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Guidelines on Prevention of Communicable Diseases in Residential

1. UVES rf GeO ean weet nors should Report w Murses Sunten Before Ertorng Aroa rng 4 2 2 Droplet precautions Droplet Precautions Influenza SARS Avian influenza amp f ANERER H ADNANE DERISEN MAHRAM Mahora shoud Report w Nureea Bertios Betere Emering Arsa Practise hand hygiene stringently Wear PPE depend on the nature of contact e g Gloves apron or gown for lifting Mask gloves and apron for bed making Cleanse or disinfect used items before subsequent use Increase the frequency of environmental cleansing and disinfect all frequently touched surfaces with 1 in 49 diluted household bleach leave for 15 30 minutes before rinsing with water and wiping dry Keep infected residents in a partition or a room as advised by doctors Let more fresh air in e g open more windows or switch on exhaust fans Practise hand hygiene stringently Keep social distance at least one metre between residents Advise person with respiratory symptoms to wear mask to reduce spread of droplets to surrounding area Educate and assist residents to maintain cough manners Advise carers to wear masks when they are working within 2 metres of the infected or to wear masks face shields and put on gowns for certain coughing or vomiting induced procedures Increase the frequency of environmental cleansing and disinfect all frequently touched surfaces with 1 in 49 diluted household bleach
2. H P EF o Guidelines on Prevention of Communicable Diseases in Residential Care Homes for Persons with Disabilities 5 Department of Health Guidelines on Prevention of Communicable Diseases in Residential Care Homes for Persons with Disabilities Centre for Health Protection Department of Health February 2011 Guidelines on Prevention of Communicable Diseases in Residential Care Homes for Persons with Disabilities INtrOdUCTION ccscssscsscvsccsccssccssescssecssscssssssssssescescnsssnsssnessnessnesseessensssessesssssessssssccsscsscnessnessnessneseneesoes 1 Concepts on communicable diseases ssesssesssesssesssesssesssecssesssecssocssocssocssoossoossoossoossoosssosssosssosssssssss 1 1 What are communicable diseases ss 04 nication dedieed adhint nahh oeaiee ete 6 1 2 Chain of infection infective agent source of infection mode of transmission hoSt eeeeeeees 6 1 2 1 Infective agenta sicrie iie Eai EA E EE sees Ocenia ee cesadiaets 6 122 lt Source of mfection ennn inan a ae A ed es 6 123 Modeoftransmission onee e r E TRR eating a ak 6 D OSt E E E E E A eae atest 6 1 3 Modes of transmission of communicable diseases and examples c cccsceesceesceseceeeeeeeesseenseeseeeaeeenes f 1 4 Principles of communicable diseases control Breaking the chain of infection eeeeeeeeeereee 8 1 5 Why RCHDs are more vulnerable to outbreaks of communicable diseases see
3. cleansing nenni areeni hee ii E A EE E sents es R Ea 21 3 3 3 Cleansing and disinfection measures for toilets and bathroomS ssssseesseeserssssersrssrerersrsesse 21 3 34 Domestic waste disposal lt icc cz co cciecccccesse cots decehvescce cei iik i i ERE R a 22 33 5 Disinfection of cleansing tools lt 3 2 ccccccsceccecscces iien ee EE ER R R e 22 3 4 Vaccination ensornir E A EEE a A wba A TA E A E A T A aba aie 22 Page 3 4 4 2 4 3 4 4 4 5 4 6 4 7 5 1 5 2 5 3 5 4 5 5 5 6 6 1 6 2 6 3 6 4 Infection control MEASULES scccsccssccsscssserecsssessscssscssscessssssssscsscssssnessnessnessnessecssenssessessessssssseeses Standard precautions EE dakevtes Maveepae sees h eae adeeiolanteae igen hw Gata E 23 4 1 1 Hand thy giene senansa nh aoe A hes ie A E 23 4 1 2 Respiratory hygiene and cough ManmePS ccccceeccessceseceeeesecseecseeeseeeseeseeeeeeeeeeneeeeeeeensees 23 4 1 3 Use of personal protective equipment PPE ccccecceessceseeesecseecseeeeeeeneeeeeeeeeeeeeaeenseenseeaees 23 414 Cleansing and disinfection of used or exposed articles cccccececsseesseeeeeseeeseeeeeeeeeeteeeeensees 26 4 1 5 Sharps disposal and prevention of sharps injury cccccsceeeseesseeseeeeceeeceeceeceseesaecsnecseeeneeenes 26 41 6 Clinical waste disposal risene nee teow ae a E E E EEE Meeks en ee tes 26 Transmission based precautions cccccecscesscssscesecesecesecseecseeeseeeneeseeeces
4. disposable towels first then disinfect the surface and its neighbouring areas with appropriate disinfectant Use 1 in 49 diluted household bleach for non metallic surfaces and 70 alcohol for metallic surfaces Allow bleach to leave on the surface for 15 30 minutes before rinsing with water Cleansing and disinfection measures for toilets and bathrooms Keep toilets and bathrooms clean and hygienic Provide liquid soap and disposable paper towels or hand dryers for hand washing Ensure the flushing system of the toilet is functioning properly all the times Make sure that the drain pipes are built with U shaped water traps Do not alter the pipelines without authorisation Pour about half a litre of water into each drain outlet regularly about once a week so as to maintain the water column in the pipe as water lock to prevent the spread of micro organisms Ensure the soil pipes and sewage drains are functioning properly without leakage so as to avoid breeding of infective agents Page 21 3 3 4 Domestic waste disposal e Discard rubbish into a garbage bin with lid e Keep the garbage bins always covered e Empty garbage bins at least once a day even it is not full e Wash hands thoroughly after handling garbage 3 3 5 Disinfection of cleansing tools e Rinse floor mop wipers or other cleansing tools with water to remove solid or bulky waste e Immerse them into 1 in 49 diluted household bleach for 30 minutes for dec
5. gt LERF G QUES BE AARE Ne 4 Put on Eye Protection Ti lt Face Shield if necessary AGS Sy and Disposable Cap A Zz Wash Hands oF Etre kK in 7t his E Put on Gown Remove Disposable Cap amp Eye Protection Face Shield Finally Remove Mask Wash Hands Again fe aan BN seh ce Se OS BS Re Disposable PPE should be properly discarded in dustbin with lid Page 24 A Gloves Wear gloves when handling blood body tissues excreta body fluid secretion or contaminated waste Wear gloves when touching mucosa or wounds Remove gloves and perform hand hygiene immediately after each task or procedure to prevent cross contamination between different body sites and transmission of infective agents to other person or environment Discard used surgical or examination gloves Do not wash or disinfect them for reuse Do not double gloving B Surgical mask also called facemask Select three layer designed surgical masks facemask for infection control purpose Encourage person with respiratory symptoms to wear surgical mask to reduce spread of droplets to surrounding area Wear mask when taking care of residents with respiratory symptoms Wear mask properly to ensure optimal protection C Protective gown Put on long sleeved protective gown to protect skin personal clothing or uniforms from soiling with respiratory droplets blood body fluid secretion urine faeces or infectious material
6. leave for 15 30 minutes before rinsing and wiping dry Arrange a separate room for infected residents Page 27 4 2 3 Airborne precautions Airborne Pulmonary m Get vaccinated for vaccine preventable diseases like precautions tuberculosis TB measles E Identify person with airborne infection and arrange prompt medical consultation E Separate the infected resident from others before Measles transfer Room isolation is required E When entering the room non immunised staff and carers may wear N95 masks or respirators for their own protection E Advise the infected to maintain cough manners and wear mask unless contraindicated E Practise stringent hand hygiene smear positive Chickenpox 4 3 Visitors Advise visitors to comply with infection control measures including e Perform hand hygiene before and after visits e Maintain cough manners e Beware of their own health conditions e Avoid visiting RCHDs if recently exposed to infectious disease or having any sign or symptom of infectious diseases e g fever e Wear surgical masks when having respiratory symptoms e Write down their contact information in the visiting record as requested by the institution or the Department of Health e Follow instructions e g wearing appropriate PPE Inform visitors when the institution is having an outbreak and they should refrain from visiting as advised by the Department of Health They may contact the residents by o
7. lymph nodes pink to purplish blotches on or under the skin inside the mouth nose or eyelids Patients with HIV infection can be without symptoms for years Influenza Fever cough sneeze runny nose sore throat muscle ache fatigue Pneumonia Chest infection Fever fatigue cough thick sputum yellowish or greenish sputum shortness of breath Scabies Rash thread like lesions or vesicles may be seen on the skin Intensive itchiness which is more severe at night or after a bath Common affected areas finger webs skin folds of wrists elbows armpits nipples lower abdomen buttocks and groins Severe Acute Respiratory Syndrome SARS Fever fatigue headache chills cough shortness of breath difficulty in breathing diarrhoea Tuberculosis Persistent fever cough sputum with blood fatigue weight loss night sweating Page 39 Appendix B Checklist on signs and symptoms of infections General symptoms The body temperature is above the reference value or more than 1 C above baseline Malaise Headache Lass of appetite or unexplained weight loss Confusion drowsiness feeling irritable and restless Sudden change in body function e g increased weakness or fall for unknown reason g Red eye Heart and lung symptoms a Runny nose sneezing b Sore throat c Cough d Increased amount of sputum Blood stained sputum f Shortness of breath Ches
