What has SARS taught us about infection control in nursing homes?

To the Editor:

Following submission of my editorial, “What Has SARS Taught Us About Infection Control in Nursing Homes?,” the Centers for Disease Control and Prevention (CDC) has made new recommendations based on what they learned during the worldwide SARS outbreak. The CDC has recommended a “Respiratory Hygiene/Cough Etiquette Strategy for Healthcare Facilities,” including specific “Recommendations for Long-Term Care Facilities.” My editorial mentions the lack of sensitive, real-time diagnostic tests to determine which organism is responsible for cough and fever in a resident with an acute change in status. Even the rapid influenza tests have problems with sensitivity. The editorial also mentions that familiar respiratory viruses such as influenza, parainfluenza, and respiratory syncytial virus (RSV), especially complicated by pneumonia, have mortality rates in nursing home residents greater than the 9% figure cited for SARS cases in the community. Because clinicians seldom know the precise etiology of an infectious respiratory syndrome, the CDC now recommends universal respiratory hygiene for all patients who present with an infectious respiratory syndrome, especially during periods of increased respiratory activity in the community (ie, evidence of ongoing transmission). The approach includes droplet secretion precautions. Given the fact that influenza, SARS–CoV, parainfluenza, and RSV are all transmissible and potentially lethal in nursing home residents, and could be clinically indistinguishable, it seems prudent to initially approach all residents with symptoms of acute respiratory infection with droplet secretion precautions modified to the reality of your facility.3, 4, 5