預防措施及認識Prevention & Control

HKWC-QMH-OSH

CND AB-506

Severe Acute Respiratory Syndrome Severe Acute Respiratory Syndrome (SARS )(SARS )

Severe Respiratory Syndrome (SRS)Severe Respiratory Syndrome (SRS)

嚴重急性呼吸道綜合症

Severe Acute Respiratory Severe Acute Respiratory Syndrome (SARS) Syndrome (SARS)

Prevention & Control1. Knowledge of SARS 2. 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

INFECTION CONTROL

• INFECTION

• INFECTIOUS AGENTS

• CROSS CONTAMINATION

• CHAIN OF INFECTION

• PROCESS OF INFECTIOUS DISEASE

• INFECTION RISK

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

• AVOIDING CROSS CONTAMINATION

“In health care facilities, it is essential that careful hand washing be done by all

caretakers to avoid cross-contamination.”

(Luckman & Sorensen, Basic Nursing, 3rd Edition, p. 506)

INFECTION CONTROL (cont.)

Chain of Infection

Portal of

Entry

Susceptible

Host

Infectious

Agent

Reservoir

Portal of

Exit

Mode of

Transmission

Disrupting the Chain

Portal of

Entry

Susceptible

Host

Infectious

Agent

Reservoir

Portal of

Exit

Mode of

Transmission

Keep natural body defenses intact

WASH HANDS

Maintain effective immunization. Limit Exposure

Personal hygiene & Health life-style

Use disinfectants, antiseptics,

antimicrobial drugs WASH HANDS

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

WHAT IS SARS (SRS)? 嚴重急性呼吸道綜合症 ?

SARS - Coronavirus family ( 變 種冠狀病毒 )

Paramyxovirus

ATYPICAL Pneumonia:

Influenza: Mycoplasma, Chlamydia, Adenovirus

Chemical:TYPICAL Pneumonia:

Bacteria-Streptococcus

Unknown agents

典型肺炎

非典型肺炎 :

支原體過濾性病毒化學性

病因不明

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

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.

Cumulative Number

累積個案

Total No. of Discharged Patients

康復出院

(The numbers in bracket are those with pneumonia

symptoms) 病人總數（括弧內為其中有肺炎徵狀

的人數）

Patients, family members & visitors

病人、病者家人及探訪者 1308 (4) 786 (20)

Total 總數 1678 (4)[78R] +7 1059 (24

Nature性質

Total No. of Deaths *

死亡人數 *

Health care workers of Hospitals/Clinics and medical students

醫院 /診所醫護人員及醫科學生 370 (0) 274 (4)

215(3)

Signs & Symptoms of SARS

Symptoms 徵狀 Frequency 頻數Fever 發燒 ≧ 38℃ 100%Chills 發冷 92%Malaise 全身不適 90%Headache 頭痛 84%Myalgia 肌肉痛 67%Cough 咳嗽 50%Dizziness 頭暈 49%Rigors 寒顫 44%Sore throat 喉嚨痛 43%Runny nose 流鼻水 39%Productive cough 咳嗽有痰 36%

Chest X-ray: changes compatible with pneumonia

Chinese University of Hong KongDepartment 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

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

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

Routes of Entry

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

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

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 :

1.Wash hands before wearing a facemask. 佩戴口罩前必須清潔雙手。

Proper Hand Washing

1 2 3

4 5

6

Wearing Facemask (cont.)2. Follow the instructions on the packet carefully, 3. 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

Wearing of Surgical Mask

Wearing Facemask (cont.)

4. Put the facemask into a plastic bag and tie it properly before putting it into a rubbish bin.

5.Wash hands before wearing a facemask.

6. Replace the facemask immediately if it is damaged or soiled.

Wearing of Respirator N95Hold respirator in hand

Cover Face with Mask

Bands over the head

Test Respirator N95

Fit Respirator N95 to face

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.

MEASURES

5 c.c.

10 c.c.

15 c.c.20c.c.

