預防措施及認識 Prevention & Control

1. 預防措施及認識Prevention & Control Severe Acute Respiratory Syndrome (SARS ) Severe Respiratory Syndrome (SRS) 嚴重急性呼吸道綜合症 HKWC-QMH-OSH CND AB-506

2. Severe Acute Respiratory Syndrome (SARS) Prevention & Control • Knowledge of SARS • Prevention at Workplace * Personal Protective Equipment (PPE) * Daily Cleansing * Terminal Cleansing 3. Personal Precaution * Healthy Lifestyle & Personal Hygiene 4. Donning & Removing PPE for SARS Cases

3. INFECTION CONTROL • INFECTION • INFECTIOUS AGENTS • CROSS CONTAMINATION • CHAIN OF INFECTION • PROCESS OF INFECTIOUS DISEASE • INFECTION RISK

4. INFECTION CONTROL (cont.) • INFECTION – an illness produced by the invasion and multiplication of an infectious agent in body tissue. • INFECTIOUS AGENTS – are microorganisms that can cause disease • INCREASED SUSCEPTIBILITY – extremes of age; dysfunction immune system; very ill & high level of stress

5. INFECTION CONTROL (cont.) • AVOIDING CROSS CONTAMINATION “In health care facilities, it is essential that careful hand washingbe done by all caretakers to avoid cross-contamination.” (Luckman & Sorensen, Basic Nursing, 3rd Edition, p. 506)

6. Chain of Infection Infectious Agent Susceptible Host Portal of Entry Reservoir Mode of Transmission Portal of Exit

7. Use disinfectants, antiseptics, antimicrobial drugs WASH HANDS Maintain effective immunization. Limit Exposure Personal hygiene & Health life-style Keep natural body defenses intact WASH HANDS Disrupting the Chain Susceptible Host Infectious Agent Portal of Entry Reservoir Mode of Transmission Portal of Exit Maintain effective immunization. Limit Exposure WASH HANDS WASH HANDS:- Wear gloves when handling body substances Control Sources: Air Movement, water & contacts Block exit. Treat all body substances as potentially infectious WASH HANDS

8. WHAT IS SARS (SRS)? 嚴重急性呼吸道綜合症? ATYPICAL Pneumonia: Influenza: Mycoplasma, Chlamydia, Adenovirus Chemical: 典型肺炎 TYPICAL Pneumonia: Bacteria-Streptococcus 非典型肺炎: 支原體 過濾性病毒 化學性 Unknown agents SARS -Coronavirusfamily(變 種冠狀病毒) Paramyxovirus 病因不明

9. Typical Pneumonia典型肺炎病徵及病狀 * Bacteria causing lung infection 肺炎鏈球菌 * Fever 發燒 * Chest pain 胸痛 * Cough 咳嗽 * Thick phlegm or mucus 咳濃痰

10. Cumulative Figures on SARS (11-05-2003)3:00 P.M. Most of the deaths occurred in individuals who have a history of chronic diseases, or were patients who sought treatment at a relatively late stage of infection.

11. Signs & Symptoms of SARS Chest X-ray: changes compatible with pneumonia

12. Chinese University of Hong Kong Department of Diagnostic Radiology and Organ ImagingRadiological appearances of recent cases of atypical pneumonia in Hong Kong Dept of Anaesthesia & Intensive CareSevere acute respiratory syndrome (SARS) Campus (SARS) Task Force

13. PROGRESS CXR Case 1: A 31-year-old health-care worker presented with 2-day history of fever, chills and myalgia. Figure 1 - CXR at the time of diagnosis showed ill-defined air space opacification in right lower zone Figure 2 - CXR after 3 days showed partial resoulation of consolidatve changes in right lower zone. There is a new finding of ill-defined air space opacification in left lower zone Figure 3 - CXR after another 4 days showed progressive resolution of the changes in both lower zones

14. Route of Transmission傳播途徑 *Droplets 飛沫， *Direct contact and Patient’s secretions 直接傳染, 患者的呼吸道分泌物 * Fomites 中間媒介 • Confined areas with poor ventilation • 密閉空間 • Aerosol l噴霧擴散

15. Routes of Entry

16. High Risk Group to Infection 感染病毒高危一族 • Low Immunity 抵抗力薄弱 • Over exhausted & Stressed 過度疲勞 • Close contacts with infected case 與患者有近距離接觸

