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Information Regarding Severe
Acute Respiratory Syndrome (SARS)
NOTICE

OSHA has developed this Information Regarding Severe Acute Respiratory Syndrome (SARS) to provide relevant and timely information regarding this illness to employers, employees, and other interested parties. OSHA may update this information as additional information concerning SARS becomes available.

While the information references enforceable OSHA standards, the information itself is not a new standard or regulation, and it creates no new or independent legal obligations. The Occupational Safety and Health Act requires employers to comply with hazard-specific safety and health standards. In addition, pursuant to Section 5(a)(1) of the OSHAct (the "General Duty Clause"), employers must provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. Employers can be cited for violating the General Duty Clause if they do not take reasonable steps to abate or address such a recognized hazard. However, the failure to implement the information is not, in itself, a violation of the General Duty Clause. OSHA citations can only be based on standards, regulations, and the General Duty Clause.

 

 
  1. Background on SARS

    Severe acute respiratory syndrome (SARS) is an emerging, sometimes fatal, respiratory illness. The first identified cases occurred in China in late 2002, and the disease has now spread throughout the world. Although SARS is believed to be caused by a virus, the specific agent has not been identified, and there is not yet any laboratory or other test that can definitively identify cases. Suspected SARS cases in the United States have involved individuals returning from travel to Asia and health care workers and other contacts of those patients. SARS does not appear to be caused by casual contact; transmission appears to be primarily through close contact with a symptomatic patient.

    The Centers for Disease Control and Prevention (CDC) has defined a suspect case of SARS as an illness of unknown cause that began in February 2003 or later and meets the following criteria:

     
    bulletFever of at least 100.5 degrees F;

     
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    One or more clinical findings of respiratory illness, such as cough, shortness of breath, difficulty breathing, hypoxia, or x-ray evidence of either pneumonia or acute respiratory distress syndrome; and

     

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    The onset of symptoms occurs within 10 days of either (1) travel to an area with documented or suspected community transmission of SARS; or (2) close contact with either a person with a respiratory illness who traveled to a SARS area or a known suspect SARS case. Close contact means having cared for, lived with, or had direct contact with respiratory secretions and/or body fluids. A list of areas with documented or suspected community transmission of SARS can be found on the Updated Interim U.S. Case Definition of Severe Acute Respiratory Syndrome (SARS) web site.


    Suspect cases with radiographic evidence of pneumonia, respiratory distress syndrome, or evidence of unexplained respiratory distress syndrome by autopsy are designated "probable" cases by the World Health Organization (WHO) case definition.

    In addition to fever, reports indicated that the majority of SARS patients experienced chills, and about half had muscle aches and dry cough. Fewer than half have also shown other symptoms such as dizziness. The incubation period is typically 2 to 7 days, although some reports suggest an incubation period as long as 10 to 12 days. Signs of the illness include a decreased white blood cell count in most patients as well as below normal blood platelet counts, liver enzyme increase, and electrolyte disturbances in a number of patients.

    Most people with SARS are adults. Those age 40 and older and those with certain medical conditions appear to be at increased risk of more severe disease and of death. Treatment consists of antibiotics and steroids, with other options being explored. Between 10 and 20 percent of SARS patients have required ventilator support for a period of time. To date, about 4 percent of identified SARS cases have been fatal.

     

  2. Information for OSHA Staff for Public Inquiries


    The CDC has established several resources, including, the CDC SARS Domestic Team, available by phone at 770-488-7100 and online at the CDC SARS web site. The WHO has information on SARS online at the WHO SARS web site.

    Physicians, employers, and/or employees should contact their state or local health departments (CDC's List of State and Local Health Departments) to notify them of any symptomatic employees or suspected exposure incidents.

     

  3. Information on Precautions in Healthcare Facilities


    The CDC has reported very few cases of occupationally acquired SARS in the United States. The CDC is working in collaboration with state and local health departments to develop a systematic approach to survey SARS exposures and infection in healthcare workers. The CDC has issued a number of recommendations for healthcare workers who may have contact with a suspected SARS patient. The CDC provides the following documents:

     
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    CDC | Interim Domestic Guidance for Management of Exposures to Severe Acute Respiratory Syndrome (SARS) for Healthcare and Other Institutional Settings,

     

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    CDC | Triage of Patients Who May Have Severe Acute Respiratory Syndrome: Interim Guidance for Screening in Ambulatory Care Settings, and

     

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    CDC | Updated Interim Domestic Infection Control Guidance in the Health-Care and Community Setting for Patients with Suspected SARS.

     

    The CDC also provides general information on infection control for healthcare workers in the Guidelines for Infection Control in Health Care Personnel (1998) document.

