Home

Guidelines on Prevention of Communicable Diseases Residentail

Contents

1. e Group activities should be suspended during the outbreak period e Sick staff should refrain from work until fully recovered e Minimize staff movement arrange 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 will consider giving vaccination to staff and residents who have not yet received influenza vaccination as well as distributing medicines for prophylaxis against influenza 5 7 3 Outbreak of scabies e List names of persons suspected to be infected and details of their medical records e Thoroughly trace the infected cases and the contacts including staff relatives or visitors and arrange proper medical treatment for them e Implement contact precaution and preferably isolate the infected residents oO g9 a9 N oe nh until treatment has been completed o o D a D w N D e Clothing and linen of infected persons should be handled separately and ensure that high temperature disinfection procedures are performed properly Appendix M e Staff should put on protective gowns and gloves before touching infected residents under treatment and should wash their hands thoroughly after taking off the protective gowns and gloves e Instruct and supervise staff on the proper way to use and apply anti scabies medication follo
2. 3 Name position and telephone number of the contact person 4 Number of sick residents and number of residents admitted to hospital 5 Number of sick staff members 6 Total number of residents in the RCHE 7 Total number of staff members in the RCHE Further information in details f necessary 1 Detailed information of the sick e Name e Age e Sex e ID number e Room number and floor number e Symptoms e Date of onset of illness e Medical consultation record 2 Resident list 3 Staff list stating the floor or area where the staff work 4 Staff sick leave record 5 Influenza vaccination record for residents and staff 6 Floor plan of the RCHE stating the room or bed number 7 Timetable for residents activities 8 Food menu Remarks Please refer to CENO on line website www chp gov hk ceno for update list of statutory notifiable diseases gt O o Q x lt Guidelines on Prevention of Communicable Diseases in RCHEs 64 Scabies is an infectious skin disease caused by a barely visible mite It affects people of all ages Due to weakened immunity elderly are more susceptible to scabies Outbreaks of scabies have been reported in hospitals hostels and elderly homes Route of infection Scabies spreads through direct contact with an infected person As mites and their eggs can be left on clothing and bed linen contact with clothing or bed linen of the infected person can lead to infection
3. The scabies mite The mite is too small to be visible by naked eye The female mite penetrates into the Skin by its forelegs and mouth It digs tunnels and lays down its eggs The eggs hatch in 3 to 4 days The mites mature in about 10 days and then start to breed the next generation Symptoms of scabies 1 The main symptom is intensive itchiness in the infected areas which is more severe at night and after hot bath 2 The usual affected areas are the finger webs and the flexural areas of wrists elbows armpits nipples lower abdomen and external genitalia The face and scalp of elderly are uSually spared 3 Rash develops at the point where the mite penetrates the skin Thread like tunnel usually less than 1cm can be seen as they dig tunnels under the skin 4 If the infected person is allergic to the mite or its excreta he or she may develop blisters Norwegian or Crusted Scabies l Itis a rare form of scabies associated with thousands of mites harboring in the skin 2 Individuals suffered from Norwegian scabies may have marked scales and crusts particularly on the palms and soles 3 Face and scalp can also be affected 4 It occurs more frequently among people with weakened immunity physical debilitation sensory impairment or mental retardation 5 lt has enhanced potential for transmission gt O O er x lt gt O oe 5 lt i gt x lt 66 Management of scabies Management of r
4. eu gt x lt has a limited effective period 14 28 days Guidelines on Prevention of Communicable Diseases in RCHEs 56 dix H2 Preparation of bleach Procedures of prepaning diluted bleach 1 Ensure and be aware of good ventilation when diluting or using bleach 2 Put on protective gear when diluting or using bleach as it irritates mucous membranes the skin and the airway 3 Cold water should be used for dilution as hot water decomposes the active ingredient of bleach and renders it ineffective 4 Bleach containing 5 25 sodium hypochlorite should be diluted as follows e lin 99 diluted household bleach mixing Iml of bleach with 99ml of water e lin 49 diluted household bleach mixing Iml of bleach with 49ml of water e lin 4 diluted household bleach mixing Iml of bleach with 4ml of water 5 For accurate measurement of the amount of bleach added a tablespoon or measuring cup can be used Recommended Use of Sodium Hypochlonites Diluton rato Concentration Diluton 10 000 ppm one part of household For facilities contaminated 1 bleach 5 25 with blood spillage hypochlorite solution in 4 parts of water 1 000 ppm one part of household For surfaces or articles 0 1 bleach 5 25 contaminated with hypochlorite solution in vomitus excreta or 49 parts of water secretions 500 ppm one part of household For general environmental 0 05 bleach 5 25 cleaning hypochlorite solution in 99 part
5. Guidelines on Prevention of Communicable Diseases in RCHEs 4 7 Isolation measures If a resident is suspected to have contracted a communicable disease he she Should be temporarily isolated Infection control measures should be strictly implemented so as to protect uninfected residents staff members and visitors and to stop the spread of the communicable disease Isolation measures include e Reserve some quiet separate designated area rooms in the RCHEs for nursing those residents showing respiratory symptoms or infected with communicable diseases e Carers should try as much as possible to attend to both the physical and psychological needs of the isolated resident in order to reduce sense of loneliness e Staff members entering the designated area rooms to work should take appropriate protective measures including hand hygiene wearing surgical mask and the use of other suitable PPE e Separate designated area rooms should be available at any time and should not be used for any other purpose If a resident is confirmed or suspected of SARS or other serious communicable rev fon Az o cr 3 0 fon 3 O J lt O D o O lor SE o m o H g wn o n 2o Os a 1a 9q 0 SoINSedW SAIJUSADId diseases Staff from the DH will help the RCHE to delineate high risk and low risk zones and draw up working procedures For details please follow the Instruction of DH staff Guidelines on Prevention
6. How to apply Benzyl Benzoate Emulsion L In the evening after taking a bath scrub and dry the body thoroughly With the help of another person use a brush to paint the emulsion from the neck downwards to cover the whole body finger webs and toe webs should be included but not the head Then put back the same clothes On the next morning repeat the application without taking a bath Then put back the same clothes On the next evening take a hot bath and clean the whole body with soap and put on clean clothes afterwards In between the two applications of the emulsion there is no need to change the clothing or bed linen 5 Please note that two applications of the emulsion suffice to kill the mite except in Norwegian scabies Over treatment gives rise to irritation and causes contact dermatitis Re apply the emulsion to the hands after washing since the previous coating has been removed by water 6 After treatment the itching may persist for 1to 2 weeks If the itchiness lasts for more than 2 weeks or if there are other changes in the skin consult your doctor again 7 Aggressive treatment with multiple applications over the entire body at an interval of 2 7 days may be needed for Norwegian scabies Please consult the doctor in charge for instruction and re evaluation Appendix N Norovirus Infection Causative agent This infection is caused by a group of viruses Known as noroviruses also known as Norwal
7. S INSL W SAIJUDADId e Observe oral and nasal hygiene Oral cavity should be cleansed at least three times a day with visual checking 4 9 3 Prevention of pressure sore and associated infection is better than post infection treatment e Help residents to keep their skin and clothing clean and dry Avoid prolonged skin contact with sweat urine faeces which will cause skin lesions and infection e Help bed bound residents to maintain correct postures to minimize the risk of pressure sore e Apply proper techniques in lifting and transfer as well as proper positioning SO as to avoid the development of pressure sore e Help residents to change posture at least once every two hours When helping the resident change positions avoid rubbing or bumping his her body against the bed e Consider various pressure reducing aids such as cushioned mattress e Wear gloves when taking care of wounds Observe aseptic procedures Wash hands afterwards e Encourage regular exercise to enhance mobility and blood circulation Sal Ah nasc an DEAWARHAR ne CAMARMIIALcohla Picasc Guidelines on Prevention of Communicable Disease 4 9 4 Caring for residents with cognitive impainment Residents suffering from cognitive impairment such as dementia stroke or other brain lesions may develop difficulties in comprehension expression and self care They may not cooperate with the staff members of the RCHEs in implementing preventive infection control measu
8. every country or region has legislation stipulating certain communicable diseases as statutory notifiable diseases which warrant special precautions and policies are developed to prevent outbreaks and to contain their spread In Hong Kong there are 32 Statutory notifiable communicable diseases under the Quarantine and Prevention of Disease Ordinance Cap 141 the list is attached in Appendix A Attending doctors should report to the Central Notification Office CENO Centre for Health Protection CHP of the Department of Health if such cases arise Furthermore the persons in charge of RCHEs are required to report to the Director of Social Welfare of any suspected or confirmed cases of communicable diseases under section 18 of the Residential Care Homes Elderly Persons Regulation Cap 459A Guidelines on Prevention of Communicable Diseases in RCHEs z o 07 jo s d 2u09 Communicable diseases In RCHEs SJHDY Ul Saseasip 3 qged1UNWWO 2 L Common communicable diseases in RCHEsS Information shows that the most common infections in elderly homes are respiratory tract infections urinary tract infections and skin or subcutaneous tissue infections Other common infections include infectious gastrointestinal diseases and acute conjunctivitis The typical signs and symptoms of these communicable diseases are listed as follows for staff reference Mode of transmission Preventive measures Signs and symptoms U
9. Guidelines on Prevention of Communicable Diseases in RCHEs 33 4 9 Guidance notes on nursing procedures In addition to the correct use of PPE and implementation of preventive measures mentioned above a proper and appropriate nursing protocol can also reduce the risk of infections in the residents The followings are points to note for common nursing protocols adopted by RCHEs 4 9 1 Residents requinng the insertion of urethral catheter are exposed to a higher risk of urethitis Risk reducing methods include e Minimize the need for catheters by means of bladder training e If insertion is required use small size catheters to lower the risk of infection e The catheter should be changed by experienced and qualified healthcare professional e Perform hand hygiene thoroughly before and after the insertion procedure e Residents without medical contra indications should be encouraged to drink plenty of water to help dilute the urine and optimize the urine flow om oO 3 3 io o o D o Wn D D N D Nn 9q 0 SoINSeaW dAI UBADId required for irrigation of the catheter e Check if the resident has cloudy and smelly urine malaise or fever If so seek medical consultation promptly e Keep the urine bag clean and change it regularly as required Keep watch on and record the urine output e Observe the height of the urine bag regularly especially when helping the resident to change positions The urine ba
