gms | German Medical Science

International Conference on SARS - one year after the (first) outbreak

08. - 11.05.2004, Lübeck

Recommendation for the removal of personal protective equipment after caring for SARS patients


  • presenting/speaker Vincenzo Puro - National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, Rome, Italy
  • corresponding author Emanuele Nicastri - National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, Rome, Italy
  • Nicola Petrosillo - National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, Rome, Italy
  • Giuseppe Ippolito - National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, Rome, Italy

International Conference on SARS - one year after the (first) outbreak. Lübeck, 08.-11.05.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04sarsP1.04

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 26. Mai 2004

© 2004 Puro et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Background: During the SARS epidemic the use of Personal Protective Equipment (PPE) for healthcare workers (HCWs) caring for patients has been emphasized as part of the isolation measures to control the nosocomial spread of SARS-CoV, i.e. standard plus contact, droplet and airborne precautions. However, in some instances it was suggested that some occupational infections might have occurred) as HCWs removed their PPE contaminated by the patients' droplets and secretions.

Methods: Since the mid of March, in our National Institute for Infectious Diseases, training courses based on an interactive methodology using cases simulation and role playing, were performed to implement the HCWs' preparedness to manage SARS patients. During these courses we identified the priority order of PPE removal, as a critical issue. In order to find available data on this issue we checked the web.

Results: We found six documents, describing in details the routine procedure for PPE removal, with contrasting recommendations [Tab. 1].

Conclusions: We do not completely agree with the above mentioned protocols. Indeed, in all of them, hands, contaminated through direct contact with the patients' droplets and secretions placed on PPE, can re-contact nose, mouth or eyes mucous-membranes while removing PPE from the face. We believe that careful hand hygiene could prevent the risk of contamination, and that the risk of infection following the contamination of mucous-membranes of the face with unprotected, contaminated hands should be taken into account. Accordingly, as shown in the table, in our National Institute for Infectious Diseases we developed a procedure that recommends to remove most PPE while still wearing mask and eye-wear, and to accurately decontaminate hands before removing protection of face mucous-membranes. This procedure must be applied in the HCW's change area available out-side the patient's isolation room.

Supported by Ministero della Salute Ricerca Finalizzata 2001 and Ricerca Corrente IRCCS


Directives to all Ontario acute care hospitals regarding infection control measures for SARS units. Ministry of Health and Long Term Care - Directive 03-05( R). April 24 2003.
WHO Western Pacific Regional Office. Interim guidelines for national SARS preparedness. 2003 WHO, Manila, Philippines.
Australian Government Department of Health and Ageing. Interim Infection Control Guidelines for SARS,16 May 2003.
Ahuja AT and Wong JKT. Infection control measures. Prince of Wales Hospital, Shatin, N.T., Hong Kong.
Ng PC, et al Infection control for SARS in a Hong Kong tertiary neonatal centre. Arch Dis Child Fetal Neonatal Ed. 2003; 88:F405-9
UK Health Protection Agency. Guidance for hospitals on the prevention of spread of SARS