Journal Article

Why Did Outbreaks of Severe Acute Respiratory Syndrome Occur in Some Hospital Wards but Not in Others?

Ignatius T. Yu, Zhan Hong Xie, Kelvin K. Tsoi, Yuk Lan Chiu, Siu Wai Lok, Xiao Ping Tang, David S. Hui, Nelson Lee, Yi Min Li, Zhi Tong Huang, Tao Liu, Tze Wai Wong, Nan Shan Zhong and Joseph J. Sung

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 8, pages 1017-1025
Published in print April 2007 | ISSN: 1058-4838
Published online April 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/512819
Why Did Outbreaks of Severe Acute Respiratory Syndrome Occur in Some Hospital Wards but Not in Others?

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Background. Most documented “superspreading events” of severe acute respiratory syndrome (SARS) occurred in hospitals, but the underlying causes remain unclear. We systematically analyzed the risk factors for nosocomial outbreaks of SARS among hospital wards in Guangzhou and Hong Kong, China.

Methods. A case-control study was conducted. Case wards were hospital wards in which superspreading events of SARS occurred, and control wards were wards in which patients with SARS were admitted, but no subsequent nosocomial outbreaks occurred. Information on environmental and administrative factors was obtained through visits to the wards and interviews with ward managers or nursing officers. Relevant information about host factors was abstracted from the medical records. Logistic regression analyses were used to identify the major risk factors for superspreading events.

Results. Eighty-six wards in 21 hospitals in Guangzhou and 38 wards in 5 hospitals in Hong Kong were included in the study. Six risk factors were significant in the final multiple-logistic regression model: minimum distance between beds of ≤1 m (odds ratio [OR], 6.94; 95% confidence interval [CI], 1.68–28.75), availability of washing or changing facilities for staff (OR, 0.12; 95% CI, 0.02–0.97), whether resuscitation was ever performed in the ward (OR, 3.81; 95% CI, 1.04–13.87), whether staff members worked while experiencing symptoms (OR, 10.55; 95% CI, 2.28–48.87), whether any host patients (index patient or the first patient with SARS admitted to a ward) required oxygen therapy (OR, 4.30; 95% CI, 1.00–18.43), and whether any host patients required bi-level positive airway pressure ventilation (OR, 11.82; 95% CI, 1.97–70.80).

Conclusions. Our results revealed that factors that were associated with the ward environment and administration were important in nosocomial outbreaks of SARS. The lessons learned from this study remain very important and highly relevant to the daily operation of hospital wards if we are to prevent nosocomial outbreaks of other respiratory infections in the future.

Journal Article.  4373 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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