10. and wrists for at least 20 seconds e Let the alcohol evaporate naturally Do not use paper towels to dry To minimize the risk of being infected or becoming the vector unknowingly Staff Should use appropriate PPE at work according to the risk of the nursing procedure and the physical condition of the resident so as to safeguard themselves and others Appropriate PPE should be stocked up rev fon pate oo 3 o fom 3 cE O SS O D v oO oE o m a 9 wn D D o Os vN L wn at 9q 0 SOINSeAW SAIUSADd 4 3 1 Gloves Gloves should be worn when handling blood body tissues excreta body fluids secretions or any other contaminated wastes Mucosa and wounds Should only be touched after putting on clean gloves Gloves contaminated by body secretions should be changed beforehand even though the same resident is being nursed Take off used gloves and perform hand hygiene immediately before nursing other residents so as to avoid transmission of infective agents to other residents or contamination of the RCHE s environment Please note that wearing gloves cannot substitute for hand hygiene Guidelines on Prevention of Communicable Diseases in RCHEs 4 3 2 Surgical masks goggles and face shields Surgical masks goggles or face shields can protect the mouth nose and eyes from contamination by droplets via sneezing coughing blood spill body fluids secretions and excreta like sputum urine or faeces du
11. are recommended for all individuals with signs and symptoms of a respiratory infection e Cover nose and mouth when coughing or sneezing e Use tissue paper to contain respiratory secretions and dispose them in the nearest non touch garbage bin with lid or flush them away in the toilet e Put on a surgical mask for those with signs and symptoms of respiratory infection e Perform hand hygiene immediately e g hand washing with soap and water or alcohol based handrub after contacting respiratory secretions or touching objects contaminated with respiratory secretions Institutions should ensure the availability of materials for adhering to Respiratory Hygiene Cough Etiquette in waiting areas for residents and Visitors e Provide tissue paper and non touch garbage bin with lid for disposal of used tissue e Ensure that supplies for hand washing i e liquid soap paper towels are consistently available near sinks and provide conveniently located dispensers of alcohol based handrub e Put up signage and remind residents and visitors not to spit on floor dix G Worid Health Organization s ten principles for safe food preparation Ensure proper food hygiene Take extra care when selecting processed food Cook food thoroughly Eat cooked foods immediately Store cooked foods carefully Reheat cooked foods thoroughly L 2 3 4 5 6 Avoid contact between raw foods and cooked foods 7 Wash hands frequently 8 Keep all
12. borne Infectious legs and mouths of the insects gastrointestinal and then infect human when the diseases fly borne or insects bite humans or by cross rodent borne contamination Blood Body fluid Transmitted through blood Hepatitis B AIDS transmission transfusion tattooing ear piercing or sexual intercourse Congenital Infection Infective agents enter the foetus Congenital syphilis through the mother causing infection Note Some communicable diseases have more than one mode of transmission 12 3 Host Gusceptible population Hosts refer to the susceptible population Some people are more prone to become hosts For instance elders with chronic diseases are more susceptible to infection as a result of weakened body immunity 13 Why are residential care homes for the elderly RCHEs vulnerabile to outbreaks of communicable diseases RCHEs are collective living places where communicable diseases can easily spread through close person to person contact The frailty of the elders also aids the Spread The source of infection can be staff visitors or residents e g residents newly discharged from hospital Person to person contact then leads to cross infection i e the transmission of infective agents from one person to another For instance a staff member who fails to wash hands after caring for a resident may spread the infective agents from that resident to the next resident he cares for Guidelines
13. caused by changes in the surroundings or the use of different measurement methods 2 5 4 Choice of thermometers In general there are mercury digital chemical LCD and infrared ear thermometers etc for taking oral rectal armpit ear and forehead temperature Before using a specific thermometer read the instructions carefully for the proper procedures of using the thermometer and the reference range of the readings Accuracy suitability and convenience Should all be taken into account when choosing the appropriate thermometer RCHEs that require rapid temperature taking because of the setting and working conditions may use infrared forehead thermometers Such devices however are less accurate in reflecting the true core body temperature Hence unless absolutely necessary it should be avoided as far as possible as the only type of thermometer used for taking temperature 2 5 5 Methods of taking body temperature Taking ear temperature It is non invasive and therefore has little limitations on its application It is particularly suitable and recommended for use in RCHEs First stabilize the head position of the resident Pull the ear backwards and upwards to make the ear canal straight Fit the probe tip covered with a plastic jacket slightly into the depth of the ear canal The temperature taken from the ear is 0 5 C higher than the oral temperature Follow the instructions to make suitable adjustments when using an ear thermometer Poi
14. everyday for early detection of residents with health problems and check against the checklist of signs and symptoms of communicable diseases in Appendix C Assistance can be sought from the Visiting Medical Officer VMO or the healthcare workers of the Community Geriatric Assessment Team CGAT when necessary 2 5 3 Accurate measurement of body temperature Body temperature can be divided into core temperature and Surface temperature Core temperature refers to the temperature of deep tissues which can be taken through the oral cavity rectum or ear whereas surface temperature is the temperature of surface skin tissues which can be taken through the armpit Surface temperature is more Susceptible to changes in the surroundings To avoid inaccuracy in measurement the following should be noted Guidelines on Prevention of Communicable Diseases in RCHEs 15 ok na PERS fed Fie os Se pe E a O5 a eae m WN e Residents should avoid exercise or having excessively cold or hot food and drinks within 30 minutes before taking temperature e To familiarize with the correct use of thermometers before taking temperature e For each particular resident it is preferable to take the daily temperature 3 3 ey D from the same body part at the same time of the day using the same SL U a w U M U JJ O E mi U temperature taking method to avoid deviations
15. excreta or vomitus e Clean and disinfect toilets with Lin 49 diluted household bleach 5 25 e Ensure good personal food and environmental hygiene in the RCHE e Maintain a hygienic environment in the kitchen and make sure that the refrigerator works properly e Infected staff especially food handlers should be granted sick leave to prevent spread of the disease Jo yealqgqno 5 7 2 Outbreak of respiratory tract infection e Definition of outbreak of respiratory oO 3 3 mD fet o D a D w N D tract infection There are increased number of residents and or staff with upper respiratory tract symptoms which include cough sore throat running nose and fever above the usual pattern e The RCHE should implement relevant preventive measures to prevent spread of respiratory infection e List names of people suspected to be infected and details of their medical records e Enhance health surveillance for other residents like measuring body temperature Guidelines on Prevention of Communicable Diseases in RCHEs e Switch on exhaust fans and open windows if possible to improve indoor ventilation e Infected residents not admitted to hospitals should wear surgical masks and be relocated to the same designated area room for isolation as far as possible e Be stringent with personal and hand hygiene and observe for respiratory hygiene cough etiquette Appendix F
16. kitchen surfaces meticulously clean 9 Protect foods from insects rodents and other animals 10 Use safe water gt O O gP gt SL x lt Guidelines on Prevention of Communicable Diseases in RCHEs 59 dix HE Commonly used disinfectants Hypochlorites e g household bleach containing 5 25 sodium hypocholorites Alcohols e g Ethyl Alcohol Isopropyl Alcohol Diguanides e g Concentration 1 10 000 ppm Dilution ratio Lin 4 0 1 1 000 ppm Dilution ratio Lin 49 0 05 500 ppm Dilution ratio Lin 99 equipment disinfection Please refer to Appendix H2 for Preparation of Bleach Skin metal Surface or equipment disinfection Skin and mucous membrane Environmental or Mix with water Corrosive to metals Avoid contact with Skin Or mucous membrane Contact with acids liberate toxic gas Diluted solution decomposes rapidly and its effectiveness will decrease Freshly prepared diluted bleach should be used within 24 hours Inflammable liquid Rapid action but volatile Poor penetration into organic matter Chlorhexidine disinfection and Low toxicity Hibitane e g Chlorhexidine aqueous 1100 aqueous 11000 wound dressing Low toxicity cetavion Savion Detergent properties Aldehydes Alkaline solution e g disinfection Equipment Irritate eyes skin and Glutaraldehyde Cidex respiratory mucosa Need activation and gt O O o
17. medical advice Wear gloves and a mask while disposing of or handling vomitus and faeces and wash hands thoroughly afterwards Clean and disinfect soiled linens clothes and surfaces promptly and thoroughly with household bleach 5 25 diluted in a ratio of 1 part of bleach tn 49 parts of water Wash hands thoroughly afterwards No vaccine is available for norovirus infection Disinfection of environment after vomiting incidents Keep residents away from the area during the cleaning process Wear gloves and a mask while removing the vomitus Use disposable towels to wipe away all the vomitus from outside inward before applying diluted bleach lin 49 to the surface and the neighbouring area e g within 2 metres of the vomitus Leave bleach on the soiled surface for 15 30 minutes to allow time for the bleach to inactivate viruses before rinsing the surface with water and mop dry Floor mops should not be used for cleaning the vomitus Members of Editoral Board Centre for Health Protection Department of Health e Central Health Education Unit e Infection Control Branch e Surveillance and Epidemiology Branch Elderly Health Service Department of Health
18. of Communicable Diseases in RCHEs 32 4 8 Rules for visitors Visitors should be advised to comply with infection control measures so as to prevent the spread of the disease The followings are rules for visitors e Advise visitors to pay attention to their personal health conditions In case of illness such as influenza they should not visit the RCHE so as to avoid the spread of the disease to residents e Ask all visitors including healthcare workers and relatives to wear surgical masks if they develop respiratory symptoms e If necessary visitors should comply with the request of the RCHE by filling out the visiting dates and other information required for the necessary follow up by the Department of Health e In case of outbreaks or by advice from the Department of Health visitors should refrain from visiting the RCHE to prevent cross infection If necessary other means such as telephone calls can be used to contact the residents If visits must be made advise visitors to take preventive infection control measures including wearing surgical masks cleaning hands thoroughly with liquid soap or alcohol rev fon ao o ctr 3 o fom c oO SS oO DW o O ey Se o m o 0 aN D 2o 6S a N 9q 0 S INSL W AIJU A Jd based handrub before and after visits or wearing appropriate PPE as recommended in accordance with the type of the disease and the severity of the outbreak SENT ii
19. though sporadic cases may also occur at other times To decide whether there is an outbreak day to day information on cases of communicable diseases in RCHEs has to be monitored Some examples are cited below for reference The ICO should closely monitor the situation if e The residents living in the same room or on the same floor develop similar oO MD w N h symptoms in clusters within short 3 fet oz D o D w N D period of time e The residents and staff bp concurrently develop bor similar symptoms in clusters such as Symptoms of influenza fever cough and sore throat This means that cross infection may have occurred in the RCHE Guidelines on Prevention of Communicable Diseases in RCHEs a O at o ra a ra ot Ww ra m oO MD w N oO h e 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 e 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 5 2 What should be done If outbreak is suspected Early detection of occurrence of communicable dis