8. sneezing or coughing e after using toilet e before touching the eyes nose mouth or mucous membrane e before preparing handling serving food or eating e after touching soiled objects or environments Related to personal care e before and after carrying out nursing procedure involving direct body contact e before performing a procedure involving an invasive medical device e g urinary catheter e after contacting blood body fluid secretion excretion wound or mucous membrane e g changing diaper or cleansing of respiratory secretions e after taking off gloves Page 17 3 1 6 Respiratory hygiene and cough manners Everyone should observe respiratory hygiene No spitting Cover both the nose and mouth with tissue paper when coughing or sneezing Wrap up respiratory secretion with tissue paper and discard it into nearby garbage bins with lids or flush them away in the toilet Perform hand washing with liquid soap and water immediately after contacting respiratory secretion or touching objects soiled with respiratory secretions Put on a surgical mask while having respiratory symptoms Home managers of institutions should ensure the availability of materials for residents and staff to adhere to Cough Manners Provide tissue paper and non touch garbage bin with lid for disposal of used tissue Provide adequate hand washing items i e liquid soap paper towels near sinks and alcohol based handrubs at conv
9. the influenza peak seasons in January to March and July to August each year To decide whether there is an outbreak day to day information on cases of communicable diseases in the RCHD has to be monitored Some examples are cited below for reference The ICO should closely monitor the situation if m Residents in the same room or on the same floor develop similar symptoms in clusters within a short period of time m Residents and staff concurrently develop similar symptoms in clusters Such as symptoms of influenza fever cough and sore throat This means that cross infection may have occurred in the RCHD m Two or more people develop similar symptoms after eating common food items This means that a cluster of food poisoning may have occurred The infective agent may be bacteria viruses or toxins contained in the food m A single case of communicable disease may sometimes be treated as an outbreak For example a new disease unprecedented in the past or a situation which has major impact on public health like avian influenza in 1997 and SARS in 2003 What should be done if outbreak is suspected Early detection of communicable disease is crucial to the prevention of its spread Not only the ICOs but all staff members should be responsible for close monitoring of the physical conditions of their residents to ensure early detection of communicable diseases For any suspected institutional outbreaks of communicable diseases apart from a
10. accountability to ensure their infection control practices are up to standard in their institutions It is recommended that a designated staff should be appointed for overseeing all the infection control issues in an institution and the staff should have undergone infection control training The following principles in preventing the spread of communicable diseases should be observed Medical surveillance Monitor residents and staff condition closely watch out for any sign and symptom of infection and maintain residents personal health records properly m Early treatment Arrange prompt treatment for the infected person to prevent further spread of infection by that person E Spread prevention Implement appropriate infection control measures according to the mode of transmission of the concerned communicable disease to prevent its spread For example wear a mask when having respiratory symptoms handle and dispose body fluid secretion and excretion properly perform proper hand hygiene enhance environmental cleansing and notify the Department of Health and other concerned government departments promptly for investigation and appropriate advice Page 9 2 Recognition of infections 2 1 Signs and symptoms of some communicable diseases The typical signs and symptoms of some communicable diseases are listed in Appendix A for quick reference The list is not meant to be exhaustive For more information about different types of co
11. ace urine bag below the bladder level to avoid back flow of urine which may lead to urinary tract infection Clamp drainage tube before raising urinary bag above the bladder level e g change of position Do not allow the outlet of urine bag touching the floor Prevent kinking or sagging of urinary catheter to ensure free flow of urine Do not disconnect urinary bag from the catheter It should be changed together with a new catheter If deemed necessary perform hand hygiene and disinfect the connection part with 70 alcohol swab before and after disconnection Use liquid soap and water for daily cleansing of urethral opening and removing debris from the surface of urinary catheter during bathing or showering Page 29 4 5 2 Prevention of aspiration pneumonia associated with nasogastric tube feeding Residents requiring nasogastric tube feeding have higher risk for aspiration pneumonia Risk reducing methods include Change nasogastric tube regularly by a qualified nurse Observe proper feeding procedures Prop up the resident in a sitting position of at least 30 degrees Make sure nasogastric tube is in right position before feed Ensure each resident has his her own feeding set Flush feeding set with water after each feed and air dried before putting it into clean container for the next use Disinfect reusable feeding bottle daily e g boiling it for 10 minutes after cleansing Discard disposable feeding tubing daily Ap
12. asures promptly Please refer to Notification Mechanism for Communicable Diseases in RCHDs Appendix H for details Inform the relatives or guardians of the residents Keep medical records of residents and sick records of staff properly Restrict group activities during outbreak period Minimise contact between persons of different floors and arrange staff of the same team to take care of a fixed group of residents as far as possible in preparing duty roster Alert the attending health care facilities such as clinics hospitals etc that there is currently an outbreak of communicable disease in the institution Discourage visits Increase the frequency of environmental cleansing and disinfection Disinfect all non metal frequently touched surfaces such as furniture floors and toilets with 1 in 49 diluted household bleach leave for 15 30 minutes before rinsing with water and wiping dry For metal items such as handrails door knobs use 70 alcohol and let it dry 5 5 Disinfection and cleansing during an outbreak of communicable disease 5 5 1 Decontamination of the environment e Use disposable absorptive materials for preliminary cleansing of surfaces soiled with vomitus or excreta before performing disinfection procedure e Disinfect furniture floors commodes and toilets with 1 in 49 diluted household bleach Appendix F leave for 15 30 minutes before rinsing with water and wiping dry special attention should be paid to
13. cable diseases ccecceseeeeeteereeeeeneeees 39 Appendix B Checklist on signs and symptoms of infections cccccseesceesceeseeeeceseceseeeseenseeeeeseeeaes 40 Appendix C Residents fever record ecceecceescssseeseeesecesecseecaeecseeeseceneeeesseeeseenseceseceaeeeaecaecnseceeeaeeeaes 41 Appendix D Five keys to food safety eesseessseseessesersrsseertsstertsseststestrsessteresstsreseseestsseenesstsressesees 42 Appendix E Disinfectants oann Maes A Ran ae en Reda eis te RA 43 Appendix F Preparation and use of bleach cceeceeecceseeesecsceeseeeseeeseeseeeeeeseeeseensecaecaeeaeeeecaeeeseeenes 44 Appendix G Cleansing and disinfecting commonly used medical items and articles in RCHDs 45 Appendix H Notification mechanism for communicable diseases in RCHDS eesecceseeeeeeeeneeeees 47 Appendix I Statutory notifiable communicable diseases as at 08 10 2010 ee eeeeeeseeeeteeneeeeeneeeres 48 Appendix J Notification form for suspected infectious disease outbreak in RCHD ee eeeeeeeeees 49 Appendix K Required information for outbreak investigation essccesesseeeecneeeeceseeeceseeateeeenereees 50 Memibers of Editorial Board ermi den eted ane Ses ss cova opeven can docvaag E a Ea A a ea eiie 51 Introduction Effective prevention of communicable diseases is vital in every residential care home for persons with disabilities RCHD 1 and it is incumbent on every staff member and ca
14. ccecsccsescecesscesessccessccsesccsssscessscssescccssscessscsessoesee 3 1 Personal hy Qieme 2202 cnni levee det i eet E AE E EEEE EA SEEN N Ea 15 3 1 1 Hand ly pieine yee E E E A E E AS E A AE E AE AE E 15 e S Hand iF ii T AEE E E T E E E E EAE A 15 343 Alcohol based handr b rnst na aeaa aia enai r ni nainis aaan iaoea nE STe 16 3 1 4 Hand hygiene technique ccecceeccesecesecsseescecseeeseeeeeesseeeeesceeseceeecaecaecaecaeeeaeeeaeeeeeenseeereees 16 3 1 5 When to perform hand hygiene ccccecceseesseesseeseeeseeeseeeceseenseceaeesecaecaecaeeeaeseneeeeeeeeeenreees 17 3 1 6 Respiratory hygiene and cough Manne s cceccsseesseeseeesceseceeeceseceseeesecaecseeeneeeseeeeeenseeneees 18 BI Skincare ee esate eiie EEE tanned ice laid AR IEE O E ENEE LEA ER 18 3 2 1E1010 ATE a1 ate ann ee ena EEO EA ca Ocoee A E eee E 19 3 2 1 BOG Hath eSenior a a E feascnte tag E A te tet onteeons tus eee a ENSE 19 e PSA E E ts 38 beds sae ete eet E E oa coeur state te leet sted sede stu eels 19 323 sCHOICCOF TOO resa e ala homens the 8 a sect a ed oR stokes ae ais Slat 19 324 Food preparation ces oiccfalewcstessuct ncestevs ascshivaceedonvsnceseveh ocesueys ideas ih T a E AE EEE tones 19 B25 THOOMStOTA LES E EENE sunt neceucnsideshtvns cedeneszeste T E E 20 3 3 Environmental hygiene cerea E easc ste cas E ote cineca aan Raden Beceem pete dee 20 33 1 Choiceofdisinfectantsssc mesio oeii rene NENE ahd EEE ane eal eee 21 332 General