500 c.c.

500 c.c.

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.

• 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

Clean up of Spilt body fluids or vomitus

Clean up of Spilt body fluids: phlegm, vomitus or others

溢濺物的處理

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.

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.

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.

Daily Disinfection (Office)

Personal Precautions預防措施 — 個人

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

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

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.

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.

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

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.

PREVENTION AT HOME預防措施 - 家居

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.

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.

Public Washrooms 公用手洗間1 2 3

45 6

78 9

WHO-LIST OF AFFECTED AREAS

24-Apr-03Country Area Canada TorontoSingapore Singapore

Beijing, Guangdong, Hong Kong Special Administrative Region of China, Inner Mongolia, ShanxiTaiwan Province*

United States of America Areas not reported*United Kingdom London*Viet Nam Hanoi

Affected Areas - Severe Acute Respiratory Syndrome (SARS)

China

An "affected area" is an area in which local chain(s) of transmission of SARS is/are occurring as reported by the national public health authorities.

*Area with limited local transmission and no evidence of international spread from area since 15 March 2003 and no transmission other than close person-to-person contact reported.

Country  

Cumulative number of case(s)2  

Number of new cases since last WHO update2,3  

Number of deaths  

Number recovered4  

Date last probable case

reported  

Date for which cumulative number of cases is current  

Australia   4   0   0   4   23/Apr/2003   6/May/2003  

Brazil   2   0   0   2   10/Apr/2003   24/Apr/2003  

Bulgaria   1   0   0   0   24/Apr/2003   28/Apr/2003  

Canada   148   0   22   93   4/May/2003   5/May/2003  

China   4409   138   214   1460   6/May/2003   6/May/2003  China, Hong Kong Special

Administrative Region5   1646   9   193   958   6/May/2003   6/May/2003  

China, Macao Special Administrative Region   1   0   0   0   30/Apr/2003   5/May/2003  

China, Taiwan   116   0   10   25   5/May/2003   6/May/2003  

Colombia   1   1   0   1   5/May/2003   5/May/2003  

France   5   0   0   4   11/Apr/2003   5/May/2003  

Germany   7   0   0   7   22/Apr/2003   6/May/2003  

I ndia   1   1   0   0   5/May/2003   5/May/2003  

I ndonesia   2   0   0   1   23/Apr/2003   5/May/2003  

I taly   9   0   0   4   29/Apr/2003   6/May/2003  

Kuwait   1   0   0   1   9/Apr/2003   20/Apr/2003  

Malaysia   7   0   2   4   4/May/2003   6/May/2003  

Mongolia   8   0   0   4   1/May/2003   5/May/2003  

New Zealand   1   0   0   1   30/Apr/2003   2/May/2003  

Philippines   3   0   2   1   28/Apr/2003   29/Apr/2003  

Poland   1   0   0   0   1/May/2003   1/May/2003  

Republic of I reland   1   0   0   1   21/Mar/2003   24/Apr/2003  

Republic of Korea   1   0   0   0   29/Apr/2003   4/May/2003  

Romania   1   0   0   1   27/Mar/2003   22/Apr/2003  

Singapore   204   0   27   149   5/May/2003   6/May/2003  

South Africa   1   0   1   0   9/Apr/2003   3/May/2003  

Spain   1   0   0   1   2/Apr/2003   24/Apr/2003  

Sweden   3   0   0   2   18/Apr/2003   23/Apr/2003  

Switzerland   1   0   0   1   17/Mar/2003   5/May/2003  

Thailand   7   0   2   5   12/Apr/2003   5/May/2003  

United Kingdom   6   0   0   6   11/Apr/2003   6/May/2003  

United States   65   4   0   32   4/May/2003   4/May/2003  

Viet Nam   63   0   5   58   14/Apr/2003   4/May/2003  

Total   6727   153   478   2826    

Quarantine and Prevention of Disease Ordinance (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

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

HA-SARS COUNSELING心靈綠洲 - OasisCentre of Personal GrowthAddress: 147B Argyle Street, KH Nurses Quarters, 1/F.

