section name header

Introduction ⬇

Severe acute respiratory syndrome (SARS) is linked to a coronavirus (SARS-CoV). It is an atypical pneumonia that was first identified in Guangdong Province, China, in 2002, but since then has been seen in Asia, Europe, and North America. SARS is spread by person-to-person contact or contact with infectious material (e.g., respiratory secretions). Symptoms include fever (higher than 100.4 °F or higher than 38 °C), headache, cough, shortness of breath, muscular weakness, malaise, confusion, and diarrhea.

Procedure ⬆ ⬇

  1. Collect a respiratory tract specimen, blood sample, or stool specimen.

  2. Respiratory specimens may be collected from nasopharyngeal aspirates or swabs or oropharyngeal swabs.

    1. Nasopharyngeal aspirates are collected by instilling 1–1.5 mL of nonbacteriostatic saline into one nostril and then subsequently aspirating, through a plastic catheter, into a sterile vial.

    2. Nasopharyngeal or oropharyngeal specimens can be obtained by inserting a swab into the nostril or posterior pharynx, respectively. The swabs should then be placed into sterile vials containing 2 mL of viral media.

  3. Obtain 5–10 mL (at least 1 mL in pediatric cases) of whole blood in a serum separator tube, or in an EDTA tube. If collected in a serum separator tube, the blood is allowed to clot and then centrifuged.

  4. Collect 10–50 mL of stool, place in a leak-proof stool cup, and cap securely.

  5. Label specimens with the patient’s name, date, and test(s) ordered and place specimens in a biohazard bag.

  6. Assays for the SARS-CoV infection include:

    1. ELISA

    2. Reverse transcriptase PCR (RT-PCR)

    3. Indirect fluorescent antibody

  7. If the sample is to be shipped, it should be either packed in cold packs (4 °C) for domestic travel or in dry ice if being shipped internationally.

Procedural Alert

Do not use swabs with wooden sticks or calcium alginate because they may contain substances that can interfere with the analysis.

Clinical Implications ⬆ ⬇

Detection of the antibody to SARS-CoV in a convalescent-phase serum obtained more than 28 days after onset of symptoms is evidence of the infection.

Clinical Alert

Evidence of SARS should be reported to local, state, and federal health departments.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain necessity, purpose, and procedure of testing. Assess for and document signs and symptoms of infection (fever, cough, shortness of breath, muscular weakness). Ask the patient about travel (especially travel within the last 10 days to a SARS-affected area), living accommodations, and contact with suspected cases. Also, ascertain whether the individual is a healthcare worker who may have been in direct contact with patients.

  2. Close contact (e.g., living with or taking care of a person with SARS), sharing eating or drinking utensils, or close conversation (lesser than 3 feet) may result in transmission of the infection.

  3. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Assess for and document any change in signs and symptoms.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

  1. If you are caring for someone with SARS, you should protect yourself by wearing disposable gloves; do not use silverware, towels, bedding, or other items that have been used by the person with SARS until thoroughly washed; make sure the individual covers their nose and mouth with a tissue before coughing or sneezing.

  2. Clean all contaminated surfaces with household disinfectant.

Reference Values ⬆

Normal

Negative for SARS-CoV antibody in a convalescent-phase serum obtained more than 28 days after onset of symptoms.