17. Clinical Diagnosis and Treatment診斷及治療 * History of Illness, Signs & Symptoms 病徵及病狀 * X-Ray Chest X光肺 * Blood for analyses 血液分析 * High-dose of steroid, Ribavirin and cover with board-spectrum antibiotics. 用對抗過濾性病毒的藥物和抑制免疫力的類固醇特效藥

18. Wearing Facemask 佩 戴 口 罩 • Properly donned - satisfactory protection • The general public may wear a facemask for self protection. • Points to note應注意事項: • Wash hands before wearing a facemask.佩戴口罩前必須清潔雙手。

19. Proper Hand Washing 2 3 1 6 5 4

20. Wearing Facemask (cont.) • Follow the instructions on the packet carefully, • Surgical facemask: • The facemask should fit snugly over the face. • The coloured side of the facemask should face outside. • Tie all the strings that keep the facemask in place or fix the rubber bands of the facemask round the ears properly. • The facemask should fully cover the nose, mouth as well as the chin. • The metallic wire part of the facemask should be fixed securely over the bridge of the nose to prevent leakage. • Under general circumstances, the surgical mask should be changed daily

21. Wearing of Surgical Mask

22. Wearing Facemask (cont.) • Put the facemask into a plastic bag and tie it properly before putting it into a rubbish bin. • Wash hands before wearing a facemask. • Replace the facemask immediately if it is damaged or soiled.

23. Wearing of Respirator N95 Bands over the head Cover Face with Mask Hold respirator in hand Fit Respirator N95 to face Test Respirator N95

24. Daily Disinfection * Use domestic detergent to clean floor, and surfaces, then use household bleach 1:50 to rinse floor and services. (Use 20 ml/cc household bleach + 980 ml/cc of tap water = 1000 ml/cc dilution) N.B: NEVER mix bleach solution with other chemicals or detergents.

25. MEASURES 500 c.c. 20c.c. 15 c.c. 500 c.c. 5 c.c. 10 c.c.

26. Daily Disinfection (Cont.) * Pay attention to all sides of beds, head and foot ends, bed side rails, lockers; doors, door-knobs, door handles, pull-push trolleys, taps and sinks. * Use designated cleansing tools: cloth, mops buckets for isolated areas.

27. Clean up of Spilt body fluids or vomitus • Put on disposable gloves & masks, wipe the vomitus, phlegm or body fluid with paper towel. • Use household bleach 1:50 dilution to clean the affected area and the surrounding

28. Clean up of Spilt body fluids: phlegm, vomitus or others溢濺物的處理

29. Terminal Disinfection • Clean all floors and services first with domestic detergent, then household bleach 1:50 dilution to disinfect the floor, all corners and surfaces. • Use domestic detergent to clean bed: head and foot ends, bed frames, mattress, side rails, lockers, pull-push trolley; handles, doors, door-knobs, taps & sinks. Then use household bleach 1:50 dilution to wipe all services washed with detergents.

30. Terminal Disinfection (Cont.) * Bedside medical equipment: stethoscope, sphygmomanometer must be cleansed and disinfected before using on other patients * Use 70% Alcohol wipe for parts that cannot be washed. Cuff of sphygmomanometer must be washed with household detergent, rise and dry well before use * All surfaces of isolation room must be washed with household detergents, then disinfect with household bleach 1:50 dilution.

31. Precaution in Office Environment 預防措施—辦公室 * Remind staff having cough & fever to consult doctor and be granted leave to stay at home * Personal hygiene, rigorous hand washing & wear masks if suffering from common cold. * Adequate spacing between office workers * Open window to allow circulation of fresh air. * Frequent cleaning of air-conditioning system and filters. * Daily vacuum clean floors and carpets, maintain good housekeeping.

32. Daily Disinfection (Office)

33. Personal Precautions預防措施 — 個人

34. Precaution - Personal * See to personal health and hygiene * Always cover mouth and nose with handkerchief of paper handkerchiefs/ tissue paper while sneezing, coughing or yawning. * Proper disposal of used paper handkerchiefs/ tissue paper. * Wash hand thoroughly after coughing, sneezing, toileting or using public facilities. * Immediate seek medical advice if having cough and fever

35. Personal – Healthy Life Style預防措施 — 個人 (绩) • A balanced diet (adequate fat, protein carbohydrates) and plenty of fluid. Eliminate or minimize caffeine & alcoholic drinks均衡及充足的飲食，避免不健康食品，如咖啡、酒精飲品 * Quit Smoking 戒煙

36. Jawetz,E; Melnick, J.L.& Adelber, E.A. (1987). Review of Medical Microbiology, 17th Ed. Appleton & Lange. Chapter 40 pp. 474 “The coronaviruses include human strains from the respiratory tract, avian infectioius brochiturs virus (IBV), mouse hepatitis virus (MHV), an enteritis vius of swine and others…………” “Growth of humancoroaviruses are difficult in cell cultures…….The optimal temp. for growth is 33-35C “Coronaviruses of lower animals can establish long-term infections in their natural hosts (pigs, chickens, mice). They may also set up inapparent persistent infections in humans.

