Three-level Response Alert System & Infection Control in the Community

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1 Three-level Response Alert System & Infection Control in the Community Dr Rodney Lee Clinical Microbiology and Infection Pamela Youde Nethersole Eastern Hospital

2 Framework of Government s Preparedness Plan for Influenza Pandemic Health Welfare and Food Bureau February 2005

3 Hong Kong Government Response Systems Three-level response system have been based on risk-graded epidemiological scenarios 1. Alert Response Level 2. Serious Response Level 3. Emergency Response Level

4 Alert Response Level HPAI in poultry outside HK HPAI in HK - 1. quarantined imported birds 2. wild birds 3. recreational parks 4. pet shops 5. natural environment Human cases of HPAI outside HK

5 Serious Response Level HPAI outbreaks in HK poultry in 1. retail markets 2. wholesale markets 3. Farms Human cases in HK without evidence of efficient human-tohuman transmission

6 Emergency Response Level Efficient human-to-human transmission of novel influenza Pandemic influenza - the strain is causing several outbreaks a country, and spread to other Human transmission of Avian Flu countries 人 類 感 染 禽 流 感 的 途 徑 Source: Next Magazine

7

8 GUIDELINES ON INFECTION CONTROL PRACTICE Serious Response Level or Emergency Response Level

9 Incorporation of droplet and contact precautions in standard practice Surgical mask must be worn in clinic areas.

10 Incorporation of droplet and contact precautions in standard practice (c) Handwashing is mandated after each patient contact (d) Protective clothing, for example, white coat, or gown should be worn in clinic areas within the designated clinic boundary.

11 Precaution focusing on patients/clients Advising all patients/clients specifically requiring those with respiratory signs/symptoms or fever to wear surgical mask

12 Patient triage (i) Patients asked to self-identify if high risk. (ii) A client at higher risk of infection must wear a surgical mask and the consultation should be in a designated room. (iii) N95 mask, gloves, goggles and protective clothing should be worn during high risk procedures.

13 Designated room (a)good ventilation and preferably separate hand washing facilities. (b) Avoid aerosol-generating procedure.

14 Designated room (c) Wastes should be placed in waste bags, which are tied and put in covered containers for disposal in the normal channels. (d) Contaminated PPE and other items should not be brought into non-clinic areas.

15 Following the care of a patient suspected with or known to have novel influenza (a) The area should be closed for disinfection as soon as possible. (b) Consultation area/equipment should be disinfected with 1:49 household bleach (or 70% alcohol for metallic surfaces).

16 Thank You

17 Alert Response Level Medical Services Stockpile medications for public hospitals and clinics. (HA) Formulate clinical management guideline. (HA) Monitor bed occupancy, and review mobilization/compliance with admission guidelines. Assess and plan for scaling down nonemergency activities. (HA)

18 Serious Response Level Essential medical services Set up designated clinics and protocol for triaging patients with influenza-like illness at primary care level. (HA) Isolate and treat confirmed cases in designated hospitals. (HA)

19 Serious Response Level Essential medical services Update / revise clinical guidelines on management/admission criteria for various specialties. Reduce non-urgent and nonemergency services. (HA) Discussion with private hospitals on patients transfer/diversion/sharing workload. (HA)

20 Emergency Response Level Essential medical services Additional hospitals for isolation Further re-organize or reduce nonurgent services Mobilize convalescent hospitals/wards and private sector to increase capacity to treat acute cases

21 Emergency Response Level Essential medical services Updated guidelines and protocols Mobilize more designated clinics and centres in collaboration with the private sector and voluntary agencies Review and update protocols on research projects

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