Volume 3, Number 15 (Published on Week 43, 25 October 2013)

th

WHATS NEW?
Get a Flu Shot to Fight the Flu. It Starts with You.
As patients and visitors may bring the influenza virus with them to the hospital, health care workers (HCWs) are more likely to be exposed to the flu. If HCWs get infected, they are likely to pass the flu along to their patients. Some of the patients are more susceptible to influenza and its complications. Hence, hospital staff who have received flu vaccination can reduce a risk of transmission of flu to their patients, their families and colleagues. So let's all get our flu jab today!

Photo 1: Dr. S H Liu, Chairman of Central Committee on Infectious Disease and Emergency Responses (CCIDER)

Photo 2: Dr. Dominic Tsang, Chief Infection Control Officer

Photo 3: Dr. C T Hung, Cluster Chief Executive of KCC and Hospital Chief Executive of QEH

: Maintain Good Hand Hygiene, Clean Your Hands

To facilitate patients in performing hand hygiene, e.g. before eating and taking medication and after using the toilet, 2 posters below were endorsed at the 8th ad hoc VRE meeting. Hard copies will be available for distribution to hospitals next week. In the meantime, hospitals may use the soft copy for initial printing. It was suggested that the posting location of these posters will be up to the individual hospitals decision based on risk stratification (e.g. to post up in high risk areas first). As to additional needs that may arise locally, and/or judged professionally to be of benefit to a particular situation, the hospital infection control team / hospital management can of course introduce additional precautions as required.

Photo 4: Souvenir cup cover for every HA colleagues who participated in this years flu vaccination programme

Vancomycin-Resistant Enterococci (VRE) Control at Queen Elizabeth Hospital (QEH)

To further control and prevent the transmission of VRE, a discussion with Professor K Y Yuen on existing control strategy was held on 1st August 2013. The progress is summarized below and other hospitals are in the process of stepwise implementation. Recommendations Implementation
1 2 3 4 5 6 7 8 PAN-VRE screening Cohorting all inpatients into clean, contact, known and unknown categories in designated cubicles. Screened and follow up contacts if discharged to dialysis centre or elderly homes. 4. Electronic tagging so that whole HA knows. Two step decontamination with detergent and then Clorox twice daily on all surfaces. Top down to all COS & consultants Bottom up Education by open staff forum: junior staff can ask senior staff to do hand hygiene according to WHO recommendations. Hand hygiene (HH): alcoholic hand rub at all bed ends. All patients must have Directly observed alcoholic hand rub before meals, HH before oral medications Toilet has poster to educate patients. HH with medicated soap after using toilet. Installation of toilet cleanser in patient toilet Antibiotic optimization to decrease overall use of antibiotics and give shortest possible duration of antibiotics according to clinical settings. Surveillance to see that the epidemic curve is really going down with these measures. 30 September to 11 November 2013 Yes according to Guideline High risk screening on 1 August 2013 Yes according to Guideline monitoring and compliance Yes. Task Force in May 2013 9 August 2013 then weekly Yes since 2008 Yes in May 2013 August 2013 August 2013 18 September 2013 23 September 2013 Yes Antibiotic Stewardship Program Yes weekly reporting since May 2013

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CICOs Biweekly Update

HOSPITAL INFECTION UPDATE
Respiratory viruses infection Data source: Five HA laboratories (PMH, PWH, QEH, QMH, TMH) Time frame covered (dd/mm/yyyy): Week 42 (13/10/2013-19/10/2013), Week 43 (up to 24/10/2013) Positive rate of parainfluenza has been increasing for four weeks (from 1.8% in week 39 to 3.5% in week 43); Positive rate of influenza A, influenza B, RSV, parainfluenza and adenovirus were at low level. Circulating influenza A strain Data source: Virus Isolation and Serology Testing (Respiratory Pathogens) results, Virology Division, PHLC Time frame covered (dd/mm/yyyy): Week 41 (07/10/2013-12/10/2013), Week 42 (15/201319/10/2013) In week 41 and 42, 96.1% of the typed isolates (270/281) were subtype H3 and others were subtype H1 (Swine).