15. ceseeceeseereeeeeneeeees 9 1 6 Key points on basic management of communicable diseases in RCHDS eecceeeceteeeeteteeeeeeneeeees 9 2 Recognition of infections ccccsccsscccccsssscccsssssccsssesccccssccessseessecsescecssscessscssesccssesceesessessscsseseeees 2 1 Signs and symptoms of some communicable disecases ccsccesseesseescesseeesceeeceseceseceseceecseeeaeeeaeeneeeeeeees 10 2 2 Observation and assessment n ocea aE eet ioe ehh aes 10 2 3 Measuring body temperature ccceececsseessessceeseeesceecesecsecsaecaaecseeeaeeeseceaeeeeeseeeseeeseceseeeaeenaecaeeseeeneeenes 10 2 3 1 The importance of taking body temperature 0 cccececeseesseeeceeseeeeceeeeeeceseceseenseeaecaecseeeaeeenes 10 2 3 2 Core and surface temperature ceceecseesseescesscesscesecesecnecssecseecaeecseseneseneeeeeeeeeneeereneenseensees 11 2 4 Proper us of thermometers s s3c5 ses Ran cecsiceriet RAG easton Ade RROH BNE Bn rena Ae 12 24 1 Choice of thermometers s aiosciee cep ai hase gE leaps EEA ete Meee pees 12 24 2 Methods of taking body temperature ceecceesceesceeeceeceseceeecseecaeeeseeeeeeeeeeeeeeeeneeneeeeenaees 13 24 3 Cleaning and disinfection of thermometers after use c cceseceseesseeeeeeseeeeeeeeeeeeeeeeneeneensees 14 2 5 What should be done when a resident develops fever cceccessessseesceeseeeeeeeceseceaecseecaeeeneeeeeeeeeeneeees 14 3 General hygiene advice cccscsccsssssecscsccsscccssccecss
16. checking it should not be the only available thermometers in institutions Whenever in doubt staff should use another type of thermometer to recheck the body temperature To reduce the risk of cross infection allocate a designated thermometer to each resident especially those having an infection Page 12 2 4 2 Methods of taking body temperature Method Steps for measuring Points to note Recommendations Ear 1 Switch on and check the The ear temperature a Non invasive fast functions of ear is usually 0 5 C response time and thermometer higher than the oral with an 2 Cover the probe tip with temperature easy to read a plastic probe cover a Direction of the probe display 3 Stabilise the position of tip should be correct the person s head otherwise it will give a Not applicable for 4 Pull the ear backward an inaccurate person with otitis and upward to straighten reading or with obstruction the ear canal and gently a The ear pressed of ear canal place the probe deep against the pillow caused by ear wax into the ear canal during bed rest has 5 Press the SCAN button higher temperature 6 Remove the so the other ear thermometer from the should be used for ear when it beeps taking temperature 7 Read digital display and record accordingly Oral 1 a concen a Avoid cold or hot a Not applicable for and be ablete close his foods and drinks for persons who are or her mouth tight at least 30 minut
17. d spill proof container which is labelled with Sharps Box and Biohazard Seal sharps box when it is 3 4 full Pack the sharps box in a well fastened clinical waste bag by using swan neck sealing method with a warning sign of Beware of Sharps for disposal Clinical waste disposal Separate clinical waste e g used needles and gauze soaked with blood from domestic waste Pack and label clinical waste properly in colour coded bags with biohazard signs Wash hands thoroughly after handling clinical waste Store clinical waste securely before collected by licensed clinical waste collector Contact the clinical waste collector when there is substantial amount of clinical waste Keep disposal record of clinical waste properly Enquiry the Environmental Protection Department EPD at hotline 2838 3111 or visit the website of EPD for more information lt www epd gov hk epd clinicalwaste nonflash eindex html gt Page 26 4 2 Transmission based precautions Apart from standard precautions when the infectious agent and its modes of transmission are known specific preventive measures should be adopted Some diseases can be transmitted by more than one mode To prevent the spread of such diseases combined preventive measures should be considered 4 2 1 Contact precautions MRSA infection Acinetobacter infection Acute conjunctivitis Head lice Scabies Gastroenteritis Contact precautions
18. d with body fluid Rub all parts of the hands including the wrists with proper hand hygiene technique for at least 20 seconds for details please refer to Section 3 1 4 Do not re contaminate washed hands by touching the faucet directly or sharing towel with others Use disposable paper towel or hand dryer to dry hands Page 15 3 1 3 Alcohol based handrub Using 70 80 alcohol based handrub to rub hands is effective to prevent contracting and spreading communicable diseases via hands when hands are not visibly soiled Same as hand washing rub all parts of the hands including the wrists with proper hand hygiene technique for at least 20 seconds for details please refer to Section 3 1 4 Allow alcohol to evaporate naturally for maximum effect No need to use paper towels to dry the hands after applying alcohol handrub 3 1 4 Hand hygiene technique Palm to palm Right palm over left Palm to palm with dorsum with interlaced fingers interlaced finger amp vice versa d Backs of fingers to Rotational rubbing of opposing palm with right thumb clasped over fingers imeriocked left palm amp vice versa Rotational rubbing Wrists are rubbed backwards and forwards with clasped fingers of right hand in ben paim amp vice versa Page 16 3 1 5 When to perform hand hygiene It is impossible to list out all situations when hand hygiene is needed Basically hand hygiene should be performed General e after
19. disinfection of toilets kitchens and frequently touched objects such as light switches door knobs and handrails e Since household bleach contains chlorine which is corrosive to metal care should be taken to avoid its use on metallic surfaces For disinfection of metallic surfaces use 70 alcohol 5 5 2 Handling of linen e During outbreak situation soak linen soiled with blood or secretions in 1 in 49 diluted household bleach for 30 minutes before washing Page 33 5 6 Specific recommendations on management of selected communicable diseases 5 6 1 Outbreak of respiratory tract infection e Definition of outbreak of respiratory tract infection There are increased number of residents and or staff with respiratory tract symptoms which include cough sore throat runny nose and fever above the usual pattern e List the names of affected people and details of their medical records and report to the Department of Health for investigation e Enhance health surveillance for other residents e g measuring body temperature e Switch on exhaust fans and open windows to improve indoor ventilation if possible e Infected residents who are not admitted to hospitals should wear surgical masks and be isolated as far as possible e Be stringent with personal hygiene especially hand hygiene respiratory hygiene and cough manners e Suspend group activities during outbreak period e Ensure sick staff members are refrained from work un
20. drome SARS infective agents The infective agents float in the air E e niiogenpos Air borne E Measles for some time and enter the body transmission E Pulmonary tuberculosis through the respiratory tract Smear positive Food borne water borne transmission Through ingestion of contaminated food or water or use of contaminated eating utensils Bacillary dysentery Cholera Escherichia coli infection Food poisoning Hepatitis A Hepatitis E Norovirus infection Viral gastroenteritis Vector borne transmission Through vectors usually insects The infective agents parasitise and breed in the bodies of the insects Mosquito borne E Dengue fever m Japanese encephalitis E Malaria Blood Through blood transfusion E Hepatitis B body fluid tattooing ear piercing or sexual E Acquired Immune Deficiency transmission intercourse Syndrome AIDS Congenital infection From the pregnant mother to the foetus E Congenital rubella syndrome Congenital syphilis E Congenital cytomegalovirus infection Some communicable diseases have more than one mode of transmission e g chickenpox Page 7 1 4 Principles of communicable diseases control Breaking the chain of infection As mentioned in 1 2 infective agent the source of infection the mode of transmission and the host are crucial factors to the spread of communicable diseases Henc
21. during the process of care Remove protective gown after caring of residents or when it is soiled by blood or other potentially infectious fluid Take off soiled protective gown carefully and perform hand hygiene immediately D Goggles and face shield E Cap Put on goggles face shield mask and water repellent gown to enhance protection during anticipated splashing situations Wear cap to hold all hair inside to enhance protection during anticipated splashing situations Page 25 4 14 Cleansing and disinfection of used or exposed articles 4 1 5 4 1 6 Handle used or exposed instruments and articles carefully as they may become soiled by infective agents Ensure used or exposed instruments and articles are cleansed thoroughly before storage or subsequent use Cleanse all visible soils before disinfection Wipe items such as electrical and electronic equipment with alcohol since they will be damaged by soaking in aqueous solution Ensure the disinfectant reaches all surfaces including internal surfaces of lumens Replace articles with disposable items when they cannot be cleansed or disinfected properly Please refer to Appendix G for the details on cleansing and disinfection of commonly used medical items and articles in RCHDs Sharps disposal and prevention of sharps injury Always take precautions to prevent sharps injury Use recapping devices when needed Dispose sharps directly into a puncture proof an
22. e to break the chain of infection controlling the spread of communicable diseases should focus on controlling these four factors Factors of transmission Control measures Infective agent E Disinfection to kill the infective agents E Early detection isolation and treatment of Source of infection the sick person E Removal of breeding sites Maintenance of good personal environmental and food hygiene Mode of transmission Adoption of infection control measures appropriate to the different modes of transmission Host B Building up personal immunity by susceptible population immunisation and healthy lifestyle Page 8 1 5 Why RCHDs are more vulnerable to outbreaks of communicable diseases RCHDs are collective living places where communicable diseases can easily spread through close person to person contact The frailty of persons with disabilities also aids the spread The source of infection can be staff carers visitors or residents e g resident who is newly discharged from the hospital Person to person contact may lead to cross infection i e transmission of infective agents from one person to another For example a staff member who fails to perform hand hygiene between caring of different persons may spread the infective agents from that person to the next person he she cares for 1 6 Key points on basic management of communicable diseases in RCHDs The home managers have the