20. 721 or 2834 7414 Enquiry Time Monday to Friday 8 45am 1 00pm 2 00pm 6 00pm Guidelines on Prevention of Communicable Diseases in RCHEs Inspectors of LORCHE telephone list Inspector Telephone No Inspector Telephone No o amo O o s s m s a pe e Hospital Authority Enquiry hotline 2300 6555 Hospital Authority s enquiry hotlines Community Geriatric Assessment Teams Hospital Telephone No J oO MD U oO gt J O ag mi U cr w h h Kwong Wah Hospital 3517 5026 3517 5456 Shatin Hospital 2636 7618 Tai Po Hospital 2607 6932 North District Hospital 2683 7745 Tuen Mun Hospital 2468 5801 Guidelines on Prevention of Communicable Diseases in pcre United Christian Hospital 2379 5154 Princess Margaret Hospital 2 49 8212 Hospital Authority s enquiry hotlines and fax numbers Community Nursing Services Hospital Community Nursing Service Centre Tel No Fax No Cluster East Cluster Hospital CNS Hotline Hong Kong West Cluster Tung Wah Hospital CNS Station 2589 8266 2548 2912 Kowloon Queen Elizabeth Hospital CNS Referring 2958 2451 2374 5897 Central Station Cluster Kowloon Hospital CNS Centre 3129 6969 27614258 Kowloon Kowloon East Cluster CNS Headquarter 2340 0815 2349 6616 East Cluster 35B 4517 Kowloon Caritas Medical Centre Main Centre 3408 7701 2745 8301 West Cluster Kwong Wah Hospital CNS Centre 3517 5187 3517 5188 3517 2762 Princess Margaret Hospital
21. C siicdccts ver scaviedeneetansciecsenisdnatazeraeenweds ZO DIAC EA O Ws asec cect ence nese EE E avs cwenecancsesieverenets 2L Palina Unna ON eee ER E EES E EEEE ENS 22 Frequent GAMA ON isscinsceesrwsnissececondaysouniebineniases cwayiuteceussias saednsiciesapeuseupieaerecows Zoe CHOU CN WC ace png cee eon nanan E cn Ea OEE E A E E EE 2A BOOT Mi WINS ce aici eeac e eee OE E EE E E AE eaa EA A e z 25 Sudden onset OF pruritiS ssnarrrurrrrnrrrrrrrrnrrrrnrrrrnnrrnnrrrnnrrrnnrrnrrrrnrrrrnnrrnn gt D 26 P e E E E E E E EEE EEEE E S 2 27 Local symptoms of skin reddening swelling Or PaIN ccccceeeeeeeeeeeeeeeaeees 28 Pressure sore with pus draining or offensive OCOUN ccccceeeee eee eeeeeeeeeeeeaes 29 Increased heart Vale seen oeenedcos es aceaetsaneseenaneetemnsoeno trasaeean areeeautarenjeensqeenseatennceres Guidelines on Prevention of Communicable Diseases in RCHEs Aiders with higher nsk of infection L Bedridden elders Elders of older age over 75 2 3 Diabetic elders 4 Elders with poor body immunity e g elders with renal failure or cancer 5 Elders with cognitive impairment and low self care ability Invasive medical devices and procedures L Urethral catheter 2 Intermittent self catheterization 3 Tracheostomy tube 4 Nasogastric catheter Ryle s tube 5 Percutaneous gastric tube feeding gastrostomy tube 6 Continuous Ambulatory P
22. CNS Station 27414317 2990 3482 Yan Chai Hospital CNS Station 2417 8831 2405 0015 Our Lady Maryknoll Hospital CNS Centre 2354 2222 2354 9867 New Alice Ho Miu Ling Nethersole Hospital 2689 2777 2666 9404 Territories CNS Centre East Cluster North District Hospital CNS Centre 2683 7742 2683 7743 PWH Community Outreach Service Team 2604 9639 2693 9619 aia Centre New Tuen Mun Hospital CNS Liaison Office 2468 5713 2453 2317 Territories 2468 6664 West Cluster J MD U h J TE mi U cr fan r h Guidelines on Prevention of Communicable Diseases in RCHEs 6 4 3 Websites Organization Website Centre for Health Protection World Health Organization http www who int JJEIS AHDY 40 S 0Y Felines on Prevention of Communicable Diseases in RCHEs gt O o Q x lt 48 e Acute poliomyelitis e Amoebic dysentery e Bacillary dysentery e Chickenpox e Cholera e Community associated MRSA infection e Dengue fever e Diphtheria e Food poisoning e Influenza A H5 Influenza A H7 or Influenza A H9 e Japanese Encephalitis e Legionnaires disease e Leprosy e Malaria e Measles Footnote Please refer to CENO on line website http www chp gov hk ceno for the update list of statutory notifiable diseases Guidelines on Prevention of Communicable Diseases in RCHEs Meningococcal infections Mumps Paratyphoid fever Plag
23. Prevention of Communicable Diseases in Residential Care Homes for the Elderly Personal Protective Equipment Safe Food Preparation WE j Val 1 eait Ta arse i i or N F p ii Ss eo N algu i rie i 4 JEA Department of Health Introduction Effective prevention of communicable diseases in residential care homes for the elderly RCHEs will not only safeguard the health of the residents and the staff by minimizing the harm caused by the diseases but will also reduce the chance of hospitalization of the residents and thus help to save community resources It is therefore incumbent on every staff and resident to learn how to prevent communicable diseases This guideline is intended to provide practical information on prevention measures of communicable diseases for those who work in RCHEs Every employee of RCHEs has the responsibility to understand the guideline and to take care of the elderly according to what has been laid down therein The guideline is prepared according to the previous version published in 2003 It is divided into seven sections While individual staff may refer to the relevant sections as necessary it is important for infection control officers ICOs to familiarize themselves with all the content so as to assist the responsible officers of the RCHEs in preventing the spread of communicable diseases within the institution However this set of guideline is not meant to be exhaustive In case of doubt or w
24. able diseases in the RCHE The ICO of the RCHE should be responsible for the Supervision and coordination 4 11 What are standard precautions Standard precautions are designed to reduce the risk of transmission of infective agents from recognized or unrecognized sources of infection They are applicable to all staff and residents When coming into contact with or taking care of the residents staff should regard blood all body fluids secretions and excretions except sweat like excreta Saliva sputum vomitus or secretions from wounds non intact skin like wound and mucous membrane as potentially infectious and adopt appropriate and relevant protective measures in different situations By as AO S oO o trix 3O0q 3925 e e v oz3 oro HER T Oa E Wn q gt MD AWN fet w 2E S VY o gt O Wn Guidelines on Prevention of Communicable Diseases in RCHEs 2 4 12 Aspects include e Hand hygiene e Use of personal protective equipment e Handling of contaminated articles e Handling of sharps 4 2 Hand hygiene Hand hygiene is a general term referring to any action of hand cleansing Itis a basic infection control measure to prevent the spread of communicable diseases The common hand hygiene practices recommended include hand washing and proper use of alcohol based handrub 4 2 1 Basic rules of hand washing e Research shows that washing hands properly is the most effective way t
25. accumulation of stagnant water and breeding of mosquitoes To prevent rodent infestation avoid stacking of unnecessary articles e Commence clean up actions immediately when there are any signs of pest or rodent infestation such as excreta of rats cockroaches mosquitoes and flies In case of need call the Food and Environmental Hygiene Department hotline at 2868 OOOO or relevant departments to follow up e Fora hygienic environment it is not advisable to keep pets like dogs and cats in the RCHE saseasip 3 GedUNWWOD JO UOlUdAaIA uo SaUljapInb e1 u 9 3 3 2 Maintain a clean and hygienic kitchen e Keep the kitchen clean wash the exhaust fan and range hood regularly and store eating utensils in a clean cupboard e Worktops in the kitchen should be kept clean e The floor should be kept dry after cleaning so that residents and staff will not slip over e Do not store personal items such as clothes and shoes in the kitchen e Cover garbage bins properly to avoid breeding of cockroaches flies and rodents 3 3 3 Cleaning and disinfection measures for toilets and bathrooms e Keep toilets and bathrooms clean and hygienic e Provide liquid soap and disposable paper towels or hand dryers for washing hands e Ensure the flushing system of the toilet is in proper function all the times e Make sure that the drain pipes are built with U shaped water traps do not alter the pipelines without authorization e Pour about
26. al which move pain frequent hygiene from the large urination women should Intestine to the urinary urgency wipe their urinary tract nocturia urinary genitalia from More commonly incontinence the front to the found in lower back after women people abdominal pain urination with urinary low back pain ensure catheters hematuria adequate fluid diabetic etc cloudy urine intake avoid etc holding back urine avoid putting urinary bags at high position for people with urinary catheters maintain good hygiene when changing urinary bags Guidelines on Prevention of Communicable Diseases in i o a SJHDY UI SOUSeOVSIP jqe runw wo Skin and subcutaneous tissue infections Infectious gastrointestinal diseases Acute conjunctivitis Parasites e g scabies head lice bacteria e g Staphylococcus aureus Streptococcus pneumoniae fungi e g moniliasis tinea Viruses e g rotaviruses Noroviruses bacteria e g Salmonella Staphylococcus aureus Vibrio cholerae Viruses bacteria Mode of tansmission Contact transmission Consuming contaminated food or water contact with vomitus or faeces from infected persons contaminated object or aerosols in case of Norovirus infection Appendix N Contact transmission Guidelines on Prevention of Communicable Diseases in RCHEs Signs and symptoms Itching localized rash d
27. be overloaded and should be disposed of properly when it is 3 4 full e Keep sharp boxes clean and dry e Seal the sharp box and dispose in a well fastened robust plastic bag with a warning signs reading Biohazard or Beware of Sharps to alert others during disposal Please refer to the guideline on the disposal of clinical waste by Environmental Protection Department for details If there is a substantial amount of clinical wastes and sharps for disposal it is best to contact a clinical waste o Q RES rr 3 0 32 er 3 O D v O open E o m 1a 2a wn Oo Ae Des DY 3 N q 0 S INSL WU dAIUaADd collector Pay attention to any amendment of the legislation on clinical waste handling and make the corresponding arrangements for compliance If in doubt contact the Territory Control Office of the Environmental Protection Department at 2835 1055 for enquiry Guidelines on Prevention of Communicable Diseases in RCHEs 30 4 6 Tansmission based precautions In addition to general hygiene practices vaccination and standard precautions specific preventive measures should be adopted when dealing with diseases with different modes of transmission Preventive Examples of Preventive Measures Strategy Disease Standard All communicable As list under section 4 1 precautions diseases Droplet Influenza SARS Maintain good indoor ventilation precautions Cover mouth and nose when sneezin
28. cable to confirmed cases of statutory notifiable communicable GiSCASES cccecceeseeseeeeeeeeeeseeeeeeeseees 38 General guideline on the management of a suspected outbreak of Communicable GiSCASE cccccceceeeeceeseseeeeseeeeeeeeens Disinfection during an outbreak of communicable disease Specific recommendations on management of selected communicable diseases food poisoning outbreak of respiratory tract infection and scabies Outbreak c ccccesseeeeeeeeeeees Roles of RCHE Staff The basic rule for prevention of communicable diseases IM RC MESrcsccccvescncaindosecentebblnstaccesdcenbsendeteoliuatgiensil inden Responsibilities of persons in charge or operators of RCHEsS 42 Appendix A Statutory notifiable communicable diseases Duties of infection control officers ICOs in RCHEs Checklist of signs and symptoms of communicable diseases Fever record for residents E Guidelines for good handwashing F Respiratory hygiene cough etiquette G World Health Organization s ten principles for safe food preparation H1 Commonly used disinfectants H2 Preparation of bleach I Cleansing and disinfection of articles commonly used in RCHEs J Flow chart of the notification mechanism for communicable diseases in RCHEs K Notification form for suspected infectious disease outbreak in RCHE L Common information required by staff of CHP Centre f
