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Volume 10, Number 7—July 2004

Perspective

Environmental and Occupational Health Response to SARS, Taiwan, 2003

Eric J. Esswein*Comments to Author , Max Kiefer†, Ken Wallingford‡, Greg Burr‡, Lukas Jyhun-Hsiarn Lee§, Jung-Der Wang¶, Shun Chih Wang#, and Ih-Jen Su**
Author affiliations: *National Institute for Occupational Safety and Health (NIOSH), Denver, Colorado, USA; †NIOSH, Atlanta Field Office, Atlanta, Georgia, USA; ‡NIOSH, Cincinnati, Ohio, USA; §Department of Health, Taipei, Taiwan; ¶National Taiwan University, Taipei, Taiwan; #Institute of Occupational Safety and Health, Taipei, Taiwan; and; **Taiwan Center for Disease Control, Taipei, Taiwan

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Table 1

Environmental findings from hospitals and medical centers in Taipei, Taiwana,b

Hospitals IRs Single pass AHU HEPA UV Pressure monitors BP review Comments
T-1
10c
27d
N
Y
Y
Y
Y
Medical center (largest healthcare facility category in Taiwan). Affiliated with Taiwan University School of Public Health. Two visits made by CDC team.
T-2
9c
3d
Y
Y
Y
Y
Y
Two visits made by CDC team. Three IRs were constructed within 1 week for the ER.
T-3
0
Y
Y
N
N
Y
No IRs. Instead windows in SARS patient rooms kept open. Suggested closing windows and adjusting thermostat and fan settings in patient rooms to increase negative pressure.
T-4
12a
12c
Y
Y
N
Y
Y
Suburban hospital, scheduled to receive SARS patients.
T-5
108–120d
Y
Y
Y
Y
Y
Under conversion to a designated SARS hospital.
T-6
1c
6d
Y
Y
Y
Y
Y
Rural hospital approximately 2 hours from Taipei City.
T-7
10a
Y
Y
Y
Y
Y
Suburban hospital where non-SARS patients from Ho-Ping Hospital (facility closed during the SARS outbreak) would be transferred.
T-8
56d
Y
Y
Y
Y
Y
Medical center with entire building being converted to a SARS wing.
T-9
77d
Y
Y
Y
Y
Y
Formerly closed military hospital, this facility was under conversion to designated SARS hospital.
T-10
77d
Y
Y
Y
Y
Y
Medical center and only private hospital of the group visited. The newly installed single-pass ventilation system with HEPA/UV filtration was excellent.
Fever clinics e Y e e Y N Under construction in paved parking areas adjacent to the hospital.

aAll hospitals listed strongly suggested (or required) wearing filtering face-piece respirators when entering the hospital. Persons entering these facilities are screened for fever before entering the facility (using infrared skin or tympanic membrane sensors) and dispensed sanitizing gels or disposable hand-cleaning wipes.
bIRs, isolation rooms; AHU, air handling units; BP, blue print or engineering designs plans available for review; Y, yes; N, no; CDC, Centers for Disease Control and Prevention; SARS, severe acute respiratory syndrome.
cIRs available during initial visit (numbers include IRs in all areas of the hospital).
dIRs planned for completion (within weeks).
eIRs planned ranged from 2 to 6 per location. Ventilation in IRs ranged from simple (standard bathroom exhaust fans, without HEPA or UV treatment of exhaust air) to well-designed single-pass exhaust air systems with HEPA/UV treatment of exhaust air. No IRs present at time of visit. Hospital used standard patient rooms for SARS patients, providing 100% supply air, with exterior windows remaining open. Pressure differentials between patient rooms and remainder of floor where minimal hospital evaluation not possible. Determination made on the number or adequacy of IRs available. The NIOSH/CDC team recommended that this hospital not be used for SARS patients based on lack of information regarding ventilation system. Fever clinics included tented areas or small buildings (generally under construction) outside hospital ERs used to screen for fever and other symptoms to identify possible SARS-infected patients before entering the hospital.

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