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
Latest Information
Atypical Pneumonia: Information for Visitors to Hong Kong| |
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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
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