29. ch 5 25 is sufficient for general cleaning purpose though 1in 49 diluted household bleach 5 25 should be used for places contaminated with excreta or secretions Besides many detergents on the market claim to have a disinfectant composition Purchasers should check whether the claim is genuine and should note the directions for use because the effectiveness of different disinfectants will be different Please refer to Appendix H1 for details 3 4 Vaccination Aders suffering from influenza will develop fatal complications more easily Therefore unless vaccination is contra indicated residents and staff should be encouraged to receive influenza vaccination provided by the Department of Health to enhance their immunity and help prevent complications caused by influenza Guidelines on Prevention of Communicable Diseases in RCHEs Apart from general hygienic practice and vaccination staff of RCHEs should also adopt appropriate preventive measures against communicable diseases The measures fall under two main categories e Standard precautions applicable to all staff and residents e Transmission based precautions precautions based on the mode of transmission In addition isolation of residents with communicable diseases urging visitors to observe the RCHE s rules on prevention of communicable diseases and nursing high risk residents with greater caution will also help to minimize the chance of outbreak of communic
30. dual including residents should put on a surgical mask when there is respiratory symptom if applicable and tolerable Never share toothbrushes razors or other objects likely contaminated by blood Standard precautions Should be strictly followed when clearing up objects contaminated by blood Avoid unprotected unsafe sex Cannot resist the invasion of infective agents because of impaired body immunity No specific symptoms May have persistent fever uncommon Infections and or tumors etc Blood body fluid transmission Guidelines on Prevention of Communicable Diseases in RCHEs oz a w U a U J O T mi U O 3 c O ey Si D p Types of Infective Mode of Signs and Preventive o diseases agents transmission symptoms measures PERS ow D Myiasis Larvae of flies Flies lay their Larvae crawl out Maintain good s eggs on mucous from the mouth oral hygiene for D 3 membranes or wo ound etc and residents To wounds there are especially for a purulent and those requiring smelly nasogastric discharges tubes for feeding Wounds should be properly treated Maintain good environmental hygiene Install appropriate fly screen and repellent devices SARS Coronaviruses_ Droplets Fever fatigue Have adequate rest and nutrition to build up body headache chill cough Shortness of to
31. e cccceeeeeeeeeeeeeeeeees 2 Lowered blood pressure i e systolic pressure below QOMMHG eeeeee eee 3 PVE AN NS ee eer E he wee eee eee see we ace ene ena eee Sense ee E A A T 4 Loss of appetite and or unexplained weight IOSS ccccceeeeeeeeeeeeeeeeeeeees 5 Confusion drowsiness feeling irritable and reStleSs ccccceeeeeeeeeeeeeeee eee ees 6 Sudden change in body functioning e g increased fragility or falling Over TOR UNKHOWN reaSOii seinien on nonen aE ence canner ecco sec eas onars cecenerotara mers RUNNING NOSE SNECZING cccceeecceeee eens ssee eee eeeenaeeeeeeeeesaaeeeerenasaaeeeeeenasgaeeneeens ge e EEn E pean tee nnree T cette nn ee ene re ee eee Or T OE a E E ES D COU E E E E E EE 1L Increased sputum PIrOdUCTION ccccceccceece eee eeseeeeeeeeesaaceeeeeeesaaeeeeeenesaaaeeeeees 12 Blood stained SOUTUM cc cece cece eens eee e eee eee esaeeeeeeeeesaaeeeeensaaeeeeeennsgaaeenenneggas 13 Chest pain on DUCA ING scr icscievcssstanencantatanecussewecduveruscsseuenewaveuesconscntvenisianeieens 14 Shortness Of Dreatn ccc ccccec ccc ee cece n eee e ne ce nena een seen eneeeeenanenneaeeenaaenenasenenenens Ta PROA O ar A E E EEE EE E EEEE 16 Abdominal Dal ierrnsrsresrrer nennen REE EEN TERETE SRS I NOMIN ee E E E E EEE NE To DIO r E E EE E EEE 19 Sudden onset of or increased INCONUNCENCE
32. e the trolley surface with 70 alcohol Feeding set After each feed the feeding set Follow manufacturer s feeding funnel Should be flushed with water and air instruction and tubings dried before putting into box for the next use The feeding funnel should be disinfected daily by boiling for 10 minutes The feeding tubings should be disposed daily Bowl plastic Clean with detergent and water Store dry Urine measuring Rinse with water first then clean with jar detergent Disinfect with disinfectant e g Lin 49 diluted household bleach 5 25 rinse and store dry Drain away and clean with detergent and water Then cleanse with a brush and disinfect with 1in 49 diluted household bleach 5 25 Rinse and store dry gt O O o 5 el gt x lt 60 Recommended method Articles Commode Wash with detergent and water after each use and regularly If any contamination noted wash with detergent and water before cleansed with a brush and disinfect with lin 49 diluted household bleach 5 25 Rinse and store dry Using disposable equipment is most desirable Gown and Cap Clean with detergent and water first Immerse in Lin 49 diluted household bleach 5 25 for 10 minutes Rinse and store dry Face shield or goggles Using disposable latex gloves is most desirable Gloves disposable latex gloves or household gloves Note Wearing gloves cannot replace hand hygiene Regular c
33. ease is essential to the prevention of its spread For such purpose all healthcare workers including the ICOs and other staff in the RCHEs should be responsible for close monitoring of the physical conditions of the residents to enable early detection of communicable diseases particularly the statutory notifiable diseases and notify the relevant parties according to Appendix as soon as possible so that control measures can be implemented promptly Please refer to section L5 for details 5 4 is notfication only applicable to confinmned cases of s notfiable communicable diseases Doctors are required by law to report suspected or confirmed cases of statutory notifiable communicable diseases to the Department of Health If a home manager suspects or knows of such a case among the residents or staff of a RCHE or suspects or knows that any such person has been in contact with a case of statutory notifiable communicable disease he she should immediately report to the CENO of CHP and Director of Social Welfare The ICO should contact the infected resident s attending doctor if there is query about the resident s condition The Department of Health also encourages doctors home managers or ICOs of RCHE to report suspected outbreak of communicable diseases to CENO of CHP and Licensing Office of Residential Care Homes for the Elderly of the Social Welfare Department The notification form is shown in Appendix K Please refer to Appendix L f
34. eritoneal Dialysis x ipu ddy Guidelines on Prevention of Communicable Diseases in RCHEs dix D Fever record for residents Name of RCHE Contact person Telephone No Number of residents with fever Number of Number of seeking medical treatment residents PE Number of Bed admitted to admitted Date residents Visiting Community Private Accident amp with fever UMPe Medical Geriatric practitioner Emergency hospital with fever Officer Assessment Dept with gt O O o m a x lt 52 CMIS on Prevention of Communicable Diseases in RCHEs Handwashing when done correctly is an Important personal hygiene practice to prevent contracting and spreading communicable diseases When should we wash our hands e Before touching the eyes nose and mouth e Before eating or handling food e After using the toilet e When hands are contaminated by respiratory secretions e g after coughing or sneezing e After touching public installations or equipment such as escalator handrails elevator control panels or door knobs e After changing diapers or handling soiled articles when looking after young children or the sick Steps for good handwashing 1 Wet hands under running water 2 Apply liquid soap and rub hands together to make a soapy lather 3 Away from the running water rub the palms backs of hands between fingers backs of fingers thumbs finger tips and wrists D
35. esidents and staff in elderly home 1 Staff should closely monitor the conditions of themselves and their residents Immediate medical advice should be sought when a person have symptoms suggestive of scabies infection If there are several residents and staff confirmed to have scabies the staff should report to the Centre for Health Protection and Social Welfare Department During a scabies outbreak people who are in close contact with the patient e g roommates and staff should apply the anti scabies medication to prevent the spread of the disease Staff should wear gloves and apron when performing cleansing work or taking care of the infected patient After direct care care givers should change their working clothes and wash their hands thoroughly Management of the clothing and bed linen 1 Patient s clothing bed linen pillowcase etc should be washed separately from those of their family members or other elderly home residents Patient s clothing bed linen pillowcase etc must be boiled in hot water 60 C or above for not less than 10 minutes to get rid of the mite and their eggs Place all non washable personal items such as shoes mattress etc in a plastic bag and seal them up for at least 14 days before they can be used as usual Medical treatment 1 Effective medical treatment for scabies include anti scabies agents e g Benzyl Benzoate Emulsion and drugs to control itchiness
36. esquamation swelling scales etc suppurating or smelly wounds e g pressure sores Abdominal pain vomiting diarrhoea lack of appetite fatigue fever Redness of eyes itching eyes excessive tears abnormal secretion Preventive measures Wear gloves during patient contact and arrange early medical treatment for the patients disinfect the linen and clothing of patients with scabies following protocol or instruction Maintain good personal food and environmental hygiene wash hands after using the toilet food handlers should refrain from work and seek early medical advice if falling sick proper handling of vomitus and excreta Never share towels observe good personal hygiene perform hand hygiene before touching the eyes 2 2 Other important communicable diseases in RCHES Types of Infective Mode of Signs and Preventive diseases agents transmission symptoms measures Hepatitis B Viruses Blood body fluid Fever jaundice Ditto transmission fatigue loss of Staff may also appetite consider vaccination against hepatitis B Pulmonary Mycobacterium Airborne Persistent fever Have adequate tuberculosis tuberculosis transmission cough sputum rest and Smear positive with blood nutrition maintain fatigue weight good ventilation loss night and environmental sweating hygiene Do not Spit Observe respiratory hygiene cough etiquette any indivi
37. esrinctsnanesspostonenseenmiuiadesneieasianepewsdacddasesaes Be Meas ec cs pecs osc cea E E tea E E aa Preventive mea ci to be adopted i i Standard PP SC a UU OSs castes eciraevepaceeipnosssdeenunteecas eve iubcelenneninaddexigasess 25 staff against communicable disease a Eg l Hand YONI G vases nace cadercctsnasersavsdoczessaadastapaue xacestanercasadagaacandaneecene 26 Use of personal protective equipment PPE csccecsesseeeeeeeeees aN S a Ae Sra N ae _ i mi 4 Handling of contaminated Articles cccccccecceeeeeeeeseeeeeeeneeeeeneeeenees 5 eE pR SINS es aecs sacs tec oan cueanncanios srasiniod tee daca E E TFANSMISSION DASEC PFECAULIONS cccceceeeceeeeeeeeeeeeeeeeeneeeeeeeeeeeeees Isolation MEASUIES ccccecccsccesccecccecccesucecseeesautseensanenuuesuaetsnensaners Rules SCN rien cates eave ocneaceaiobacienataeesceatacuieecesaweeacedesdueeloen Guidance notes on nursing procedures urethral catheter nasogastric tube pressure sore cognitive problems Care of residents newly discharged from hospitals o2 SEE on Prevention of Communicable Diseases in RCHEs What does outbreak of communicable diseases Me AaN 0c000 37 What should be done if outbreak iS SUSPECtEd ceeeeeeeeee eee eees 38 What are statutory notifiable communicable diseases 065 38 Is notification only appli
