Epidemiology and Infection

Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore

M. D. TELEMAN a1c1, I. C. BOUDVILLE a2, B. H. HENG a3, D. ZHU a3 and Y. S. LEO a4
a1 Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
a2 GlaxoSmithKline Biologicals, Singapore
a3 Disease Management, National Healthcare Group, Singapore
a4 Communicable Disease Centre, Tan Tock Seng Hospital, Singapore

Article author query
teleman md   [PubMed][Google Scholar] 
boudville ic   [PubMed][Google Scholar] 
heng bh   [PubMed][Google Scholar] 
zhu d   [PubMed][Google Scholar] 
leo ys   [PubMed][Google Scholar] 


Between 1 and 22 March 2003, a nosocomial outbreak of Severe Acute Respiratory Syndrome (SARS) occurred at the Communicable Disease Centre in Tan Tock Seng Hospital, Singapore, the national treatment and isolation facility for patients with SARS. A case-control study with 36 cases and 50 controls was conducted of factors associated with the transmission of SARS within the hospital. In univariate analysis, contact with respiratory secretions elevated the odds ratio to 6·9 (95% CI 1·4–34·6, P=0·02). Protection was conferred by hand washing (OR 0·06, 95% CI 0·007–0·5, P=0·03) and wearing of N95 masks (OR 0·1, 95% CI 0·03–0·4, P=0·001). Use of gloves and gowns had no effect. Multivariate analysis confirmed the strong role of contact with respiratory secretions (adjusted OR 21·8, 95% CI 1·7–274·8, P=0·017). Both hand washing (adjusted OR 0·07, 95% CI 0·008–0·66, P=0·02) and wearing of N95 masks (adjusted OR 0·1, 95% CI 0·02–0·86, P=0·04) remained strongly protective but gowns and gloves had no effect.

(Accepted June 9 2004)

c1 Dr M. D. Teleman, Department of Clinical Epidemiology, Tan Tock Seng Hospital, 142 Moulmein Road, Singapore 308087. (Email: monica_teleman@ttsh.com.sg)