23. effectiveness 4 Use a measuring cup to measure the amount of bleach and water accurately 5 Dilute household bleach containing 5 25 sodium hypochlorite as follows Recommended Concentration of Sodium Hypochlorite Dilution ratio Concentration Usage 1in 99 500 ppm For general environmental cleansing mixing 1 partt of 5 bleach with 99 parts of 0 05 water 1in 49 1 000 ppm For surfaces or articles soiled with mixing 1 partt of 0 1 vomitus excreta or secretion bleach with 49 parts of water 1in4 10 000 ppm For surfaces or articles soiled with mixing 1 partt of 1 blood spillage bleach with 4 parts of water Precautions m Avoid using bleach on metals wool nylon silk dyed fabric and painted surfaces m Avoid using or mixing bleach with other chemical including detergents as this may produce toxic gas resulting in accidents and injuries Always rinse detergents out thoroughly with water before using bleach for disinfection Do not allow bleach come into contact with skin or mucous membrane If bleach gets into the eyes rinse with copious water immediately and consult a doctor m Store concentrated bleach in a cool and a shaded place where residents cannot reach Avoid purchasing nearly expired or over stocking bleach products Diluted bleach should only be used within 24 hours after preparation Page 44 Appendix G Cleansing and disinfecting commonly used medical items and articles in RCHDs Medical
24. em apesar wing SEES References Centre for Food Safety Food and Environmental Hygiene Department www cfs gov hk english multimedia multimedia_pub files 5keys_pos Overall pdf World Health Organization s ten principles for safe food preparation www who int entity foodsafety publications consumer en 5keys_en pdf Page 42 Appendix E Disinfectants Disinfectants Usage Properties Bleach Household bleach usually containing 5 25 sodium hypochlorite Need further dilution with water before use Non metal items or environmental disinfection Corrosive to metals m Release toxic gas when expose to sunlight or contact with acids E Decompose rapidly when diluted Therefore bleach should be diluted when necessary and used within 24 hours Alcohols e g Ethyl Alcohol Isopropyl Alcohol Concentration 70 Metal surface or equipment disinfection Em Inflammable and must be stored away from high temperatures or flames E Rapid action but volatile Poor penetration into organic matter Page 43 Appendix F Preparation and use of bleach Procedures of preparing diluted bleach 1 Ensure good ventilation 2 Puton protective gear such as mask rubber gloves apron and goggles as bleach irritates mucous membranes the skin and the airway 3 Use cold water for dilution because hot water breaks down the active ingredient of bleach and reduces it
25. enient places for use Put up signage and remind people not to spit 3 1 7 Skin care Staff should pay attention to the following points for residents skin care Help residents to check their skin condition and pay particular attention to skin fold under the armpit around the neck and groin area Assist dependent residents to dry the skin fold between the toes properly and do not use talcum powder as it forms crusts and causes skin irritation Cleanse and cover abrasion if present with dressing to prevent wound infection Advise ambulant residents to put on socks or shoes to prevent abrasion around the soles or toes Page 18 3 2 Food hygiene 3 2 1 Food handlers Staff having fever diarrhoea or vomiting should inform their employers seek medical advice and be refrained from handling food If there is wound on hands cover it with waterproof dressing to prevent passing infective agents from the wounds to food 3 2 2 Kitchen 3 2 3 3 2 4 Keep kitchen clean and tidy Clean exhaust fan and range hood regularly Keep worktops and floor in kitchen clean and dry Do not store personal items in kitchen such as clothes and shoes Store utensils in a clean cupboard Always cover garbage bins to avoid breeding of cockroaches flies and rodents Choice of food Buy fresh meat and vegetables Do not patronise illegal food hawkers Do not buy packaged food without proper labelling beyond its expiry date or wi
26. es unconscious 2 Cover the thermometer before taking confused or who with a plastic shield temperature cannot close their ie Pie al E If the resident eE thermometer under the lly bit ff tongue near the root a neS o 4 Instruct the person to y close the mouth tight thermometer he she and do not speak or bite should be Sent ie ais on the thermometer hospital immediately 5 Remove the digital without delay thermometer when it beeps and check the reading For a mercury thermometer remove the thermometer after 3 minutes and check the reading 6 Record accordingly Armpit 1 Put the thermometer E Armpit temperature is E Unless for the very under the armpit 2 Place the person s forearm horizontally on the chest to hold the thermometer in position 3 Wait for 6 to 8 minutes before checking the reading 4 Mark the value clearly in record as armpit temperature usually lower than oral temperature a The thermometer should be held tightly under the armpit when taking temperature B Ensure the privacy of the residents and protect them from catching cold when taking temperature thin person with a socket like hollow armpit armpit measurement is suitable for conditions when all of the above temperature measurement methods are not applicable Page 13 2 4 3 Cleaning and disinfection of thermometers after use e Thermometers cannot be disinfected by heating methods as heat ca
27. firmed cases of statutory notifiable communicable diseases 32 General guidelines on management of suspected outbreak of communicable disease eee 33 Disinfection and cleansing during an outbreak of communicable disease ceceeecceseereeteeneeeeeneees 33 5 5 1 Decontamination of the environment ssssssseseesseseesessteressestsrestrstestenessestesreseeseeseesessreressee 33 oo VAM Handling of Timer EARE A EE E A T T 33 Specific recommendations on management of selected communicable diseases cscccceceseeees 34 5 6 1 Outbreak of respiratory tract infection cceccesecsceesseesceesceeeceeecesecesecesecsaecaeecaeeeseeeseeneeeneeees 34 5 6 2 Outbreak of acute gastroenteritis AGE ccccccecsseessessceesceeecesecesecseceaecsaecseecaeeeneeseeeneeenreees 34 563 Outbreak of s ables sit Faith te ise Siete ete tid cata a Att See i canons Satake 35 SOA FOOd POIsOnin gy ssp tens cedexase a a exdenuee a aa anedeness 35 Roles of RCHD Staff sccsscsssccsscsssenssessssssssesscssecssscssessssscsescsssssessnessnessnsssesssesssesssssssssssscoescoees Responsibilities of operators or home managers Of RCHDS ccceecceeseeesceeeceeeeseceecateeseeeeeeneeenseees 36 Roles of TOO reene e i PEA EE EERE eatin eesti peda dees ete 37 Useful telephone nuimbers rnn nnie cesceu ete i tl RE REE T EEE 38 Useful WebSites enan e a E e a E a E ees 38 Appendix A List of signs and symptoms of some communi
28. formation card on Details of Rehabilitation Service Unit kept by the RCHD and produce the patient referral note when taking the sick resident to seek consultation at the general out patient clinic or the accident and emergency department or to register for hospitalisation Page 36 6 2 Roles of ICO Coordinate and oversee all matters related to infection control and the prevention of infectious diseases in the RCHD Disseminate guidelines and updated information on infection control to all the staff and residents in the RCHD Oversee that all medical equipment and other instruments are properly disinfected after use and soiled linens and wastes are handled carefully and disposed of properly Observe signs and symptoms of infectious diseases Such as unusual clustering of fever upper respiratory tract symptoms and gastrointestinal symptoms in residents and the staff Assist the home manager of RCHD in reporting suspected and confirmed cases of infectious diseases to the Centre for Health Protection CHP of the Department of Health and the Registration Office of Private Residential Care Homes for Persons with Disabilities ROPRCHD of Social Welfare Department Provide information as necessary to CHP to facilitate their investigation and collaborate with the Department of Health to contain the spread of infectious diseases Isolate the infected person according to the instruction of the in charge doctor to prevent the spread of
29. g doctor is required to report to the Department of Health through CENO of CHP when he she has reasons to suspect his her patient is suffering from any statutory notifiable communicable disease When a staff member suspects or knows a case or case contact of statutory notifiable communicable disease he she should immediately arrange medical consultation and report to the Director of Social Welfare The ICO should contact the attending doctor if there is query about the resident s condition Apart from statutory notifiable communicable diseases any suspected institutional outbreak of communicable diseases should also be reported to CENO for investigation and recommendation of appropriate control measures and to the Registration Office of Private Residential Care Homes for Persons with Disabilities ROPRCHD of Social Welfare Department for information Some common examples are as follows Respiratory tract infections Acute gastroenteritis Acute conjunctivitis Scabies Hand foot and mouth disease Head lice The notification form is shown in Appendix J Please refer to Appendix K for content of the relevant information Page 3 5 4 General guidelines on management of suspected outbreak of communicable disease Isolate the patients properly and arrange medical consultation promptly Notify relevant parties according to the established procedures soon after settling down the sick resident so that these parties can implement control me