38. f PPE Observe for signs and symptoms of infectious diseases such as unusual clustering of fever upper respiratory tract symptoms and unusual clustering of gastrointestinal symptoms in residents and staff assist the home manager to report cases or suspected cases of infectious diseases to the Licensing Office and the Centre for Health Protection CHP of the Department of Health as appropriate if the home Is covered by CGAT Community Geriatric Assessment Team CGAT should also be informed provide information as necessary to CHP to facilitate their investigation and collaborate with CHP to contain the spread of the infectious disease and Assist the home manager in assessing the risk of infectious disease outbreak In the residential care home regularly review and devise strategies to prevent infectious disease outbreaks through consultation with the home manager medical staff CGAT or VMO and the Department of Health The above appendix is provided by the Social Welfare Department and has been incorporated in the Code of Practice for Residential Care Homes Elderly Persons October 2005 Revised Edition Readers should check if the content has been further revised by the Social Welfare Department 49 gt O O er x lt dix C Checklist of signs and symptoms of communicak diseases The followings are some common signs and symptoms of infection in the elders 1 Fever or body temperature TCor more above DaSelin
39. g or coughing Use tissue paper to contain respiratory secretions and dispose them in garbage bin with lid Keep both hands clean In particular perform hand hygiene properly and immediately after making contact with patients or handling respiratory secretions Sick residents staff and visitors should wear surgical masks Try as much as possible to keep a distance of at least one meter from the patient Adopt proper isolation Use appropriate PPE when necessary Saseasip ajqediunwwod suree jes JHDyY Ag pajdope 9q 0 S INSL W SAI UDADId Airborne Pulmonary Maintain good indoor ventilation precautions tuberculosis Cover mouth and nose when sneezing or coughing Smear positive Dispose used tissue paper properly Keep both hands clean In particular perform hand hygiene properly and immediately after making contact with patients or handling respiratory secretions Sick residents staff members carers or relatives Should wear surgical masks Adopt proper isolation Contact Conjunctivitis Keep both hands clean and perform hand hygiene precautions Head lice properly Scabies Clean and disinfect items used by patients properly Gastroenteritis Do not share towels and other personal items Wear gloves when making contact with patients Adopt proper isolation Note Some diseases can be transmitted by more than one mode To prevent the spread of such diseases combined preventive measures should be considered
40. g should always be placed below the level of the bladder to avoid reflux which may lead to urinary tract infection e Do not disconnect the urinary bag from the catheter If deemed necessary perform hand hygiene and disinfect the connection part with alcohol swab after disconnection and before reconnection Guidelines on Prevention of Communicable Diseases in RCHEs 4 9 2 Residents requiring nasogastric tube for feeding are exposed to a higher nisk of aspiration pneumonia Risk reducing methods include e Observe proper feeding procedures and in particular the position of the resident for example bed bound residents should be propped at an sitting angle of at least 30 e Make sure that the nasogastric tube goes into the stomach e Pay attention to the cleaning method of the feeding set the temperature of the food and the distance between the feeding syringe funnel and the resident e The nasogastric tube should be changed regularly by the resident nurse or the community nurse After each feed the feeding set should be flushed with running water and air dried before putting into box for the next use The feeding funnel should be disinfected daily by boiling for 10 minutes The feeding tubings should be disposed daily Appendix 1 e Each resident should have separate feeding sets e All items should be thoroughly cleaned after use and kept in clean containers io ro 3 o o D o N D D 0a D Nn 9q 0
41. 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 e Make sure that the soil pipes are unobstructed and the sewage drains are functioning properly without leakage so as to avoid breeding of infective agents Guidelines on Prevention of Communicable Diseases in RCHEs j i oO_ amp iiweiim j 3 3 4 Disposal of waste e Garbage bins should be covered with lids e Rubbish should be properly wrapped up and discarded into garbage bins with lids e Garbage bins should be emptied at least once a day Staff should wash their hands thoroughly after handling refuse 3 3 5 Hoor mop wiper and other cleaning utensils contaminated with body fluids or blood should be treated propery after use for re use e Rinse floor mop wiper or other cleaning utensils with water to remove Ee a gt lt O D o 3 5 mE ao o aS nlw o gc VO no amp qo q gt 0o32 3 5 S D a O 9 5 og a gt solid bulky waste if any e Disinfect such utensils by immersing them in lin 49 diluted household bleach 5 25 for 30 minutes e Then wash with detergents and clean water e Re use after drying out 3 3 6 Choice of disinfectant Generally speaking household bleach which normally contains 5 25 available chlorine is the most convenient and effective disinfectant Lin 99 diluted household blea
42. hen further information on specific communicable disease is needed advice can be sought from the Visiting Health Teams VHTs of the Elderly Health Service of the Department of Health in different districts please refer to section 6 4 2 for details Lastly opportunity is taken to thank the Hospital Authority and the Social Welfare Department for their invaluable comments during the revision of this guideline Editorial Board Department of Health 2nd edition 01 re E A ete 4 Chain of infection infective agent source of infection mode of transmission host Why are residential care homes for the elderly RCHEs more vulnerable to outbreaks of communicable diS aS S cccceeeeeeee 6 Principles of control of communicable diseases What are the statutory notifiable communicable diseases 7 Common communicable diseases in RCHES cccsecccecccceccasceaeceaees Other important communicable diseases in RCHES csecseeeeees Early signs and symptoms of infection in the elderly c 0cceeees B Management of suspected cases of communicable diseases among residente OF Staffers aeri EE RRi hii Measuring body temperatur siecsssesvevesscceeseseissccerunddecberebeseceedeecanss General guidelines on communicable disea POP SOS 4 le sisas ar 3 Po ye a eaters wees cose en inten atcrnns ws bina eyed S ES Environmental PY IS ocnc
43. iately after purchase Before refrigeration pack the food into smaller portions if it is not intended for use in one go e Surplus food should preferably be disposed of or stored in the refrigerator if need to be retained e Make sure that the refrigerator is clean and functioning properly and clean it at regular intervals Keep the temperature inside the refrigerator at or below 4 C and the freezer at or below 18 C Each refrigerator should have a temperature log book with temperature recorded regularly e Avoid overcrowding to allow adequate ventilation inside the refrigerator e Do not wrap food with newspaper unclean paper or coloured plastic bags RCHEs should implement the World Health Organization s ten principles for safe food preparation Appendix G Guidelines on Prevention of Communicable Diseases in RCHEs 3 3 Enwronmental hygiene Since infective agents can Survive in the environment for a period of time it is essential to observe environmental hygiene 3 3 1 Keep the enwronment of RCHEs clean and hygienic e Always open the windows for ON good indoor ventilation j Fans exhaust fans can be used to x o lt Laue ro om nN O oO ym nN Oo rap S om ra o fan improve indoor ventilation k e Clean the dust filters of air conditioner regularly ep ca ca a re Ke Q ca fa Wn e e Clean and disinfect frequen
44. ion e Wash hands properly before preparing food F e Wear mask and washable or disposable is aprons and cap during handling of cooked food e Protect wounds on hands with waterproof dressing to prevent passing infective agents from the wounds to food e Wash food thoroughly and scrub with a brush when appropriate e Handle store raw foods and cooked foods separately Use separate knives and chopping boards for each to avoid cross contamination e Discard the outer leaves of leafy vegetables and immerse the vegetables in water for lhour before washing to eliminate possible pesticide residues e Frozen meat or fish must be thawed completely before cooking Guidelines on Prevention of Communicable Diseases in RCHEs e Cook food thoroughly before consumption e Sample food with a clean spoon not with fingers e Consume food as soon as it is cooked e Do not prepare too much food at one time to avoid wastage or over stocking e Cooked food taken out from the refrigerator should be reheated thoroughly before consumption e Do not touch cooked food with bare hands e Staff should not handle food if suffering from illnesses such as fever diarrhoea and vomiting Saseasip 3 GeduNWWOD JO UOlUdAaIA e Do not smoke while handling food uo SaUljapInh jeuauay 3 2 3 Storage e Store food in well covered containers e Never leave perishable food at room temperature e Store perishable food in refrigerator immed
45. is a reminder to help infection control officers ICOs to carry out preliminary health assessment on individual residents for early detection of infections and prompt medical treatment 2 44 Management of suspected cases of communicable diseases among residents or staff The operator of RCHE should appoint either a nurse or a health worker as an Infection Control Officer ICO who is the key person responsible for dealing with matters related to infection control and prevention of the spread of infectious diseases in the residential care home ICOs should observe the following principles in preventing the spread of communicable diseases e Medical surveillance maintain and keep proper personal health records of residents and carefully assess their signs and symptoms e Early treatment to avoid secondary spread by the infected residents or staff e Spread prevention appropriate isolation precautions should be adopted with respect to the mode of transmission of respective communicable diseases to avoid outbreaks and further evolution into an epidemic For example patients with respiratory tract infections should wear masks excreta of elders should be properly disposed of the guidelines for hand hygiene should be strictly observed etc If in doubt promptly notify CENO and the Licensing Office of Residential Care Homes for the Elderly of the Social Welfare Department for follow up investigation NB The duty list of ICOs is de
46. k like viruses or small round structured viruses SRSVs These viruses are a common cause of sporadic cases of acute gastroenteritis as well as outbreaks of food poisoning and acute gastroenteritis especially in elderly homes and schools The disease affects people of all age groups and tends to be more common during winter Clinical features The disease is usually self limiting with symptoms of nausea vomiting diarrhoea abdominal pain low grade fever and malaise The symptoms usually last for 12 to 60 hours Miodes of transmission The infection can be transmitted via the following ways e by food or water contaminated with the virus e by contact with vomitus or faeces from infected persons e by contact with contaminated objects or e by aerosol spread with contaminated droplets of splashed vomitus Incubation period The incubation period is usually 24 to 48 hours 6 7 gt O O D O x lt 68 Management Given adequate fluids to prevent dehydration and supportive treatment the disease is usually self limiting lasting 1to 3 days Antibiotics are of no value in treatment Prevention Maintain high standards of personal food and environmental hygiene Wash hands before handling food and eating and after going to toilet All food particularly shellfish should be cooked thoroughly before consumption Food handlers and caretakers developing vomiting or diarrhoea should refrain from work and seek