• Psychological Concern on SARSTel.: ： 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

1dh100100100all

 

Atypical Pneumonia

FAQ on Atypical Pneumonia

Last updated on April 7, 2003

Main Findings of an Investigation into the (in Portable Document Latest Figures on atypical pneumonia(as at 1 pm, 24 April 2003)List of Buildings with Confirmed Severe Acute Respiratory (Last Updated: 9 pm, 24 April 2003)NewsSARS Bulletin(Last Updated: 5 pm, 24 April 2003)

Frequently Asked Questions

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預 防非 典 型 肺 炎 須 知

Regional OfficeTelephone

NumberHong Kong 2961 8729Kowloon 2199 9149New Territories East 2158 5107New Territories West 2615 8571

Education and Manpower Bureau

Hotline : 2892 2352

Public Hospitals & Institutions HotlinesPrivate Hospitals Hotlines

Department of Health (for Notification of Infections)

Social Welfare Department Hotline : 2343 2255

Central Health Education Unit

Hong Kong's hygiene laws - safeguarding public health

Good health and a clean environment are needed to combat atypical pneumonia. In Hong Kong, where the rule of law prevails, there are comprehensive laws in place that relate to our daily lives and the running of businesses. These laws protect our rights and define the government's powers and responsibilities. This pamphlet highlights the most relevant laws that relate to the control of atypical pneumonia. Members of the public are encouraged to get acquainted with these laws, not just to avoid prosecution, but to better discharge their civic responsibilities and support law enforcement and implementation. If we all play our part, we will all benefit and Hong Kong will become a cleaner and more hygienic city

IndividualThe Health Authorities are empowered to require:• The owners or occupiers of premises to make improvements residence or related facilities dangerous to health (e.g. water tank, sewage pipe, refuse container) • The owners or occupiers of premises to remove the waste at common part of a building, found on a canopy, •The owners or occupiers of premises to destroy the vermin at premises found infested • The owners or occupiers of premises not to obstruct scavenging operation and cleaning workers. • No spitting is allowed in public places. • Used tissue paper, masks and other waste shall not be disposed of in public places.

The laws on health and quarantine set out in this pamphlet are contained in the Laws of Hong Kong or laid down in the common law. The relevant statutory laws include -

•Public Health and Municipal Services Ordinance (Cap. 132) •Hawker Regulation (Cap. 132 sub. leg. AI) •Places of Amusement Regulation (Cap. 132 sub. leg. BA) •Public Cleansing and Prevention of Nuisances Regulation(Cap. 132 sub. leg. BK) •Food Business Regulation (Cap. 132 sub. leg. X) •Prevention of the Spread of Infectious Diseases Regulations(Cap. 141 sub. leg. B) •Education Regulations (Cap. 279 sub. leg. A) •Road Traffic (Public Service Vehicles) Regulations(Cap. 374 sub. leg. D)

In most cases, a person who contravenes any relevant provision is liable to a maximum fine of $50,000 and imprisonment for one year. The offender may also be subject to civil claims.

Department of Health• Central Health Education Unit

24-hour Health Education Hotline: 2833 0111

• Education and Manpower Bureau Hotline : 2892 2352

• Social Welfare Department Hotline : 2343 2255

• Health Talk Materials • Presentation Slide - Prevention of Respiratory Tract

Infections (Microsoft PowerPoint Format ; Picture Format) Last updated on March 27, 2003

Related WebsitesHong Kong Traveller's Health Service

Central Health Education Unit

Hospital Authority

World Health Organisation

Centres for Disease Control and Prevention, USA

Health Canada

Ref: HA – ICN:SRS Management & GuidelinesHKMA -

HKU

CUHK

DH - Leaflets

* Prevention of Atypical Pneumonia

* Atypical Pneumonia: Guidelines for the Workplace

Wellness to All THANK YOU