30. infection Assist the home manager of RCHD in e arranging infection control training for staff e coordinating and overseeing that the infection control guidelines are being observed and implemented properly by the staff and residents e arranging provision of the necessary personal protective equipment PPE e advising and supervising the staff on the proper application and disposal of PPE e assessing the risk of infectious disease outbreaks in the RCHD and e reviewing and devising strategies to prevent infectious disease outbreaks through consultation with healthcare professionals e g Visiting Medical Practitioners and the Department of Health Page 37 6 3 Useful telephone numbers Report of suspected outbreak to the Central Notification Office CENO of the Centre for Health Protection CHP Department of Health and m Tel No 2477 2772 E Fax No 2477 2770 Registration Office of Private Residential Care Homes for Persons with Disabilities ROPRCHD Social Welfare Department E Enquiry Tel No 2891 6379 m Fax No 2153 0071 m Enquiry time Monday to Friday 8 45 am to 1 00 pm 2 00 pm to 6 00 pm 6 4 Useful websites Organisation Department of Health www dh gov hk E Centre for Health Protection www chp gov hk E Central Notification Office CENO www chp gov hk ceno E Central Health Education Unit www cheu gov hk Social Welfare Department www swd gov hk Hospital Authority www ha org hk Food and Env
31. ironmental Hygiene Department www fehd gov hk Environmental Protection Department www epd gov hk Centres for Disease Control and Prevention www cdc gov World Health Organization www who int Page 38 Appendix A List of signs and symptoms of some communicable diseases Diseases Signs symptoms Acute Conjunctivitis Discomfort redness itching and discharge of the eye some may have swollen eyelid or sensitivity to light Avian Influenza Similar symptoms as influenza viruses but more likely to result in high fever chest infection respiratory failure multi organ failure and even death Chickenpox May have low grade fever skin rash develops on scalp and body which spreads to the face arms and legs with formation of vesicles over a period of 5 days vesicles are itchy dry up and form a scab in about three days Dengue Fever Sudden onset of high fever severe headache pain behind the eyes muscle and joint pains anorexia nausea and rash Gastroenteritis Abdominal pain vomiting diarrhoea poor appetite fatigue fever Hand Foot and Mouth Disease Fever poor appetite malaise sore throat painful sores in the mouth rash red spots on palms of the hands and soles of the feet Hepatitis Fatigue poor appetite fever jaundice Human immunodeficiency Virus HIV Infection and Acquired Immune Deficiency Syndrome AIDS Weight loss fever profuse night sweating swollen
32. isease Dengue fever Diphtheria Enterovirus 71 infection Escherichia coli 0157 H7 infection Food poisoning Haemophilus influenzae type b infection invasive Hantavirus infection Influenza A H2 Influenza A H5 Influenza A H7 or Influenza A H9 Japanese encephalitis Legionnaires disease Leprosy Leptospirosis Listeriosis Appendix l Statutory notifiable communicable diseases as at 08 10 2010 Malaria Measles Meningococcal infection invasive Mumps Paratyphoid fever Plague Psittacosis Q fever Rabies Relapsing fever Rubella and congenital rubella syndrome Scarlet fever Severe Acute Respiratory Syndrome Smallpox Streptococcus suis infection Tetanus Tuberculosis Typhoid fever Typhus and other rickettsial diseases Viral haemorrhagic fever Viral hepatitis West Nile virus infection Whooping cough Yellow fever Footnote These are the infectious diseases specified in the First Schedule to the Prevention and Control of Disease Ordinance Cap 599 Notification of suspected or confirmed cases of these diseases by medical practitioners is required by law Monthly notification figures are available at the CHP website Please refer to Central Notification Office CENO on line website lt www chp gov hk ceno gt for updated list of statutory notifiable communicable diseases Page 48 Appendix J Notification form for suspected infectious disease outbreak in RCHD Suspected I
33. ital Total number of residents O MOM NOTA F WN PB Total number of staff members Further details if necessary 1 Detailed information of the sick Name Age Sex ID number Room number and floor number Symptoms Date of onset of illness Medical consultation record Residents list Staff list stating the floor or area where the staff work Staff sick leave record Vaccination record of residents and staff of the RCHD Floor plan of the RCHD stating the room or bed number Timetable for residents activities Oo Noa FF WN Food menu Please refer to Central Notification Office CENO on line website lt www chp gov hk ceno gt for updated list of statutory notifiable communicable diseases Page 50 Members of Editorial Board m Centre for Health Protection Department of Health e Infection Control Branch Surveillance and Epidemiology Branch Page 51 Published by the Department of Health
34. items Recommended method Reusable suction bottle Replace it with disposable bottle to minimise the risk of exposure during manual cleansing If reusable suction bottle is used Empty the bottle daily Brush to cleanse the bottle with detergent and water Immerse in 1 in 49 diluted household bleach for 10 minutes Rinse and store dry Suction connection tubing and Y shape connector Oxygen tubing and oxygen nasal cannula Tracheostomy tube Oxygen masks and nebulizer masks Replace with disposable items Tongue depressor Stainless m Wash with detergent and water until clean steel m Then immerse in 70 alcohol for not less than 10 minutes Mouth gag Wipe dry with clean disposable towel m Store in a clean covered container or in a package Dressing trolley stainless m Cleanse with detergent and water steel m Wipe the trolley surface with 70 alcohol m Wipe dry with clean disposable paper towel Mercury thermometer m Wash with detergent and cold water E Then immerse in 70 alcohol for not less than 10 minutes E Air dry and store in a clean container with a cover Stethoscope m Wipe with 70 alcohol before and after use Feeding set m After each feed flush the feeding set with water and air dried before feeding funnel and tubing putting it into clean container for subsequent use m Disinfect the reusable feeding funnel daily e g boiling for 10 minutes Follow manufacturer s ins
35. keep pets like dogs cats poultry or birds in RCHDs Page 20 3 3 1 Choice of disinfectants Household bleach generally contains 5 25 sodium hypochlorite solution It is an effective disinfectant when it is diluted appropriately Appendix E Care should be taken to avoid its use in metal surfaces since chlorine is corrosive to metal Please refer to Appendix F for procedures of preparing diluted bleach 1 in 99 diluted household bleach is adequate for usual situation Use 1 in 49 diluted household bleach for surfaces or articles soiled with respiratory secretions vomitus or excreta and in outbreak situation Use 70 alcohol to disinfect metal surfaces Apart from bleach there are many environmental disinfectants in the market Purchasers should check the content and note the directions for use because different disinfectant is designed for different targeted agents 3 3 2 General cleansing 3 3 3 Make sure the air conditioning systems are well maintained and the air filters are cleansed regularly Examine and cleanse residents lockers regularly to avoid food remnants Cleanse and disinfect frequently touched surfaces and commonly shared items at least daily e g handrails furniture computer keyboards Use 1 in 99 diluted household bleach for non metallic surfaces and 70 alcohol for metallic surfaces When there are obvious contaminants such as respiratory secretions vomitus or excreta wipe the contaminants away with
36. mmunicable diseases please visit the CHP website www chp gov hk Please note that many other diseases may also cause the above signs and symptoms These complaints should be compared with the past health record of the individual As fever is a common presenting symptom residents temperature should be checked regularly and their personal health records should be properly maintained 2 2 Observation and assessment Infections can be identified by observing and monitoring of certain signs and symptoms Staff and carers should pay more attention to those with special health conditions or medical devices as these residents are more prone to infections It is a good practice for the infection control officer ICO to conduct a preliminary health assessment for those who were suspected to have infection with the Checklist on signs and symptoms of infections Appendix B and seek prompt advice from the medical professionals Arrange the resident for urgent medical consultation once he she is found to have the following conditions Disorientation confusion restlessness Weaker than usual Lethargy Fall Shortness of breath Increased or irregular heart rate Unexplained changes in behaviour and body functions e g loss of bladder control or faecal incontinence Person with untreated infection may serve as a reservoir and continue spreading the infective agents to the others Thus it is very important to detect infected persons ea
