To fight Ebola virus, radiologists share lessons learned from SARS pandemic

As Ebola continues to strike fear into the hearts of healthcare workers everywhere, those stationed in imaging areas—or regularly passing through—should look back on, and learn from, the SARS pandemic of 2003.

The October issue of the American Journal of Roentgenology includes a report that will enable interested parties to do just that.

In the piece, three radiologists from Singapore, which was second only to China in number of cases, present several “learning points” gleaned from their experiences. 

First they recount how the SARS coronavirus, a strain of pneumonia (the acronym stands for severe acute respiratory syndrome), touched down in Singapore when a previously healthy young woman returned from vacation in Hong Kong. It turned out she had stayed on the same hotel floor as an infected physician from China. The woman was hospitalized with no special contact restrictions. Soon enough, several healthcare workers, nearby patients and hospital visitors became sick. The pandemic was on.

SARS-CoV spread across 26 countries, striking more than 8,000 people. In Singapore, 238 probable cases were identified, 33 of which (14%) were fatal.

“The pandemic served as a wake-up call for the medical services, which had to respond and reorganize quickly to meet the rapidly developing clinical situation,” the authors write. “The lessons learned during the epidemic have formed the basis of a contagion-response plan that is still in use today and proved valuable in combating the more recent novel influenza A H1N1 outbreak in 2009 and Middle East respiratory syndrome coronavirus threat in 2013.”

The learning points include:

  • Infection control is essential for all radiology staff. Of the SARS cases in Singapore, 40.8% were among health care workers and a healthcare institution was the source of infection in 73.5% of cases. Notably, 10 cases were directly attributed to the radiology department: four staff members and six visitors or outpatients of the department. “Because of the expensive and bulky equipment in the radiology department, an imaging or interventional center typically processes relatively large numbers of inpatients and outpatients who come into direct contact with health care workers and other patients,” the authors write. “All members of the team need to believe in and practice the appropriate protocols daily for every patient. Regular audits can help achieve a higher level of compliance, but staff buy-in through education is likely to be more effective than audits.”
  • Infection control must be considered when planning radiologic facilities. Traditionally, radiology departments have been organized for maximum efficiency and patient throughput, with equipment of the same imaging modality clustered together. With this standard model, the authors warn, segregation of patients with different infection risks is difficult to pull off. In facilities where there’s no practical way to separate imaging facilities for outpatients and inpatients, “segregation can also be achieved through temporal separation of inpatients and outpatients.” Either way, high-efficiency particulate air filters “should be considered an essential component of room ventilation. Several guidelines and standards for environmental infection control are available and should be consulted when planning radiologic facilities.”
  • Infection control must be considered in the daily scheduling of radiological exams and procedures. At Singapore General Hospital, vacuuming and mechanical buffing of floors were halted during the SARS outbreak to prevent inadvertent aerosolization of the virus. “Today these tasks occur after office hours to minimize staff exposure. Adequate time must be factored in to the schedule to allow thorough cleaning of the rooms; otherwise, staff will tend to rush through this activity.”

“While we carry out our mission of imaging diagnosis and intervention, we need to be cognizant of not compromising the safety and well-being of our patients, our staff and the community,” the authors conclude. “The tiniest of creatures do and will continue to challenge us, and we must continue to respond to protect ourselves, our patients, and the community. Our experience with SARS has shaped and changed our daily practice of radiology.”

To read the report in its entirety, click here