47. leansing If contaminated with body fluid soak in Lin 49 diluted household bleach 5 25 for 30 minutes before general handling Wipe with 70 alcohol regularly Sophygmomanometer cuff Altermative method For contaminated soiled reusable textile items soak In Lin 49 diluted household bleach 5 25 for 30 minutes before general handling For reusable household gloves disinfect by immersing In Lin 49 diluted household bleach 5 25 for at least 10 minutes first Clean with detergent and water Check if there are any small holes by filling with air first and immersing in water to see if there are any air bubbles leaking out If there is no hole air dried before reuse Please note that finishing the above procedure does not guarantee that these reused gloves can Safely protect the users If the recommended methods are not feasible in RCHEs adopt the alternative methods instead 6 xipuaddy dix J How chart of the notficaton mechanism for communicable diseases in RCHES Infection Control Officers monitor the health conditions of residents and staff Individual resident staff A cluster of residents or staff member develops symptoms members present symptoms Early notification Visiting Medical Officer VMO Community Genatric Assessment Team CGAT Community Nursing Service CNS Notify the Central Notify the Social Notification Office Welfare CENO Centre for Department Health Protec
48. n of Communicable Diseases in RCHEs e before touching mouth nose and eyes TN A 3 12 RCHE staff should encourage residents to wash their hands e before eating or handling food e after using the toilet e when hands are contaminated by respiratory secretions e g after coughing or sneezing e after touching public installations or equipment such as escalator handrails elevator control panels or door knobs PS Z a gt lt a gt ER a sJ TERS D w O E a gt miz O Led Oo a gt e after changing diapers or handling soiled articles r ep g gt a Fa Ke Q g gt 3 fg N e e after making contact with animals or poultry 3 13 Proper procedures for handwashing Appendix E Wash hands with liquid soap thoroughly according to the following procedures e Take off watches rings and accessories to achieve best washing results e Wet hands under running water e Apply liquid soap and rub hands together to make a soapy lather e Away from the running water Rub the palms back of hands between fingers backs of fingers thumbs finger tips and wrists for at least 20 seconds e Rinse hands thoroughly under running water after rubbing e Dry hands thoroughly with a clean cotton towel a paper towel or a hand dryer e The tap may be turned off by wrapping the faucet with the paper towel or clean the faucet after splashing with
49. ness Many diseases may cause such symptoms in the elders Infection is one of the important causes for such symptoms If the elders especially the frail ones with chronic illnesses are found to develop such symptoms carers should arrange them to seek medical advice promptly e Unexplained changes in behaviours and body functions Unexplained behavioural changes may be caused by mental confusion Changes of body functions like loss of bladder control may be due to infection like urethritis or secondary to confusion e Loss of appetite and or unexplained weight loss e Weaker than usual e Lethargy e Fall e Shortness of breath e Palpitation Sh U a fan U MD U J O T mi U O 3 O ay o D o Ta Oo o Fa oS Wc 5 5 S O JI v omer Io m WN 14 2 3 3 The above are the common bodily changes among the infected elders To detect such changes carers should familiarize themselves with the daily physical conditions and behavioural patterns of the elders As such proper personal health records should be maintained for each resident and their temperatures checked regularly In addition carers should pay more attention to elders who have special health conditions or with medical devices attached to their bodies since they are more vulnerable to infection than others For details please refer to the checklist of signs and symptoms of communicable diseases in Appendix C The checklist
50. nsing with water drying ironing and storage in clean and dry cabinets e All soiled clothes should have the solid and bulky waste cautiously removed first and handled separately They should be immersed in 1in 49 diluted household bleach mixing 1 part of 5 25 bleach with 49 parts of water for 30 minutes before routine treatment 4 4 2 Instrument e To avoid cross infection within the RCHE all instruments or articles used om ro 3 3 5 io o o D o N D o Nn D Nn 9q 0 SOINSeOW JAIJU A Jd Should be cleaned and disinfected thoroughly before re use e If stained with large amount of blood wipe it with thick paper towels dipped in Lin 4 diluted household bleach mixing 1 part of 5 25 bleach with 4 parts of water and leave for 10 minutes before cleansing and disinfection e Please refer to Appendix for cleansing and disinfection of articles commonly used in RCHEs Guidelines on Prevention of Communicable Diseases in RCHEs 29 4 5 Handling of Sharps e Take extra care when disposing of sharps e Do not recap used needles e If recapping is necessary use recapping aids to avoid being pricked by contaminated needles e Syringes and sharps must be disposed of in a puncture proof and spill proof container labeled Sharp Box and Biohazard on the outside e Take note of the capacity of the sharp box While mandatory daily disposal of sharp boxes is not necessary a sharp box should not
51. nts to note Direction of the probe tip should be correct otherwise it will give an inaccurate reading The ear pressed against the pillow during sleeping has a higher temperature so the other ear should be used for taking temperature if one Is just awake Not applicable to elders with obstruction of ear canal caused by ear wax or otitis 16 Taking oral temperature Suitable for elders who are conscious cooperative and who can close their mouths tight Staff should place the thermometer under the tongue near the root Instruct the resident to close the mouth tight but not to bite on the thermometer or talk Wait for 3 to 5 minutes when using a mercury thermometer before checking the reading If the resident carelessly bites off the mercury thermometer he she should be sent to the hospital immediately for treatment Points to note Close the mouth when taking temperature Do not speak Avoid cold or hot food before taking temperature Not applicable to residents who are unconscious confused or who cannot close their mouths tight Taking armpit temperature Suitable for conditions when all the above are not applicable Ensure privacy and protect the residents from catching cold when taking temperature Put the thermometer under the armpit and place the forearm of the resident horizontally on the chest to keep the thermometer in position Wait for 6 to 8 minutes before checking the reading Armpit temperature is usually 0 5 C lo
52. o prevent transmission of communicable diseases Staff who have neglected the importance of proper hand washing often become carriers of different infective agents and lead to cross infection in the institution rev on o RES 3 o 32 eo Ss gt O D ov O o ae o m N Seat Wn D SRo Da nN Wn Ae 9q 0 SOINSeAW SAIUSADI please refer to section 12 2 for mode of transmission Therefore both hands should be washed with liquid soap before and after caring for each resident Even though gloves are worn hands should still be washed with liquid soap after the gloves have been taken off e Alternatively if hands are not visibly soiled application of alcohol based handrub is equally effective e Improper hand drying will also result in cross infection to others through contaminated hands Both disposable paper towel and hand dryer are proper means for hand drying e Proper hand hygiene techniques should be observed and followed irrespective of whether water with liquid soap or alcohol based handrub IS used ae f Guidelines on Prevention of Communicable Diseases in RCHEs 4 2 2 Proper procedures for handwashing Appendix E Please refer to section 3 13 for details 4 2 3 Use of alcohol based handrub If hands are not visibly soiled application of alcohol handrub is equally effective e Apply alcohol based handrub and rub the palms backs of hands between fingers backs of fingers thumbs finger tips
53. o this for at least 20 seconds 4 Rinse hands thoroughly under running water Ul Dry hands thoroughly with either a clean cotton towel a paper towel or a hand dryer 6 The cleaned hands should not touch the water tap directly again e The tap may be turned off by using the towel wrapping the faucet or e after splashing water to clean the faucet or e by another person Please note e Towels should never be shared e Used paper towel should be properly disposed of e Personal towels to be reused must be stored properly and washed at least once daily It is even better to have more than one towel for frequent replacement e When hands are not visibly soiled application of 70 80 alcohol based handrub is equally effective for disinfection Guidelines on Prevention of Communicable Diseases in RCHEs 53 gt O O et x lt Hand Hygiene Technique Palm to palm Right palm over left Palm to palm with dorsum with interlaced fingers interlaced finger amp vice versa Backs of fingers to Rotational rubbing of opposing palm with right thumb clasped over fingers interlocked left palm amp vice versa Wrists are rubbed Rotational rubbing backwards and forwards with clasped fingers of right hand in left palm amp vice versa gt O O 5 Q x lt Guidelines on Prevention of Communicable Diseases in RCHEs 54 dix F Respiratory hygiene cough et quette The following measures
54. of communicable diseases Moreover good personal food and environmental hygiene should be observed 3 1 Personal hygiene Since many communicable diseases are transmitted through direct contact performing hand hygiene properly is a prerequisite for the prevention of such diseases The persons in charge of a RCHE should provide the staff and residents with adequate facilities for performing hand hygiene 3 11 RCHE staff should follow the procedures descnbed in section 3 13 and Appendix Eto perform hand hygiene after sneezing or coughing e after using the toilet e before handling preparing and serving food e when implementing any nursing procedures before and after having direct contact with residents before handling an invasive device e g urinary catheter for resident care after contacting blood body fluids secretions excretions wounds or mucous membranes e g after diapering a resident or after cleaning the respiratory secretions of the residents if moving from a contaminated body site to a clean body site during resident care e after taking off the gloves e after contacting contaminated objects or environments Note L When hands are visibly soiled handwashing should be performed 2 When hands are not visibly soiled application of alcohol based handrub is equally effective 3 Wearing gloves can never substitute for hand hygiene Always perform hand hygiene after taking off the gloves Guidelines on Preventio
55. old bleach mixing 1 part of 5 25 bleach with 49 parts of f water leave for 15 30 minutes before O oO Z O fet ra or ra let WN ra rinsing with water and mopping dry special attention should be paid to the disinfection of toilets kitchens and objects which are frequently touched such as light switches door knobs and handrails e Use highly absorptive materials to preliminarily clean up surfaces contaminated with vomitus or excreta before performing the above disinfection procedure e Since household bleach usually contains 5 25 of available chlorine care should be taken to avoid its use in metal surfaces as chlorine is corrosive to metal 70 alcohol can be used if disinfection of metal Surfaces is required Guidelines on Prevention of Communicable Diseases in RCHEs 39 TEE a 5 6 2 Handling of linen e During outbreak situation soak linen soiled with blood secretions in 1 in 49 diluted household bleach 5 25 for 30 minutes before general handling 5 7 Specific recommendations on management of selected communicable diseases 5 7 1 Food poisoning e List names of people suspected to be infected and details of their medical records as well as information on food consumed in the RCHE within several days before the outbreak in the RCHE for use by the Department of Health during investigation e Save food remnants and vomitus for investigation e Disinfect articles or places soiled by
56. on as possible If the home is covered by CGAT Community Geriatric Assessment Team CGAT should also be notified e If indicated please isolate the infected residents according to the instruction of the in charge doctor to prevent the spread of the infection 6 4 Useful telephone numbers and web pages 6 4 1 Report of suspected outbreak to the Department of Health Central Notification Office CENO of the Centre for Health Protection e Telephone No 2477 2772 e Fax No 2477 2770 6 4 2 Other support and enquiry telephone numbers oS oO a U oO h J aR m U cr w h h Department of Health Elderly Health Service Department of Health Elderly Health Service 24 hour information hotline 21218080 Telephone numbers of Visiting Health Teams under Elderly Health Service Operating hours Monday to Friday 8 30 am to LOO pm 2 00 pm to 5 30pm Guidelines on Prevention of Communicable Diseases in RCHEs 43 Visiting Health Team Telephone No Tuen Mun District Visiting Health Team 2458 0417 Kwai Tsing District Visiting Health Team 2439 5806 Yuen Long District Visiting Health Team 2458 0417 Food and Environmental Hygiene Department Hotline 2868 0000 Environmental Protecton Department Territory Control Office 2835 1055 J oO MD U h J O aE mi U cr w r h Social Welfare Department Licensing Office of Residential Care Homes for the Elderly LORCHE 2961