     

    1. Standard Precautions and Personal Protective Equipment

      Since the infectivity and route of transmission of SARS are unknown, healthcare workers treating patients known to be infected with SARS should use standard precautions, including good work and hygiene practices and the use of personal protective equipment (PPE) appropriate for bloodborne and airborne exposures. Appropriate PPE includes protective gowns, gloves, N95 respirators, in addition to and eye protection.

      If workers providing care to a SARS patient have potential exposure to blood or other potentially infectious materials, they must use PPE in accordance with OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030. Refer to the Bloodborne Pathogens Technical Links page for information on the standard.

       

    2. Engineering Controls

      Acute care facilities already should have appropriate ventilation systems (including appropriate exhaust and filtration) to eliminate the potential for exposure to airborne infectious diseases. If appropriate ventilation systems are in place, any airborne SARS exposures should also be controlled. Individuals with suspected SARS should be placed in an isolation room with negative pressure. If air recirculation is unavoidable, infected individuals should be placed in an area that exhausts room air directly to the outdoors or through HEPA filters if recirculation is unavoidable. The CDC's Guidelines for Isolation Precautions in Hospitals provides additional information on isolation rooms.

       

    3. Housekeeping

      There are no disinfectant products currently registered by the U.S. Environmental Protection Agency (EPA) for the newly identified viruses associated with SARS. The CDC recommends the use of EPA-registered chemical germicides that provide low- or intermediate-level disinfection during general use because these products are known to inactivate related viruses with physical and biochemical properties similar to the suspected SARS agents.

       

  4. Information for Laboratory Workers


    Laboratory personnel in facilities performing diagnostic tests on patients suspected to be infected with SARS should follow biosafety preventive measures established by the CDC, Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Severe Acute Respiratory Syndrome (SARS). As appropriate, they should also follow OSHA's bloodborne pathogens and respiratory protection standards.

     

    1. Biosafety Precautions and PPE

      Laboratory workers must wear appropriate PPE, including disposable gloves, gowns, eye protection, and respiratory protection. N95, N100 air-purifying respirators, or powered air-purifying respirators (PAPRs) equipped with high-efficiency particulate air (HEPA) filters are recommended. If there is potential exposure to blood or other potentially infectious materials, laboratory workers must use PPE in accordance with OSHA's bloodborne pathogens standard, 29 CFR 1910.1030. Information on the standard is found on the Bloodborne Pathogens Technical Links page.

       

    2. Engineering Controls

      Activities involving the manipulation or testing of specimens from SARS patients should be done at the appropriate biosafety level (BSL) including the use of a certified biological safety cabinet.

       

    3. Housekeeping

      The CDC advises that there are no disinfectant products currently registered by EPA for the newly identified viruses associated with SARS. The CDC recommends the use of EPA-registered chemical germicides that provide low- or intermediate-level disinfection during general use against SARS agents because these products are known to inactivate related viruses with physical and biochemical properties similar to the suspected SARS agents.

       

  5. Information for Airline Flight Crew and Airport Personnel


    The CDC has issued recommendations for aircraft crew members to follow for notifying a United States quarantine station if a passenger on an international flight returning to the United States is suspected of having SARS. Refer to the CDC's web site for the Interim Guidelines about Severe Acute Respiratory Syndrome (SARS) For Airline Flight Crew Members. Airline flight crews should notify ground and cleaning crews in the event that a passenger suspected of being infected with SARS has dis-embarked a commercial aircraft. This will allow cleaning crews that clean and disinfect the aircraft to protect themselves.

    The CDC's recommendations for other airport personnel are found at Basic Information on SARS for TSA, INS, and Airline Clean-Up Workers or Interim Guidelines about Severe Acute Respiratory Syndrome (SARS) for Transportation Security Administration (TSA) Personnel.

     

    1. Personal Protective Equipment

      CDC does not recommend the use of any personal protective equipment for airline crew members at this time. CDC recommends that airport ground personnel, including airline cleaning crews, as well as Immigration and Naturalization Service and Transportation Security Agency workers, wear gloves, but not respirators. A passenger suspected of being infected with SARS should be separated from other passengers as much as possible and provided with a surgical mask, if available.

       

    2. Hygiene Practices

      Airline flight crews and airport ground personnel should be aware of the symptoms associated with SARS. All workers should use good hygiene practices including frequent hand washing with soap and water.

       

  6. Cleaning Planes that Have Carried Suspected SARS Cases
     


    If a passenger is suspected of having SARS, providing additional information for crews cleaning that airplane is necessary. OSHA advises following the recommendations published by the CDC for this situation, Interim Guidance for Cleaning of Commercial Passenger Aircraft Following a Flight with a Passenger with Suspected Severe Acute Respiratory Syndrome (SARS).
     

    1. Personal Protective Equipment

      The CDC recommends that personnel who clean an airplane that a passenger suspected of having SARS has been on wear disposable gloves, but need not use gowns, masks, or respirators.

