Transcript HKWCOSHSARSENGLISH

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
Severe Acute Respiratory
Syndrome (SARS)
Prevention & Control
1. 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
INFECTION CONTROL
(cont.)
• AVOIDING CROSS CONTAMINATION
“In health care facilities, it is essential that
careful hand washing be done by all
caretakers to avoid crosscontamination.”
(Luckman & Sorensen, Basic Nursing, 3rd Edition, p. 506)
Chain of Infection
Susceptible
Infectious
Host
Agent
Portal of
Reservoir
Entry
Mode of
Portal of
Transmission
Exit
Disrupting the Chain
Maintain effective
immunization.
Limit Exposure
Personal hygiene &
Health life-style
Keep natural body
defenses intact
WASH HANDS
Susceptible
Infectious
Host
Agent
Portal of
Entry
Use disinfectants,
antiseptics,
antimicrobial drugs
WASH HANDS
Reservoir
Mode of
Portal of
Transmission
Exit
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
Maintain effective
immunization.
Limit Exposure
WASH HANDS
WHAT IS SARS (SRS)? 嚴重急性呼吸道綜合症?
ATYPICAL Pneumonia:
典型肺炎
TYPICAL
Pneumonia:
BacteriaStreptococcus
Unknown
agents
病因不明
Influenza:
Mycoplasma,
Chlamydia, Adenovirus
Chemical:
非典型肺炎:
支原體
過濾性病毒
化學性
SARS - Coronavirus
family (變 種冠狀病毒)
Paramyxovirus
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.
Cumulative Number
累積個案
Nature性 質
Health care workers of
Hospitals/Clinics and
medical students
醫 院 /診 所 醫 護 人 員 及 醫
科學生
Patients, family
members & visitors
病人、病者家人及探訪
者
Total 總 數
Total No. of
Discharged Patients
康復出院
(The numbers in bracket are
those with pneumonia
symptoms)
（括弧內為其中有肺炎徵狀
的人數）
病人總數
370 (0)
274 (4)
Total No. of
Deaths *
死亡人數 *
215(3)
1308 (4)
786 (20)
1678 (4)[78R] +7
1059 (24
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.
Signs & Symptoms of SARS
Symptoms 徵狀
Fever
發燒 ≧ 38℃
Chills
發冷
Malaise
全身不適
Headache
頭痛
Myalgia
肌肉痛
Cough
咳嗽
Dizziness
頭暈
Rigors
寒顫
Sore throat
喉嚨痛
Runny nose
流鼻水
Productive cough
咳嗽有痰
Frequency 頻數
100%
92%
90%
84%
67%
50%
49%
44%
43%
39%
36%
Chest X-ray: changes compatible with pneumonia
Chinese University of Hong Kong
Department of Diagnostic Radiology
and Organ Imaging
Radiological appearances of recent
cases of atypical pneumonia in Hong
Kong
Dept of Anaesthesia & Intensive Care
Severe 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
6
4
5
Wearing Facemask
2.
3.
•
•
•
•
•
•
(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
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 N95
Hold respirator in hand
Cover Face with Mask
Bands over the head
Fit Respirator N95 to face
Test Respirator N95
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
15 c.c.
5 c.c.
10 c.c.
500 c.c.
20c.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, pullpush trolleys, taps and sinks.
* Use designated cleansing tools: cloth,
mops buckets for isolated areas.
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
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 longterm 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
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.
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
4
2
3
5
7
8
6
9
WHO-LIST OF AFFECTED AREAS
Affected Areas - Severe Acute Respiratory
Syndrome (SARS)
24-Apr-03
Country
Canada
Singapore
China
Area
Toronto
Singapore
Beijing, Guangdong, Hong Kong Special
Administrative Region of China, Inner
Mongolia, Shanxi
Taiwan Province*
United States of America
Areas not reported*
United Kingdom
London*
Viet Nam
Hanoi
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.
Cumulative
number of
case(s)2
Country
Number of new
cases since last
WHO update 2,3
Number of
deaths
Number
recovered 4
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
C anada
148
0
22
93
4/May/2003
5/May/2003
4409
138
214
1460
6/May/2003
6/May/2003
1646
9
193
958
6/May/2003
6/May/2003
C hina
C hina, Hong Kong Special
Administrative Region 5
C hina, Macao Special Administrative
Region
1
0
0
0
30/Apr/2003
5/May/2003
C hina, Taiwan
116
0
10
25
5/May/2003
6/May/2003
C olombia
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
India
1
1
0
0
5/May/2003
5/May/2003
Indonesia
2
0
0
1
23/Apr/2003
5/May/2003
Italy
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 Ireland
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 - 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
dll00
1
a
0
10
h
Atypical Pneumonia
Atypical Pneumonia: Information for Visitors to Hong Kong
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預 防非 典 型 肺 炎 須 知
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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
Individual
The 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 Websites
Ref:
HA – ICN:SRS Management & Guidelines
HKMA HKU
CUHK
DH - Leaflets
* Prevention of Atypical Pneumonia
* Atypical Pneumonia: Guidelines for the
Workplace
Wellness to All
THANK YOU