Volume 3, Number 15 (Published on Week 43, 25th October 2013)

Disclaimer: The information and contents are based on the analyses and interpretations of available information obtained from sources believed to be reliable. CICO office will try to ensure their accuracy, completeness, timeliness or correctness, however, the information and contents are subject to change without notice.

Figure 1: VRE new cases identified in HA hospitals by cluster (New cases identfied in QEH VRE pan-screening exercise were not included)
90 80 70
Number of new VRE cases

NTWC NTEC KWC KEC KCC HKWC HKEC

60 50 40 30 20 10 0
2012-01 2012-03

2012-05

2012-07

2012-09

2012-11

2012-13

2012-15

2012-17

2012-19

2012-21

2012-23

2012-25

2012-27

2012-29

2012-31

2012-33

2012-35

2012-37

2012-39

2012-41

2012-43

2012-45

2012-47

2012-49

2012-51

2013-01

2013-03

2013-05

2013-07

2013-09

2013-11

2013-13

2013-15

2013-17

2013-19

2013-21

2013-23

2013-25

2013-27

2013-29

2013-31

2013-33

2013-35

2013-37

2013-39

Year-week (Reference date of the patients' first VRE isolate)

Data source: CDARS - Patient based analysis (Bacterial Culture and Sensitivity Test) (as of 21/10/2013) - New cases identfied in QEH VRE pan-screening exercise were not included

ICT TO NOTE:
Update on Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
As of 24 October 2013, World Health Organization (WHO) has been informed of a total of 144 laboratory-confirmed cases of infection with MERS-CoV since September 2012. 62 people died in total and the case fatality was 43.1%.
Countries France Italy Jordan Qatar Saudi Arabia Tunisia United Kingdom United Arab Emirates Total No. of Cases 2 1 2 6 121 3 3 6 144 No. of Deaths 1 0 2 3 51 1 2 2 62

Clinical Waste Disposal: A Reference Guide

The current practices of clinical waste segregation and disposal was introduced in 1993 and recently revised. There was discussion of the variation in practices at the 15th Infection Control Practices Implementation Committee meeting held in 2011. In order to standardize the practices for clinical waste disposal in HA hospitals, it was agreed to develop a clinical waste disposal reference guide. A variation was noted in the Intravenous (IV) infusion set disposal. For clarification, enquiry was raised to Environmental Protection Department (EPD) who replied that In view of the definition of clinical waste stated in the Waste Disposal Ordinance and considering the potential harm and the need to provide protection and safety of the public, open sharps instrument or tools arising from medical practice should be handled as Group 1 clinical waste. Used or contaminated IV spikes should be handled as Group 1 sharps waste and be packaged in sharps container. The IV drip set (with sharps parts removed) can be disposed of as municipal waste. Currently there are 2 practices in HA hospitals: one is removing the IV spike into the sharps box as group 1 clinical waste while

Update on Human Influenza A (H7N9) Infection

The National Health and Family Planning Commission announced a new confirmed case (M/67Y) of human infection with avian influenza A(H7N9) virus in Zhejiang on 23 October 2013. Since an outbreak was first reported on 31 March 2013, a total of 136 human cases of avian influenza A(H7N9) have been laboratory confirmed. The affected areas included Zhejiang ( ), Shanghai (), Jiangsu (), Jiangxi (), Fujian (), Anhui ( ), Henan (), Shandong (), Hunan (), Beijing (), Hebei ( ) and Guangdong ().

Figure 2: Clinical Waste Segregation and Disposal Quick Reference

the remaining infusion tubing is disposed into the black bag as municipal waste. The other is disposing the whole set with IV spike into the sharps box completely. Since infection control is risk based, risk assessment should be performed before removing the IV head, while the whole set can also be disposed into the sharps box in its entirety. With the input of Infection Control Teams (ICTs), the Clinical Waste Segregation and Disposal Quick Reference (Figure 2) was finalized at the 4th ICT meeting in July 2013 and has been distributed to hospitals for posting up at clinical areas in early October 2013.

2013-41