       

    2. Hygiene and Housekeeping Practices

      The managers of airline cleaning crews should be aware of the symptoms of SARS. Any employee who cleans a plane that transported a possible SARS patient should notify the company's occupational health unit if he or she develops SARS-type symptoms, within 10 days of cleaning that aircraft. The CDC believes that the main source of infectious particles will have been removed once an infected SARS patient leaves the aircraft, but it does not know whether transmission of SARS may occur through contact with residual infectious materials on surfaces. OSHA advises airline clean-up crews to follow the CDC's recommendations for hygiene practices. Clean-up crews should continue to practice frequent hand washing with soap and water. The CDC has made the following additional recommendations:

       

      1. Do NOT use compressed air to clean the airplane. (This may serve to re-aerosolize infectious material.)

         

      2. Remove or throw away gloves if they become soiled or damaged while cleaning.

         

      3. Discard gloves after you have finished cleaning (i.e., do not wash or reuse gloves that were worn during cleaning).

         

      4. If soap and water are not available, use an alcohol-based hand wash to clean hands.

         

      5. Frequently-touched surfaces in the passenger cabin (e.g., arm-rests, seat-backs, tray tables, light and air controls, and adjacent walls and windows) and passenger bathrooms should be wiped down with an EPA-registered low- or intermediate-level chemical household germicide and allowed to air dry in accordance with the manufacturer's instructions.
         

      The CDC advises that there are no disinfectant products currently registered by EPA for the newly identified viruses associated with SARS. The CDC recommends the use of EPA-registered chemical germicides that provide low- or intermediate-level disinfection during general use against SARS agents because these products are known to inactivate related viruses with physical and biochemical properties similar to the suspected SARS agents.

       

  7. Information for Workers Involved in Air Medical Transport of SARS Patients


    The CDC has published interim recommendations to protect employees who may be required to transport patients with SARS by air: Interim Guidance: Air Medical Transport for Severe Acute Respiratory Syndrome (SARS) Patients. There are several concerns that should be considered, including limiting the number of persons preparing, transporting, and receiving potential SARS-infected patients to limit potential occupational exposure.

     

    1. Personal Protective Equipment

      The use of respiratory protection is recommended. OSHA requires that employers select and use respiratory protection in accordance with 29 CFR 1910.134. In order for respirators to be effective in protecting employees, they must be properly fit-tested and employees must be appropriately trained. If workers providing care to a SARS patient have potential exposure to blood or other potentially infectious materials, they must wear other protective clothing and use PPE in accordance with OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030. Information on that standard is available on the Bloodborne Pathogens Technical Links page.

       

    2. Hygiene Practices

      Standard hygiene practices are encouraged, especially frequent hand washing with soap and water.

       

  8. Safety and Health During Handling of Human Remains of SARS Patients


    The CDC provides recommendations for those handling human remains of SARS patients. Please refer to the following document from CDC: Safe Handling of Human Remains of SARS Patients: Safe Handling of Human Remains of Severe Acute Respiratory Syndrome (SARS) Patients: Interim Domestic Guidance.

     

    1. Personal Protective Equipment

      Workers handling human remains of SARS patients should use respiratory protection (N95 or higher filter efficiency) and protective garments including surgical scrub suit, surgical cap, impervious gown or apron with full sleeve coverage, eye protection (e.g., goggles or face shield), shoe covers and double surgical gloves with an interposed layer of cut-proof synthetic mesh gloves.

      If there is potential exposure to blood or other potentially infectious materials, PPE use must comply with OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030. Refer to the Bloodborne Pathogens Technical Links page for information on the standard.

      Use of respiratory protection must comply with 29 CFR 1910.134. Please refer to OSHA's Respiratory Protection e-Tool for assistance with respiratory selection.

       

    2. Hygiene Practices

      When appropriate, employers must ensure that workers handling the remains of SARS patients comply with the hygiene provisions of OSHA's bloodborne pathogen standard, 29 CFR 1910.1030. In all cases, these workers should use good housekeeping and hand-washing practices.

       

  9. Employee Training


    All employees with potential occupational exposure to SARS, as described in this document, should be trained on the hazards associated with that exposure and on the protocols in place in their facilities to isolate and report cases and to reduce exposures.

    Employers and employees may obtain further information on OSHA training regulations and policies including the revised bloodborne pathogen standard 29 CFR 1910.1030 and needlestick prevention information located on the Bloodborne Pathogens Technical Links page. Additional information can also be obtained from the CDC's SARS web site.


     

  10. If a Worker Experiences Symptoms


    If an employee experiences a fever and respiratory symptoms after contact with a patient known to be infected with SARS, the CDC recommends that the employee be excluded from duty.


     

  11. Updated Information from CDC


    As more information becomes available, updates may be added to information on the CDC SARS web site.
     
Revised: 30 May 2003

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