57. on Prevention of Communicable Diseases in RCHEs 14 Principles of control of communicable diseases There are a number of factors crucial to the spread of communicable diseases They include the infective agent the source of infection the mode of transmission and the host the so called chain of infection Hence the control of the spread of communicable diseases should focus on controlling these 4 factors so as to break the chain Factors of transmission Control measures Infective agent Disinfection to kill the infective agents Source of infection Early detection isolation and treatment of patients and removal of breeding sites Mode of transmission Maintain good environmental personal and food hygiene adopt infection control measures appropriate to the different modes of transmission Host Susceptible population Build up personal immunity by immunization and healthy lifestyles Some communicable diseases are highly infectious and cause severe sequelae to such an extent that they threaten human lives and affect the economy If there are proper 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 occurred and the living environment are different To safeguard public health and safety
58. or Health Protection M Fact sheet on scabies N Fact sheet on norovirus infection Guidelines on Prevention of Communicable Diseases in cues saseasip ajqediunwwod jo s dadu07 04 Concepts of communicabie diseases 1L1What are communicable cliseases Communicable diseases refer to diseases that can be transmitted and make people ill They are caused by infective agents pathogens e g bacteria and viruses which invade the body and multiply or release toxins to cause damages to normal body cells and their functions In severe cases they may lead to death These infective agents can spread from a source of infection e g patients sick animals to a person through various routes of transmission 12 Chain of infection infective agent source of infecton mode of transmission host Apart from the infective agents there are three other factors necessary for the occurrence of communicable diseases 12 1Source of infection This refers to any environment in which infective agents can live parasitize and breed It includes humans e g patients carriers and people with latent infections livestock insects and soil The source of infection will normally form the basis for infective agents to infect humans Guidelines on Prevention of Communicable Diseases in RCHEs 12 2 Mode of transmission Mode of transmission Contact transmission e Direct Contact e Indirect Contact Droplet transmi
59. or content of the relevant information Guidelines on Prevention of Communicable Diseases in RCHEs 5 5 General guideline on the management of a suspected outbreak of communicable disease e Isolate the patients properly and then arrange early medical treatment for them e Notify relevant parties according to established procedures after settling down the patients so that relevant staff from these parties can implement control measures promptly Please refer to the flow chart of the notification mechanism for communicable diseases in Appendix J for details e Inform the relatives guardians of the residents e Keep a proper medical record of residents and staff e Residents or staff falling sick should avoid participating in group activities e Minimize contact between residents and staff of different floors to avoid cross infection and arrange staff of the same team to take care of a fixed group of residents as far as possible in preparation of the shift roster e Actively inform and alert staff of other health care facilities such as clinics hospitals etc where the residents attend that there is currently an outbreak of communicable disease in the RCHE e In general visit to the affected RCHE is discouraged Personal hygiene of visitors should be strictly observed 5 6 1 Disinfection of environment e Disinfect furniture floors and toilets with O og g9 w N h Lin 49 diluted househ
60. pper respiratory tract infections e g influenza Viruses e g influenza viruses bacteria e g Droplets touching of MUCOUS membranes of Fever fatigue cough sneeze running nose sore throat Maintain good ventilation and personal hygiene common cold rhinitis laryngo pharyngitis Streptococcus pneumoniae the mouth nose and eyes with hands contaminated with the infective agents Guidelines on Prevention of Communicable Diseases in RCHEs muscle aches perform hand hygiene before and after caring for each resident may wear surgical masks during close contact with patients have adequate rest and nutrition to build up body immunity Mode of Signs and Preventive transmission symptoms measures Lower Viruses e g Droplets Fever fatigue Observe respiratory tract influenza touching of cough thick respiratory infections e g viruses mucous Sputum sputum hygiene cough acute bronchitis bacteria e g membranes of with blood etiquette any pneumonia Streptococcus the mouth nose shortness of individual pneumoniae and eyes with breath including hands residents contaminated Should put ona with the infective surgical mask agents when there Is respiratory symptom if applicable and tolerable SJHDY Ul Saseasip jqe lunwwop Urinary tract Bacteria e g Usually caused Fever urination Maintain good Infections E coli by bacteria with stabbing person
61. res or meeting the requirements of such measures e For residents who retain certain degree of cognition staff members can guide them to adopt good personal hygiene to prevent infection e For residents with serious cognitive impairment staff should pay extra attention and do the cleaning for them so as to ensure proper personal and environmental hygiene 4 10 Care of residents newly discharged from hospitals e Staff should help these residents to wash their hair bathe and change their clothes rev Q NO o rr 3 0 Q e SS lt lt oO DW v O oF Ge o m ret pet av 1a OM R 2o as vN 5 Wn e Pay extra attention to their health conditions Residents showing respiratory 9q 0 SOINSeAW SAIJUBADId symptoms should wear surgical masks and have temperature taken everyday e Newly recovered residents e g after Norovirus gastroenteritis or scabies infection Should stringently observe personal hygiene Guidelines on Prevention of Communicable Diseases in RCHEs 36 x a aS ee ee a Outbreak of communicable disease Ha a 5 1 What does outbreak of ha a diseases mean If the residents or staff in a RCHE develop similar symptoms one after another and the incidence rate is higher than that at ordinary times this is an outbreak from the epidemiological point of view A common example is the outbreak of influenza which usually peaks in February March J uly and August each year
62. ring the process of nursing 4 3 3 Protective gowns Putting on clean protective gowns not necessarily disinfected can protect our Skin and prevent our clothes from contamination by respiratory droplets blood spill body fluids secretions urine or faeces during the process of nursing Contaminated protective o on aO o f r 3 o Q lor ao wD v O oF J o m a a ab Wn D om Ons vN L S 1a 9q 0 SoINSeaW SAI UBADId gown should be taken off carefully and hand hygiene should be performed immediately afterwards to avoid spread of infective agents 4 3 4 Other PPE such as caps and shoe iH Ar tes covers can protect hair and shoes from l Uy ESCE contamination by secretions during ainera the process of nursing and hence minimize the risk of transmission of infective agents from the hair and shoes of the staff to other places 23 SEE on Prevention of Communicable Diseases in RCHEs Used articles may become indirect vectors for infective agents Appropriate precautionary measures should therefore be taken in their handling 4 4 1 Linen e Infective agents can be transmitted through contact with linen Therefore all linen should be washed thoroughly before re use and appropriate PPE e g gloves masks and if appropriate disposable gowns aprons Should be used during the process of handling e Cleaning procedures include removal of stains with detergent ri
63. s of water gt O O o 5 O x lt Guidelines on Prevention of Communicable Diseases in RCHEs 57 7 Precautions e Avoid using bleach on metals wool nylon silk dyed fabric and painted surfaces e Avoid touching the eyes If bleach gets into the eyes immediately rinse with water for at least 15 minutes and consult a doctor e Bleach should not be used together or mixed with other household detergents as this reduces its effectiveness in disinfection and causes chemical reactions For instance a toxic gas is produced when bleach is mixed with acidic detergents such as those used for toilet cleaning This could result in accidents and injuries If necessary use detergents first and rinse thoroughly with water before using bleach for disinfection e As undiluted bleach liberates a toxic gas when exposed to sunlight it should be stored in a cool and shaded place out of reach of residents e Sodium hypochlorite decomposes with time To ensure its effectiveness it is advised to purchase recently produced bleach and avoid over stocking e For effective disinfection diluted bleach should be used within 24 hours after preparation as decomposition increases with time if left unused Guidelines on Prevention of Communicable Diseases in RCHEs 58 dix I Cleansing and disinfection of artcles commonly used in RCHES Recommended method Alternative method Clean with detergent and water everyday Immerse in 1in 49 dil
64. ssion Airborne transmission Common Vectors e g food borne water borne Process Through direct body contact with the infected e g lifting and assisting in taking baths Through contact with objects contaminated by infective agents e g sharing towels combs and clothes Through droplets expelled during sneezing coughing spitting and Speaking or subsequent touching of mucous membranes of the mouth nose and eyes etc with hands contaminated with infective agents The infective agents float in the air for sometime and then enter the body through the respiratory tract Infective agents enter the body through ingestion of contaminated food or water or contact with contaminated devices like eating utensils urinary catheters Examples of communicable diseases Scabies Chickenpox Head lice Acute conjunctivitis SARS Influenza Chickenpox Pulmonary tuberculosis smear positive Food poisoning Cholera Bacillary dysentery Hepatitis A Urinary tract infection O io 3 c O et o ra o ra v Tp ra N o e fap O m N h Guidelines on Prevention of Communicable Diseases in i Saseasip ajqediunwwod Jo s d 2u09 Mode of Examples of transmission communicable diseases Vectors insects The infective agents either Dengue fever parasitize and breed in the body Malaria mosquito of the insects or contaminate the
65. sultation at the out patient clinic or the accident and emergency department or to register for hospitalization the carer Should take along the information card kept by the RCHE and produce the patient referral note e Keep proper personal health record for every resident Body temperature should be checked regularly and recorded If a resident has difficulties in communication extra attention and inspections should be given This helps early detection of Guidelines on Prevention of Communicable Diseases in RCHEs problems and reduces the risk of the spread of communicable diseases e Sick leave records of staff members should be kept e Encourage staff members to receive healthcare enhancement training especially infection control training from time to time and keep related training record e Set up an area or room with proper ventilation and hand washing facilities for isolation to prevent the spread of infection e Set up rules for visitors and encourage compliance e Encourage residents and staff members to receive influenza vaccination provided by the Department of Health Provide such vaccination to staff members as far as possible e Ensure adequate hand hygiene facilities and PPE in the RCHEs e When there is a suspected outbreak the Central Notification Office CENO of the Centre for Health Protection and the Licensing Office of Residential Care Homes for the Elderly of Social Welfare Department should be notified as so
