To Make the Infection Control Practice

sustainable in the Long Term Care Settings

in Hong Kong

Christine Lam,

Operations General Manager

30th October 2014

Sister Annie Skau , a missionary nurse “Respecting Life & Impacting Life

Service provision

Haven of Hope Christian Service

Location

No. of Service Centres： 56 Service Centres and 8 Service Programs No. of Staff： 2,137 (As at Mar 2013) Service Locations： Tseung Kwan O, Sai Kung, Kwun Tong, Wong Tai Sin , Sau Mau Ping, Wan Chai & Shau Kei Wan No. of People Served in Man Time Nearly 677,371 in (In the year of 2012/13)

Long Term Care Settings

• A home like setting environment

• Frail population with lower immune response

• With long term medical problems that requires assisted daily living

Elderly are receiving care

from different people

Common & frequent endemic

infection found in LTCF (Nicolle L.E. 2000)

1. Urinary Tract Infection 2. Upper Respiratory Tract Infection 3. Skin and soft tissue infection 4. Gastrointestinal infection 5. ……….. 6. ………..

Emerging and re-emerging infections

(Threats to health)

• Ebola • MDRO (MRSA, VRE, MDRA)

• Swine Flu (H1N1)

• Avian Flu (H5N1, H5N9) • Influenza

• SARS

To protect our clients:

Prevention is better than cure

• The institution is with crowded population

• High colonization of residents with antimicrobial-resistant

organisms e.g. MRSA, VRE

• Infection not fully recover after discharge from hospital : a

source of infection

Threats of outbreak in LTCF

Outbreak calls for resources management

Practical application of Infection

Control Program in LTCF

• Appointment of Chief Infection Control Officer (CICO), Infection

Control Nurse by the Infection Control Committee

• Setting up of communication channels

• Development of updating guidelines/visual instructions

• On-going in-service education

• Surveillance on the trend of infection e.g outbreaks

Appointment of Chief Infection Control Officer

(CICO), Infection Control Nurse (ICN) by the

Infection Control Committee

• The committee composed of doctor, nurses and floor i/c

• Delegation of responsibility

• 3 monthly meeting

• Environmental round & follow up

• Discussion on everyday operation regarding IC

Setting up of communication

channels with CICO & unit heads

• Newsletter for dissemination of most updated information, sharing of

guidelines

• Reporting of cluster of infections by service units

• CICO has direct contact with the service unit: advice / management

• Instant notification for risk management

0

5

10

15

20

25

2007 2008 2009 2010 2011 2012 2013

Year

Training sessions:Attitude, Knowledge & Skills

Swine Flu

MRDO

Visual Guidelines

Proper use of gloves

感染物品 食物及食具

垃圾及拖地

一般清潔

Early detection of infected case :

Isolation

離開房間前

接觸 飛沫

+

-

- ＋

1. 疥瘡 (未完成治療前)

Scabies

2. 腹瀉嘔吐

Gastroenteritis

3. 諾沃克感染 (+ 眼罩)

Noro- virus infection

4. 副流感 / 呼吸合胞體病素

Para-influenza / RSV

接觸 飛沫傳染指引

Promotion of Hand Hygiene 2007

Our hands

New formula of Alcohol Hand

Rub (AHR) adopted by the

World Health Organization

(WHO) 2006

Promotion of Hand Hygiene 2007

(Collaboration with Dept. of Health)

1. 5/ 2007 Observational study of hand washing habit at the work

place + Questionnaire

2. 8-9/2007 5 Educational sessions on Hand Hygiene

3. 10/ 2007 Observation of Hand Washing activity 1 month after

education

4. 1/2008 Observation of Hand Washing activity 4 month after

education + Questionnaire

5. 9/2009 Observation of Hand Washing activity 1 year after +

Questionnaire

The process of the observation study

on Hand Hygiene activities after education

Study on Hand Hygiene

(Compliance 2007 - 2009)

Compliance of Hand Hygiene Programme

27.40%

84.90%

94.90%

80%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Before hand hygiene

Programme

1 month after Hand

Hygiene Programme

4 months after Hand

Hygiene Programme

1year after Hand

Hygiene Programme

Before hand hygiene

Programme

1 month after Hand Hygiene

Programme

4 months after Hand

Hygiene Programme

1year after Hand Hygiene

Programme

環境( Environment )

空氣 ( Air )

水 ( Water )

物品( Formite )

食物 ( Food )

醫療器具 ( Medical Devices )

氣管喉 ( ET Tube )

抽痰喉管 ( Suction catherter )

靜脈導管 ( IV Line )

人員 ( Personnel )

職員、訪客及其他院友

Source of Infection

Proper handling of equipment

Auditing

No one can be missed

Team

You Me He/She

The responsibility of Infection control

Change of Behavior

Thank

you!