Nu
mb
er o
f ca
ses
Not Hospitalized
Hospitalized
239239 117117
27 17
Deceased
Ministry alerts healthcare providers
Index hospital closed
SARS becomes reportable disease
Quarantine measures instituted
Provincial emergency declared
Directives for contact, droplet, airborne
precautions instituted provincially
Feb. 19Feb. 19
Mar. 28Mar. 28
Initial Actions
Response by the Ontario Government
Provincial Operations Committee
Provincial directives to hospitals, health units
Coordination of resources
Daily media conferences and reports
Outbreak Management by Public Health Branch
Set up SARS teams
Conferences to discuss cases
Routine dissemination of information
Developed policies & directives through Science Committee
Dedicated space, staff, communication lines
Hired / seconded / borrowed staff on short-term contracts
Inter-City Response: Toronto Public Health Unit
Hotline
Case management
Contact follow-up
Epidemiology team
Staff commitment
HH
HH
H
H
H
H
HH
Nosocomial Outbreak in Toronto Area Hospitals
Source: Toronto (Scarborough Grace)
Hospital
Other Regional Hospitals
• Markham-Stouffville
• York Central
Other Toronto Hospitals
• Mount Sinai
• North York General
• Scarborough General
• Saint John’s
• Sunnybrook
• Toronto General
• West Park
Infection Control in Hospitals
Enhanced infection control measures throughout
the hospitals
Creation of contained SARS wards
New directives for patient transfers and visitors
Work quarantine for selected healthcare staff
Limiting the number of healthcare settings in
which staff can work
Curtailing other health services
Enhanced Infection Control Measures in Hospitals
Wearing of personal protective equipment
(masks with fit- testing, gowns, eye-gear, gloves)
Screening patients at all points of entry
Temperature check on arrival
Completion of form indicating symptom and travel information
Outpatients positioned more than one metre (3 feet) apart
Phone-screening for outpatients prior to appointment
Banning all visitors (except on compassionate grounds)