Consistently wearing a surgical mask or respirator while caring for patients CH5424802 order was protective for the nurses who worked in two critical care units in Toronto (Loeb et al., 2004). Mask wearing was shown to be protective in multivariate analysis in a case-control study conducted in a teaching hospital in Hong Kong (Seto et al., 2003). The risk of developing SARS was 12.6 times higher for those who did not wear a mask during patient care (Nishiyama et al., 2008). Because of the physical stability of SARS-CoV,

it can survive for 4 days in diarrheal stool samples with an alkaline pH, and it can remain infectious in respiratory specimens for over 7 days at room temperature (Lai et al., 2005b). Contact with respiratory secretions was a significant risk factor for SARS transmission (Teleman et al., 2004). Exposure to body fluids of healthcare workers’ eyes and mucous membranes was also associated with an increased risk of transmission (Raboud et al., 2010). Inconsistent use of goggles, gowns, gloves, and caps was associated with a higher risk of infection

(Lau et al., 2004b). Performing high-risk patient care procedures such as intubation, manual ventilation, chest physiotherapy, suctioning, SCH772984 use of bilevel positive airway pressure, high-flow mechanical ventilation, and nebulizer therapy had been associated with nosocomial transmission of SARS among 17 healthcare workers in Toronto (Ofner-Agostini et al., 2006). In particular, endotracheal intubation was a high-risk procedure which deserved further investigation. A case-control study conducted in Guangzhou showed that the incidence of SARS among healthcare workers was significantly associated with performing endotracheal intubations for SARS patients with an odds ratio of

2.76 (Chen et al., Teicoplanin 2009). In a retrospective cohort study to identify risk factors for SARS transmission among 122 critical care unit staff at risk, 8 of 10 infected healthcare workers had either assisted or performed intubation, resulting in a relative risk of 13.29 with 95% confidence interval of 2.99 to 59.04. It was also interesting to note that the relative risk may be higher for nurses than physicians. This might be explained by the longer duration of exposure that nurses likely had in the peri-intubation period, whereas physician exposure was often limited to the procedure itself (Fowler et al., 2004). In fact, proximity and duration of contact with SARS patients may be associated with a higher risk of viral transmission. Transmission of SARS also occurred in 3 of 5 persons present during the endotracheal intubation, including one who wore gloves, gown, and an N95 respirator (Scales et al., 2003). Aerosol-generating procedures may also contribute to the transmission of SARS.