66. tailed in Appendix B MiiridNdalinac nn Dravantinn nf CAmm inirahla Nicancac in DCH ECc uUuuUIqe ines on P revention or COommunicap le JAISECASES IN RC 2 5 Measurng body temperature 2 9 1 2 9 2 The importance of taking body temperature Most elders develop fever when infected but there are exceptions Some elders have lower baseline body temperatures which rise slightly when they are infected but still within the normal range Effective surveillance of body temperature changes can only be carried out when self comparison can be made with the usual body temperature of the elders RCHE staff should thus regularly take accurate body temperature for the elders Temperature should be taken more frequently under the following circumstances e Residents with communication problems and those who are feeble e During outbreaks of communicable diseases particularly influenza like illnesses and SARS e When residents develop symptoms of infection please refer to Appendix C for details e Residents newly discharged from hospital What should be done when residents develop fever The normal temperature of human body oral temperature ranges from 36 TC to 37 2 C If a resident is found to have fever or have a temperature being IC higher than his usual one staff should be alert and note it down on the fever record for residents see Appendix D and the resident s personal health record The ICO should read the fever record
67. tion of the Department of Health All departments will take into account the environmental factors and the laboratory results so as to implement contingency measures as appropnate Meanwhile they will step up their efforts in giving advice surveillance and support on infection control and provide feedbacks on patients progress Xipuaddy Guidelines on Prevention of Communicable Diseases in RCHEs 62 dix K Notification form for suspected infectious disease outbreak in RCHE Suspected Infectious Disease Outbreak in RCHE NOTIACATION FORM To Central Notification Office CENO Centre for Health Protection Fax 2477 2770 cc LORCHE Fax 2574 4176 or 3106 3058 CGAT if applicable Fax NOTE To enable prompt investigation and control of outbreak please call CENO by phone 2477 2772 before sending fax notification Name of institution Code no No of sick residents No of sick staff Common symptoms Sore throat May tick multiple Cough Runny nose i Diarrhoea i Vomiting i Skin rash Blisters on hand foot j Oral ulcers Others Please specify Suspected disease Reported by Contact tel Xipuaddy Signature Date of fax F RCHE 2006071 7e Guidelines on Prevention of Communicable Diseases in RCHEs 63 dix L Common information required by staff of CHP Centre for Health Protection 1 Name of the RCHE 2 Address of the RCHE
68. tly touched surfaces furniture rehabilitation aids floor toilets and bathrooms regularly with Lin 99 diluted household bleach mixing one part of 5 25 bleach with 99 parts of water until dry and then rinse with water e For places soiled by secretions or excreta disinfect with lin 49 diluted household bleach mixing 1 part of 5 25 bleach with 49 parts of water leave for 15 30 minutes and then rinse with water and keep dry e For spillage of blood cleanse the visible matter with disposable absorbent material wetted with lin 4 diluted household bleach mixing one part of 5 25 bleach with 4 parts of water leave for 10 minutes and then rinse with water and keep dry e Clean the floor regularly and increase the frequency as the circumstances require The floor should be kept dry after cleaning so that residents and Staff will not slip on it Floor carpets Should be kept clean by regular washing and daily vacuum cleaning e Clean and examine the bedside cupboards of the residents regularly to avoid food remnants and hence the breeding of pests and rodents e Keep appropriate distance between beds or groups of beds not less than 1 metre to reduce the chance of transmission o infective agents by droplets Guidelines on Prevention of Communicable Diseases in RCHEs 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
69. uching of mucous membranes of the mouth nose breath difficulty immunity Observe good personal hygiene Wear Surgical masks Perform hand hygiene before and after resident contact Maintain good ventilation and environmental hygiene in breathing diarrhoea and eyes with hands contaminated with the infective agents Note For detailed guidelines on the prevention of SARS please visit the following websites www info gov hk info sars eindex htm www elderly gov hk www swd gov hk q SE on Prevention of Communicable Diseases in RCHEs 2 3 1 Although most elders develop the above common symptoms when infected 2 3 2 some elders especially those older and feeble ones may have less obvious symptoms When they are infected it would be more difficult to detect and treatment would be delayed thus increase the risk of transmission For those with cognitive impairment Such as elders with dementia communication problems with carers may arise leading to late detection of infection Carers should carefully look for the following signs and symptoms which may indicate infection in the elders e The body temperature is TC higher than the usual temperature Most elders have fever when severely infected but the body temperature for some may not exceed the normal range If the temperature is TC higher than his her usual body temperature he she may have underlying infection e Disoriented confusion restless
70. ue Rabies Relapsing fever Rubella Scarlet fever Severe Acute Respiratory Syndrome Streptococcus Suis infection Tetanus Tuberculosis Typhus Typhoid fever Viral hepatitis Whooping cough Yellow fever dix B Dutes of infec ton control officers COs in RCHES All RCHEs should appoint either a nurse or a health worker for a self care hostel the home manager as an Infection Control Officer who is the key person responsible for dealing with the following matters a b C d e f g h Coordinate and oversee all matters related to infection control and the prevention of infectious diseases in the residential care home Disseminate updated information and guidelines on infection control to all staff and residents in the residential care home and to orientate new staff to these updated information Assist the home manager in arranging training on infection control for staff Assist the home manager in overseeing that the infection control guidelines are being observed and implemented properly including the observation of personal environmental and food hygiene Oversee that all medical equipment and other instruments are properly disinfected after use and soiled linens and wastes are properly handled and disposed of Assist the home manager in arranging the provision of the necessary personal protective equipment PPE and advise and supervise staff on the proper application and disposal o
71. uted household bleach 5 25 for 10 minutes Rinse and store dry Bottle suction Connection Disposable Every time after suction of tubing and sputum rinse it thoroughly Y shape by making full use of the connector suctioning power of the machine Immerse in Lin 49 diluted household bleach 5 25 for at least 10 minutes Rinse and store dry Tracheostomy Inner and outer tubes should be Follow manufacturer s connection tubing cleaned separately Clean it with instruction cotton buds under water tap and then immerse in 1 in 49 diluted household bleach 5 25 for at least 10 minutes Rinse and store dry Mouth gag Clean with detergent and water Immerse in Lin 49 diluted household bleach 5 25 for 10 minutes Rinse and store dry Nebulizer Clean with detergent and water Follow manufacturer s everyday Immerse in Lin 49 diluted instruction household bleach 5 25 for 10 minutes Rinse and store dry Nebulizer mask Disposable Nebulizer tubings gt O O o 5 O x lt Oxygen cannula Guidelines on Prevention of Communicable Diseases in RCHEs Articles Recommended method Altermative method Disposable Follow manufacturer s instruction Tongue Disposable depressor wooden Thermometer Wash with detergent and cold water mercury and then immerse in 70 alcohol for not less than 10 minutes Store dry Dressing trolley Clean with detergent and water Wipe dry Wip
72. water or asking someone for assistance Avoid touching the faucet again with washed hands Towels should never be shared and should be hung up immediately after use and washed thoroughly at least once a day Guidelines on Prevention of Communicable Diseases in RCHEs 19 3 14 Respiratory hygiene should also be observed Appendix F Do not spit Cover nose and mouth when coughing or sneezing Soutum should be wrapped up with tissue paper and discarded into garbage bins with lids or flush them away in the toilet Perform hand hygiene immediately after contacting respiratory secretions or touching objects contaminated with respiratory secretions Put on a surgical mask for those with signs and symptoms of respiratory infection 3 2 Food hygiene Oo fap lt fap mE co om TS om o O v O ao oS f CA w om fan 3 2 1 Choice of food e Buy fresh meat and vegetables ep ca g gt s re Ke on ca fg Wn e e Do not patronize illegal food hawkers e Do not buy packaged food without proper labeling beyond its expiry date or with damaged packages e Do not buy ready to eat food and drinks that are displayed together with raw products e Do not buy food which looks smells or tastes abnormal e Avoid unpasteurized dairy products like raw milk e Do not buy excessive food to avoid problems arising from prolonged storage 3 2 2 Preparat
73. wer than oral temperature so it should be recorded as the armpit temperature Points to note The thermometer should be held tight under the armpit without clothes in between when taking temperature 2 5 6 Cleaning and disinfection of body temperature measuring Instrument after use Mercury thermometer wash with cold water and detergent first Immerse in 70 alcohol for not less than 10 minutes air dry and then store in dry place Oral and rectal thermometers should be treated separately Patients with communicable diseases should use separate personal thermometers to avoid cross infection Electronic thermometers must not be immersed in disinfectants or disinfected with high heat because it will damage the electronic components and affect the instrument s normal functioning The cleaning procedures recommended in the user manual of the electronic thermometers should be followed Q T a w U a U J O ag mi U 17 O 3 5 O ey er D Oo a gt lt D ER O 2a J TERS o fo en a nN oO fap o gt z5 5 CI fa o a ep gt ca a re Ke E Q ca a gt Nn e General guidelines on prevention enton of communicable ooo TOU lll diseases Building up immunity by having a well balanced diet in accordance with the food pyramid adequate rest and sleep regular exercise and being a non smoker are all vital to the prevention
74. wing doctor s instruction e Staff should regularly and repeatedly check the skin condition of both the infected residents and other residents and seek medical advice if any suspected case is found Guidelines on Prevention of Communicable Diseases in RCHEs 70 oO MD Pa h J O aE m a cr w h h 42 O Roles of RCHE staff Although there are different communicable diseases requiring different control measures the basic principles remain the same They should observe personal environmental and food hygiene exercise regularly maintain a balanced diet and take adequate rest to build up immunity 6 2 Responsibilities of persons in charge or operators of RCHEs e The operator should appoint either a nurse or a health worker for a self care hostel the home manager as an Infection Control Officer who is the key person responsible for dealing with matters related to infection control and prevention of the spread of infectious diseases in the residential care home The duty list is detailed in Appendix B e The home manager should report suspected or confirmed cases of statutory notifiable communicable diseases among the residents or staff of the RCHE to the CENO and the Director of Social Welfare e If an individual resident is suspected to have contracted communicable disease prompt consultation from the relevant CGAT or the VMO should be sought e When taking the sick resident to seek con

Download Pdf Manuals

Related Search

Related Contents

取扱説明書  HP NC112T PCI Express Gigabit Server Adapter User Guide  YK - LEDS  Australian Public Affairs Full Text (APAFT) User Guide  

Copyright © All rights reserved. Failed to retrieve file