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Transmission of Severe Acute Respiratory Syndrome during Intubation and Mechanical Ventilation

Interdepartmental Division of Critical Care Medicine, University of Toronto, Sunnybrook and Women's College Health Sciences Centre; Intensive Care Unit, Mount Sinai Hospital; and Department of Microbiology, Division of Infectious Diseases, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada

Correspondence and requests for reprints should be addressed to Robert A. Fowler, M.D., M.S., University of Toronto, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Room D4-78, Toronto, ON, M4N 3M5 Canada. E-mail: rob.fowler{at}sw.ca

Nosocomial transmission of severe acute respiratory syndrome from critically ill patients to healthcare workers has been a prominent and worrisome feature of existing outbreaks. We have observed a greater risk of developing severe acute respiratory syndrome for physicians and nurses performing endotracheal intubation (relative risk [RR], 13.29; 95% confidence interval [CI], 2.99 to 59.04; p = 0.003). Nurses caring for patients receiving noninvasive positive-pressure ventilation may be at an increased risk (RR, 2.33; 95% CI, 0.25 to 21.76; p = 0.5), whereas nurses caring for patients receiving high-frequency oscillatory ventilation do not appear at an increased risk (RR, 0.74; 95% CI, 0.11 to 4.92; p = 0.6) compared with their respective reference cohorts. Specific infection control recommendations concerning the care of critically ill patients may help limit further nosocomial transmission.

Key Words: severe acute respiratory syndrome • endotracheal intubation • noninvasive • high-frequency oscillatory ventilation

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