37. Great Facts about Pork “The 3,000 year old Confucian Book of Rites says, "A gentleman does not eat the flesh of pigs and dogs." Although many Chinese are avid eaters of pork today, physicians of ancient China recognized pork-eating as the root of many human ailments”. Influenza (flu) is one of the most famous illnesses which pigs share with humans. This illness is harbored in the lungs of pigs during the summer months and tends to affect pigs and humans in the cooler months. Sausage contains bits of pigs' lungs, so those who eat pork sausage tend to suffer more during epidemics of influenza. Pig meat contains excessive quantities of histamine and imidazole compounds, which can lead to itching and inflammation; growth hormone, which promotes inflammation and growth; sulphur-containing mesenchymal mucus, which leads to swelling and deposits of mucus in tendons and cartilage, resulting in arthritis, rheumatism, etc.

38. Personal – Healthy Life Style (Cont.)預防措施 — 個人 (绩) * Daily & regular exercises (deep breathing, stretch and brisk walking) 常做運動，增強身體的扺抗力 * Adequate rest and sleep充足休息及睡眠，睡前摒除雜念 * Practice relaxation techniques練習鬆弛技巧 * Face stresses positively: Take stress as CHALLENGES 減低壓力

39. PREVENTION AT HOME 預防措施 -家居 Daily Disinfection * Use domestic detergent to clean floor, and surfaces, then use household bleach 1:100 to rinse floor and services. (Use 10ml/cc household bleach + 990 ml/cc of tap water = 1000 ml/cc dilution) N.B: NEVER mix bleach solution with other chemicals or detergents.

40. Daily Disinfection (Cont.) • Pay attention to all sides of furniture: telephones, tables, chairs, chests, wardrobes, lockers; doors, door-knobs, door handles, pull-push trolleys, taps and sinks.. • Toys should be regularly cleansed by immersing in to household bleach 1: 100 dilution for 30 minutes, then rinse well and dry.

43. Prevention at Home (Cont.) • Do consult doctor immediately if any member of your family is having signs of common cold, fever or cough • If your child or toddler is suspected suffering from flu symptoms, do not sent him/her to school or nursery 。 • The affected family member should wear a surgical mask to prevent spreading to other family members. • The care-giver should also wear surgical mask while attending the affected/sick family member.

44. Public Washrooms 公用手洗間 1 2 3 4 6 5 7 9 8

45. WHO-LIST OF AFFECTED AREAS

47. Quarantine and Prevention of DiseaseOrdinance (Chapter 141)amended to control infectious disease • Regulation 4 of the Prevention of the Spread of Infectious Diseases Regulations requires medical practitioners to notify the Director of Health Amended: Sections 72 and 8(4) & First Schedule to the Ordinance and Form to Quarantine and Prevention of Disease Ordinance (Amendment of First Schedule) Order 2003 and the Prevention of the Spread of Infectious Diseases Regulations (Amendment of Form) Order 2003 With the addition of Severe Acute Respiratory Syndrome, a total of 28 infectious diseases are included in the First Schedule to the Ordinance

48. The four designated medical centres: • * Pamela Youde Child Assessment Centre (Shatin) 2/F, 31-33 Chap Wai Kon Street, Sha Tin • * South Kwai Chung Jockey Club Polyclinic 310 Kwai Shing Circuit, Kwai Chung • * Shek Kip Mei Health Centre 2 Berwick Street, Shek Kip Mei • * Sai Ying Pun Jockey Club Clinic 6/F, 134 Queen's Road West, Western

49. HA-SARS COUNSELING 心靈綠洲 - Oasis Centre of Personal Growth Address: 147B Argyle Street, KH Nurses Quarters, 1/F. • Psychological Concern on SARS Tel.:： 1833 123 (09:00-17:00, Monday to Sunday) Pager：7305 2169 (17:00-09:00, Monday to Sunday) Association of Hong Kong Nursing Staff (AHKNS) SARS Counseling Hotline：9832 4905 (14:00-17:00, Daily) SARS Enquiry：2314 6962