37. n affect their functions and cause damage Electronic thermometers e There are various types of electronic thermometers in the market Some can be immersed in disinfectant while some cannot To ensure proper maintenance of the thermometers read and follow the user manual for the recommended cleansing and disinfection method Mercury thermometers e Handle oral and rectal thermometers separately e Wash thermometers with cold water and detergent until clean e Immerse in 70 alcohol for at least 10 minutes e Air dry and then store in a clean container with a cover 2 5 What should be done when a resident develops fever If a resident has a temperature higher than the reference value for details please refer to Section 2 3 2 or 1 C of his her baseline separate him her from the others and arrange him her to seek medical advice promptly Staff should record the body temperature in the resident s personal health record as well as mark his her name or bed number in the Residents fever record Appendix C To enhance early detection of outbreak situation the Infection Control Officer ICO is responsible to monitor residents fever record for any unusual pattern Page 14 3 General hygiene advice Building up immunity is vital to prevention of communicable diseases It includes having a well balanced diet adequate rest and sleep regular exercise and being a non smoker Good personal food and environmental hygiene sh
38. nfectious Disease Outbreak in RCHD NOTIFICATION FORM To Central Notification Office CENO Centre for Health Protection Fax 2477 2770 cc Registration Office of Private Residential Care Homes for Persons with Disabilities ROPRCHD of Social Welfare Department Fax 2153 0071 To enable prompt investigation and control of infectious disease outbreak please call CENO by phone Tel 2477 2772 before sending fax notification Name of institution Code no Address of institution Contact person Post i Total no of residents Total no of staff No of sick residents No admitted to hospital No of sick staff No admitted to hospital Common symptoms O Fever O Sore throat May tick multiple items O Cough O Runny nose O Diarrhoea O Vomiting O Skin rash O Blisters on hand foot Oral ulcers O Others Please specify Suspected disease Reported to CENO CHP on date by telephone at 2477 2772 Reported by Name Telephone No Signature date Page 49 Appendix K Required information for outbreak investigation Preliminary information required by the Centre for Health Protection CHP Name of the institution Address of the institution Name position and telephone number of the contact person Number of sick residents Number of residents admitted to hospital Number of sick staff members Number of staff members admitted to hosp
39. o remove it Then soak in 1 in 49 diluted household bleach for 30 minutes before general handling Page 46 Appendix H Notification mechanism for communicable diseases in RCHDs Resident develops signs or symptoms of communicable disease Staff reports sick or develops signs or symptoms of communicable disease Infection Control Officer ICO of the institution monitors the health conditions of all residents and staff to assess the situation Promptly seek medical advice from visiting medical practitioner general out patient clinic private practitioner or A amp E department for emergency condition Similar case s is are identified A Clustering of communicable diseases is suspected No similar case is identified A suspected or confirmed statutory notifiable communicable disease is diagnosed by the attending doctor Report to the Registration Office of Private Residential Care Homes for Persons with Disabilities ROPRCHD of Social Welfare Department Page 47 Report to the Central Notification Office CENO Centre for Health Protection CHP of the Department of Health DH Follow CHP s advice and implement appropriate enhanced infection control measures Acute poliomyelitis Amoebic dysentery Anthrax Bacillary dysentery Botulism Chickenpox Chikungunya fever Cholera Community associated methicillin resistant Staphylococcus aureus infection Creutzfeldt Jakob d
40. ontamination e Then wash with clean water e Re use after they are thoroughly dried 3 4 Vaccination Residents of RCHDs may develop severe or even fatal complications when they suffer from influenza The Department of Health offers free influenza vaccination to residents and staff of RCHDs annually through the Residential Care Home Vaccination Programme They are encouraged to receive influenza vaccination unless they have contraindications Free pneumococcal vaccinations are also provided for those residents who are aged 65 or above and have never received the vaccination before The Department of Health or private doctors may also provide other vaccines to individuals or target groups for protection against certain infectious diseases Staff or residents who want to get vaccinated for their personal protection can seek advice from doctors and consider the service fee Page 22 4 1 Infection control measures Apart from general hygienic practices and vaccination staff of institutions should also adopt specific infection control measures against communicable diseases The measures fall under two main categories gt Standard precautions gt Transmission based precautions In addition isolating people with specific communicable diseases urging visitors to observe infection control rules and nursing high risk person with greater caution can minimise the risk of communicable disease outbreak in an institution Standard precau
41. ors and arrange for proper medical treatment Implement contact precautions and preferably isolate the infested residents until treatment has been completed Handle clothing and linen of infested persons separately and ensure that high temperature procedures 60 C or above for at least 10 minutes are performed properly to kill the mites and eggs Put on protective gown and gloves before touching infested residents and wash hands thoroughly after taking off protective gown and gloves Instruct and supervise staff to use anti scabies medication following doctor s instruction Check the skin condition of all residents regularly Seek medical advice if suspected case is found Food poisoning List the names of affected people their medical details and consumed food details of these several days before the outbreak to the Department of Health for investigation and management Save food remnants food samples and clinical specimens for investigation as advised by the Department of Health Disinfect articles or places soiled by excreta or vomitus Cleanse and disinfect commodes and toilets with 1 in 49 diluted household bleach Ensure good personal food and environmental hygiene Enhance hygiene practices in kitchen and make sure that the refrigerator works properly Refrain infected staff from work especially the food handlers to prevent spread of the disease Page 35 6 Roles of RCHD staff 6 1 Responsibilities of o
42. ould be observed Since many germs are transmitted through contact or droplet performing hand hygiene properly and maintaining respiratory hygiene are two prerequisites for the prevention of infections Besides observing their own personal hygiene practices staff should also supervise and provide support to residents and visitors to enhance their good personal hygiene practices 3 1 Personal hygiene 3 11 Hand hygiene Hand hygiene is a prerequisite for the prevention of many infections Two hand hygiene practices are recommended hand washing with liquid soap and using alcohol based handrub Home managers of institutions should provide adequate facilities and put alcohol based handrub at convenient locations to facilitate staff and residents to perform hand hygiene practices They should also remind residents and staff of the following 3 1 2 Remove artificial nails rings watches and bracelets as they may harbour infectious organisms Perform hand hygiene after taking off gloves Even though gloves are worn hand hygiene can never be substituted Observe proper hand hygiene techniques irrespective of whether hand washing with liquid soap or alcohol based handrub is used Staff should perform and assist residents to perform hand hygiene when necessary e g before each meal for details please refer to Section 3 1 5 Hand washing Wash hands with liquid soap and water when hands are visibly soiled or likely contaminate
43. part of this set of guidelines 2 Carers refer to family members relatives guardians or guarantors of PWDs who look after PWDs outside the RCHDs in this set of guidelines 3 Residents refer to residents of RCHDs in this set of guidelines Page 5 1 Concepts on communicable diseases 1 1 What are communicable diseases 1 2 Communicable diseases refer to the diseases that can be transmitted and make people ill They are caused by infective agents pathogens that invade human body or release toxins to cause damages to normal body cells and their functions In severe cases they may lead to death Chain of infection infective agent source of infection mode of transmission host There are four crucial factors for the spread of communicable diseases namely the infective agent the source of infection the mode of transmission and the host the so called chain of infection 1 2 1 Infective agent An infective agent is a micro organism e g bacteria viruses fungi and parasite that will cause an infection 1 2 2 Source of infection This refers to any environment in which infective agents can live parasitise and breed It includes infected human e g patients carriers and people with latent infections livestock insects and soil The source of infection will normally form the basis for the infective agents to infect humans 1 2 3 Mode of transmission This refers to the method of t
44. pendix G Maintain oral and nasal hygiene Oral cavity should be checked and cleansed at least three times a day 4 6 Prevention of infection for persons with cognitive impairment Residents with cognitive impairment may develop difficulties in comprehension expression and self care Therefore they cannot cooperate with staff in performing preventive infection control measures For residents who retain certain degree of cognition staff may guide or assist them to adopt good personal hygiene to prevent infection For residents with serious cognitive impairment to ensure proper personal and environmental hygiene staff should pay extra attention and perform cleansing for them 4 7 Care of residents recently discharged from hospitals Assist the residents to wash their hair bath and change clothes when they return to RCHD Monitor their health conditions closely Measure their body temperature more frequently for the first few days Advise them to wear surgical masks if they have respiratory symptoms Advise them to observe personal hygiene Page 30 5 1 5 2 Outbreak of communicable disease What does outbreak of communicable disease mean From the epidemiological point of view if people in a RCHD develop similar symptoms one after another and the attack rate is higher than that at usual times there is an outbreak A common example is seasonal influenza outbreaks of which tend to occur more frequently during
