Arrangements in patient care areas

During Serious Response Level

Staff and public members should wear a surgical mask in patient care areas
 

Registration counter

(a) Post notice to remind symptomatic patients to alert healthcare workers.
(b) Provide resources for performing hand hygiene and cough manner.
(c) Post visual alerts such as posters and/or broadcast video in conspicuous positions to remind patients and their companions to practise cough manner and hand hygiene.
(d) Staff should wear a surgical mask at the minimum. Eye protection (e.g. face shield) should also be considered if the physical environment does not provide adequate barrier between staff and patient.
 

Case assessment at triage station

(a) Use epidemiology criteria - Fever, Travel, Occupation, Contact, and Cluster (FTOCC) for risk assessment.
(b) Exercise standard precautions with appropriate personal protective equipment (PPE) including surgical mask, eye protection, gown, gloves and disposal cap(optional).
(c) When handling a suspected or confirmed case, exercise standard, contact, droplet, and airborne precautions with appropriate PPE included surgical mask or N95 respirator*, eye protection, gown, gloves and cap (optional). *N95 respirator should be used for aerosol generating procedures
 

Actions to be taken for suspect/confirmed patient

Isolation of patients

(a) Isolate suspect/confirmed patient in a negative pressure airborne infection isolation room (AIIR). Cohort probable case(s) with strong epidemiological link, such as household contacts.

(b) Arrange a single room for isolation if AIIR is not available in clinic setting.    The items in room should be kept minimal.  If a single room for isolation is not available, place the case in a designated isolation area (separate from others >1 metre, e.g. corner of the clinic or areas with least traffic) while waiting for transportation. 

(c) Confirmed cases should not be nursed in the same area with suspected cases. 

(d) The suspected case in the clinic should be transferred by ambulance to the nearby hospital for further management as soon as possible. 
 

Surveillance and case reporting

All registered medical practitioners are required to notify the Centre for Health Protection if patient fulfilling the latest reporting criteria and patient should be isolated immediately.

(https://cdis.chp.gov.hk/CDIS_CENO_ONLINE/disease.html)

(Notified the Central Notification Office (CENO) of the CHP via fax (2477 2770), phone (2477 2772) or CENO

On-line (https://cdis.chp.gov.hk/CDIS_CENO_ONLINE/ceno.html).

For details, please refer to “Letters to Doctor” at CHP website

https://www.chp.gov.hk/en/healthprofessionals/31/index.html

Infection control measures

Hand hygiene

(a) Perform hand hygiene frequently. Wash hands with soap and water when hands are visibly dirty or visible soiled with blood, body fluid, after using the toilet or changing the diapers. When hands are not visibly soiled, 70-80% alcohol-based handrub is also an effective alternative.    
 

Use of Personal Protective Equipment (PPE)

 (a) Wear surgical mask or N95 respirator*, eye protection, gown, gloves and cap (optional) when caring for a suspected or confirmed case.

*N95 respirator should be used for aerosol generating  procedures

(b) Perform donning and doffing of PPE properly. 

(c) For detailed PPE recommendation under Serious Response Level, please refer to the following:

https://www.chp.gov.hk/files/pdf/recommended_ppe_for_nid_eng.pdf

Extract

Recommended Personal Protective Equipment for routine patient care and performing aerosol-generating procedures in hospitals/clinics under Serious / Emergency Response Level.

Apply Standard Precautions +/- transmission based precautions for all patients

Specimen collection & transportation

(a) Exercise standard, contact, droplet and airborne precautions during specimen collection.

(b) Adherence to Triple Packaging System for specimen packaging to minimize the risk of spillage during transportation. 

Transport of patient

(a) Patient should wear a surgical mask and staff should wear appropriate PPE.

(b) Inform the receiving parties and relevant staff before patient transfer to facilitate appropriate arrangement.   

Cleaning and decontamination

Environmental cleaning and decontamination

(a) Clean and disinfect patient environment with 1 in 49 diluted household bleach (mixing 1 part of household bleach containing 5.25% sodium hypochlorite with 49 parts of water), especially high-touch areas, at least twice daily or whenever visibly soiled. Leave for15-30 minutes, and then rinse with water and keep dry. 

(b) For handling suspected/confirmed case, if the place is contaminated with blood, secretions, vomitus and excretions, disinfect with 1 in 4 diluted household bleach (mixing 1 part of household bleach containing 5.25% sodium hypochlorite with 4 parts of water), leave for 10 minutes, and then rinse with water and keep dry.

(c) For metallic surface, disinfect with 70% alcohol.

(d) Perform terminal disinfection upon patient discharge.

(e) Maintain drainage pipes properly and regularly (about once a week) pour about half a liter of water into each drain outlet (U-traps), to ensure environmental hygiene. For details, please refer to https://www.chp.gov.hk/files/pdf/make_sure_the_trap_is_not_dry.pdf
 

Decontamination of health care equipment

(a) Dedicate individual equipment for the patient. 

(b) Clean and disinfect shared equipment before reuse.

(c) Use disposal items when those items cannot be cleaned or disinfected properly

(d) Use bedpan washer for disinfection of bedpans and urinals. 
 

Linen management 

(a) Avoid sorting linens in patient areas.

(b) Used linen should be classified as infected linen, and linen bags should be tagged with “infected linen” tag. 

(c) Send the infected linen to laundry as soon as possible.  
 

Waste management

(a) All wastes arising from the patient care should be treated as clinical waste and disposed in red bags. 

(b) Staff handling clinical waste should wear appropriate PPE.

Other essential points to note

Handling of dead body  

(a) Handling and disposal of dead body according to Cat 2 (Yellow label).   For detail, please refer to the following guideline:

https://www.chp.gov.hk/files/pdf/grp-guideline-hp-ic-precautions_for_handling_and_disposal_of_dead_bodies_en.pdf
 

Staff sickness monitoring

(a) Monitoring staff sickness condition and alert to any unusual clustering among staff.

(b) Staff should report to supervisor if develop respiratory symptoms or pneumonia, wear a surgical mask, refrain from work, seek medical advice promptly.
 

Additional Measures for Emergency Response Level

(a) Staff and public members should wear a surgical mask in all areas. 

(b) Except this, PPE recommendation under Emergency Response Level are the same as in Serious Response Level at this moment. Please refer to the following for details:

https://www.chp.gov.hk/files/pdf/recommended_ppe_for_nid_eng.pdf