45. perators or home managers of RCHDs Ensure infection control standards are maintained Oversee all infection control issues Designate a nurse or a health worker as an Infection Control Officer ICO If there is no nurse or health worker in the RCHD the home manager should be the ICO ICO is the key person responsible for dealing with matters related to infection control and prevention of the spread of infectious diseases in the RCHD Set up rules for visitors and encourage compliance Keep and maintain residents personal health records and staff s sick leave records properly Ensure the body temperature of residents are checked and recorded regularly by staff Encourage residents and staff to receive vaccination provided by the Department of Health Arrange staff to attend infection control training on regular basis and keep the training record Ensure adequate hand hygiene facilities and PPE Set up a designated isolation area or room with good ventilation proper waste disposal and hand hygiene facilities Report promptly suspected or confirmed cases of statutory notifiable communicable diseases and outbreak situation to the Registration Office of Private Residential Care Homes for Persons with Disabilities ROPRCHD of the Social Welfare Department and the Centre for Health Protection CHP of the Department of Health as appropriate Seek medical consultation for suspected case promptly Remind staff to bring along the in
46. ransfer by which the infective agent moves or is carried from one place to another Some communicable diseases have more than one mode of transmission e g chickenpox can be transmitted by contact or air borne transmission Please refer to the Section 1 3 for more details about the mode of transmission of some common communicable diseases 1 2 4 Host Hosts refer to the susceptible population Some people are more prone to infection and become hosts For instance young children elders and patients with chronic diseases are more susceptible to infection because of weakened body immunity Page 6 1 3 Modes of transmission of communicable diseases and examples Mode of transmission Process Examples of communicable diseases Contact transmission Through direct body contact with the infected person e g playing together with direct skin contact or through indirect contact with objects soiled by infective agents e g sharing towels combs and Acute conjunctivitis Chickenpox Hand foot and mouth disease Head lice Herpes zoster infection Methicillin resistant Staphylococcus aureus MRSA clothes infection E Scabies Inhale or contact of droplets expelled from the sick during E Acute bronchiolitis sneezing coughing spitting and m Pneumonia Droplet speaking or through subsequent E Seasonal influenza transmission touching of the mouth nose and E Severe acute respiratory eyes with hands soiled with syn
47. re inside refrigerator at or below 4 C and freezer at or below 18 C e Regularly monitor temperatures of refrigerator and freezer to ensure they are functioning properly Each refrigerator should have a temperature log book e Cleanse freezer or refrigerator at regular intervals e Avoid over packing to allow adequate ventilation inside the refrigerator e Do not wrap food directly with newspaper unclean paper or coloured plastic bags e Do not prepare too much food at one time to avoid wastage or over stocking e Follow Five Keys to Food Safety Appendix D for safe food preparation 3 3 Environmental hygiene Since infective agents can survive in the environment for a period of time it is essential to observe environmental hygiene Maintain good indoor ventilation open windows wide or turn on exhaust fans Keep appropriate distance between beds not less than 1 metre for persons with infectious diseases which are transmitted via droplets to reduce the chance of transmission E Empty water in the saucers underneath flower pots and change water in vases at least once a week Top up all defective ground surfaces to prevent accumulation of stagnant water and breeding of mosquitoes Avoid stacking of unnecessary articles to prevent rodent infestation Commence clean up actions immediately if there are any signs of pest or rodent infestation such as cockroaches mosquitoes flies rats and their excreta Do not
48. rer to maintain vigilance This not only safeguards the health of the residents and the staff by minimising the harm caused by the diseases but also reduces the chance of hospitalisation of the residents and thus helps to save community resources We intend to provide practical information on prevention of communicable diseases for those working in institutions for persons with disabilities PWDs Every staff member should understand these guidelines and undertake preventive measures accordingly These guidelines comprise six sections While individual staff member may refer to the relevant sections as necessary the infection control officers ICOs should familiarise with the content to coordinate the infection control issues and prevent the spread of communicable diseases within their institutions This set of guidelines does not meant to be exhaustive For the most updated information please visit the Centre for Health Protection CHP website at www chp gov hk Lastly we would like to take this opportunity to thank the Hospital Authority and the Social Welfare Department for their generous and valuable advice on the preparation of these guidelines Editorial Board Centre for Health Protection Department of Health February 2011 1 RCHDs refer to residential care homes for persons with disabilities PWDs in this set of guidelines The guidelines are intended for RCHDs Staff of day centres for PWDs can take reference of the relevant
49. rly 2 3 Measuring body temperature 2 3 1 The importance of taking body temperature Most people develop fever when being infected but there are exceptions Some people have lower baseline body temperatures even their body temperatures have raised during infection the body temperatures may still be within the reference range These changes can only be identified when their usual body temperatures are monitored on a regular basis Therefore it is a good practice to check and document the body temperature of high risk residents daily Page 10 Besides residents with the following conditions should have their body temperature checked more frequently e Being feeble e With communication problems e Having symptoms of infection e Recently discharged from hospital e Having been exposed in communicable diseases outbreaks particularly acute respiratory diseases If the temperature deviates from the resident s usual body temperature he she may have an underlying infection 2 3 2 Core and surface temperature Body temperature can be divided into core temperature and surface temperature Core temperature refers to the temperature of deep tissues and can be taken through the oral cavity rectum or ears whereas surface temperature is the temperature of surface skin tissues and can be taken through the forehead or armpits Comparatively surface temperature is more easily affected by the surroundings To avoid inaccurate measurement
50. rranging medical consultation for the sick residents staff should report the situation to Central Notification Office CENO of the Centre for Health Protection CHP for investigation Staff should notify the relevant parties according to Appendix H as soon as possible so that effective control measures can be implemented promptly Page 31 5 3 Is notification only applicable to confirmed cases of statutory notifiable communicable diseases Some communicable diseases are highly infectious and cause severe problems to such an extent that they threaten human lives and affect the economy If there are effective precautionary or control measures in place the disaster posed by these communicable diseases can be averted The evolution of outbreaks of communicable diseases and their management vary to a certain extent with different countries or regions where the types of communicable diseases occur and the living environment are different To safeguard public health and safety every country or region has legislation stipulating certain communicable diseases as statutory notifiable diseases that warrant special precautions and policies are developed to prevent outbreaks and contain their spread In Hong Kong as at 8th Oct 2010 there are 47 statutory notifiable communicable diseases under the Prevention and Control of Disease Ordinance Cap 599 List of statutory notifiable diseases Appendix l According to the Cap 599 the attendin
51. secnseeesecaecnaeceecaeeeaeeeseeeneenreees 27 42 1 Contact precautions ses sicwises cite hohieia ovis ea dl aati a a Antal i a E ie 27 422 Droplet precautions arici e ea eaads seis a acs a lea ion E 27 A423 _ AImbOrme PLECAautlOMs niemiin te edaaskces ese cnddnash a i eases idndea sud oes a a a E a 28 VISILOTS eenn a aiaa ira dee heh ira Men a a a i a Mea ie Ao 28 Tsolation MeaSures sc55 ise teins oa BGAN awk AHA dak ER AOAA das Sana eee eal 29 Prevention of healthcare associated Infections ccesccesecsseesseeseeeseeeeceseeeseeeseceaecaecseecaeeeaeeeseeeeeerenes 29 4 5 1 Prevention of urinary catheter associated infections sssesseesseseeseesssteressesersreseesessrsressese 29 4 5 2 Prevention of aspiration pneumonia associated with nasogastric tube feeding 06 30 Prevention of infection for persons with cognitive impairment ceeceecceeeceseeeeceeeceeeseeeneeneeeeeees 30 Care of residents recently discharged from hospitals ccccsccsssessseesceesceseceeeeseceneceeceeeneeeseeneeeseeees 30 Outbreak of communicable disease ccccsssccssscssscesscsssesssensssnessesseesssssesesscssssssssssesssssssesssessoesenes What does outbreak of communicable disease Mean ceeceesseesceesceeseeseceseesecsecseecaeecseeeseeneeeneeees 31 What should be done if outbreak is suspected 0 0 2 eeceseesseesseesceeseeeeceseceseeesecsaecsaecseecaeeeaeeeseeneeeeenes 31 Is notification only applicable to con
52. staff should e Be familiar with the correct use of thermometers e Use the same temperature taking method for each resident e Take temperature from the same body part around the same time every day to avoid deviations caused by changes in the surroundings e Defer temperature taking when residents having exercise after bathing or foods and drinks within 30 minutes Body temperature varies with age time of the day and level of physical activity For screening purpose temperature above the reference reading quoted below will be considered as significant and staff should arrange medical consultation for the resident if fever is suspected Measuring method Celsius scale C Fahrenheit scale F Ear 38 0 C 100 4 F Oral 37 5 C 99 5 F Armpit 37 3 C 99 1 F Rectal 38 0 C 100 4 F Page 11 2 4 Proper use of thermometers 2 4 1 Choice of thermometers There are digital mercury and infrared thermometers in the market for oral rectal armpit ear and forehead temperature measurement Accuracy suitability and convenience should all be taken into account in choosing the appropriate thermometer Before using a specific thermometer read the instructions carefully for the proper procedures and the reference range of the readings Infrared forehead thermometers are less accurate in reflecting the true core body temperature although some institutions are using it for the routine temperature
53. t pain on breathing h Low blood pressure i e systolic pressure below 9Ommbg i Increased heart rate Abdominal symptoms a Abdominal pain b Vomiting c Diarrhoea Urinary symptoms a Urination difficult painful frequent new onset of incontinence b Urine cloudy urine blood in urine Skin symptoms a Sudden onset of skin itchiness b Rash c Local symptoms of skin reddening swelling or pain d Wound with pus draining or bad smell Page 40 Appendix C Residents fever record Name of RCHD Contact person __ Post Telephone No Name Bed Number of Febrile Residents Seeking Medical Advice crema i rate gon Visiting Medical Practitioner Febrile Residents Page 41 Appendix D Five keys to food safety 1 Choose Buy food from hygienic and reliable shops 2 Clean Wash hands and utensils properly before and during food preparation 3 Separate Use separate knives and cutting boards to handle raw and cooked food 4 Cook Cook or reheat food until it is steaming hot throughout 5 Safe temperature Put leftovers promptly in the refrigerator at or below 4 C RMSE 5 Keys to Q od Sa afe ENAN ERRAZ Follow five keys a to ensure food safety Vey EH YE He A Buy food from hygienic and rebabls shops RERWNRBRS area TERRA MER EMRA Use ber rate knis to Tarte corendecoked ce CATRETMR BAFRA Cook or reheat food unti amp is steaming not throughout E
54. th damaged packages Do not buy ready to eat food and drinks that are displayed together with raw products Do not buy foods which look smell or taste abnormal Avoid unpasteurised dairy products like raw milk Do not buy excessive food to avoid prolonged storage Food preparation Wash hands properly before preparing food Wear mask cap and apron washable or disposable during food preparation Wash food thoroughly or scrub them with a brush when appropriate Handle and store raw food and cooked food separately Use separate knives and chopping boards for raw and cooked food to avoid cross contamination Thaw frozen food completely before cooking The recommended thawing method are thawing in refrigerator thawing under cold running water thawing by a microwave oven Cook or reheat foods thoroughly before consumption Do not touch cooked food with bare hands Page 19 3 2 5 Food storage e Keep the storage place clean to avoid pest infestation e Store food in well covered containers e Label the expiry date of food which has been prepared and stored for serving later e Never leave perishable food in room temperature e Store perishable food in the refrigerator immediately after purchasing e Before refrigeration pack the food into smaller portions if it is not intended for use in one go e Dispose of surplus food If surplus food needs to be retained store itina refrigerator e Keep the temperatu
55. ther means such as by telephone Page 28 4 4 Isolation measures Whenever a resident is suspected to have a communicable disease doctor should be consulted early for isolation advice For some highly contagious diseases room isolation is strongly recommended m Reserve a designated area or room for the isolation purpose It should not be used for other purpose E Implement appropriate protective measures including hand hygiene wearing mask and the use of appropriate PPE when caring residents in the designated area or room m Attend to the physical and psychological needs of the isolated residents to reduce their sense of loneliness 4 5 Prevention of healthcare associated infections In addition to the above preventive measures proper nursing protocols can further reduce healthcare associated infections in RCHDs which include the followings 4 5 1 Prevention of urinary catheter associated infections Residents requiring indwelling urinary catheter are exposed to a higher risk of urinary tract infections Risk reducing methods include Insert or change urinary catheter by a qualified nurse Perform hand hygiene thoroughly before and after handling urinary catheter Encourage residents to drink plenty of water to dilute urine and to optimise urine flow when there is no medical contraindication Check regularly if residents have malaise fever cloudy and smelly urine If so seek medical consultation promptly Always pl
56. til fully recovered e Minimise staff movement by arranging the same group of staff to take care of the same group of residents as far as possible and provide them with appropriate protective gear e Depending on the situation the Department of Health may consider distributing prophylactic medicines against influenza and giving vaccination to staff and residents of RCHD who have not received influenza vaccination 5 6 2 Outbreak of acute gastroenteritis AGE e Definition of outbreak of acute gastroenteritis There are increased numbers of residents and or staff with symptoms of acute gastroenteritis which include vomiting and or diarrhoea above the usual pattern e List the names of affected people and details of their medical records and report to the Department of Health for investigation e Disinfect articles or places soiled by excreta or vomitus e Save food remnants food samples and clinical specimens for investigation as advised by the Department of Health e Cleanse and disinfect commodes and toilets with 1 in 49 diluted household bleach e Ensure good personal food and environmental hygiene e Donot allow infected staff on duty until fully recovered Page 34 5 6 3 Outbreak of scabies 5 6 4 List the names of affected people and details of their medical records and report to the Department of Health for investigation Thoroughly trace the infested cases and their contacts including staff relatives or visit
57. tions Standard precautions are based on the concepts that all blood urine faeces excreta saliva sputum vomitus secretions from non intact skin wounds and mucous membrane should be treated as potentially infectious Everyone should take appropriate protective measures when coming into contact with them These include Hand hygiene Respiratory hygiene and cough manners Use of personal protective equipment Proper cleansing and disinfection of used or exposed articles Prevention of sharps injury Waste management 4 11 Hand hygiene Please refer to section 3 1 1 Hand hygiene 4 1 2 Respiratory hygiene and cough manners Please refer to section 3 1 6 Respiratory hygiene and cough manners 4 1 3 Use of personal protective equipment PPE Personal protective equipment is the barrier that aims at protecting skin and mucous membranes from exposure to potentially infectious materials thus minimise the risk of being infected They include gloves surgical mask also called facemask protective gown goggles face shield and cap According to the occupational safety requirement managements are responsible for ensuring appropriate PPE are provided to staff Staff should learn how to select and use appropriate PPE according to the risk assessment of nursing procedures and the infectious diseases situations Page 23 AF SN eee P Weal Hance Sat Remove Gloves FOS Put on Mask Abt 353 for aS AK Remove Gown 37
58. truction Use disposable feeding tubing for not longer than 24 hours Page 45 Articles Recommended method Nebulizer bottle Humidifier bottle of oxygen concentrator Water reservoir of ultrasound nebulizer Cleanse with detergent and water daily Immerse in 1 in 49 diluted household bleach for 10 minutes Rinse with sterile water If this is not feasible rinse the device with tap water and then rinse with isopropyl alcohol Dry in a drying cabinet or with forced air Washing plastic bowl Cleanse with detergent and water Immerse in 1 in 49 diluted household bleach for 10 minutes Rinse and store dry Urine measuring jar Rinse with water first then cleanse with detergent Immerse in 1 in 49 diluted household bleach for 10 minutes Rinse and store dry Bedpan Cleanse and brush with detergent and water after each use Immerse with 1 in 49 diluted household bleach for 10 minutes between users Rinse and store dry Commode Cleanse and brush with detergent and water after each use Wipe with 1 in 49 diluted household bleach between users Wait for 15 30 minutes then rinse and store dry Cleansing brushes Cleanse with detergent and water first Immerse in 1 in 49 diluted household bleach for 30 minutes Rinse and store dry Sphygmomanometer cuff cover Wash with detergent and water regularly Hot water cycle machine wash is preferred If soiled with body fluid rinse t

Guidelines on Prevention of Communicable Diseases in Residential

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