Authors (including presenting author) :
Lau KY(1), Lui PM(1), Tam LW(1), Wong YF(1), Cheung NC(1), Kwok ML(1), Tang MY(2)
Affiliation :
(1)Ward B001 / Siu Lam Hospital (2)Infection Control Unit / Castle Peak Hospital , Siu Lam Hospital
Introduction :
‘Infectious outbreak’ had been rated as the top risk in ward for severe grade mental handicap patients, who were cared with caution such as tracheostomy tube, N.G. / PEG tube, fall risk, choking risk and medical problems such as epilepsy and osteoporosis. It was experienced that precise identification of the contributing factors to spread of infectious diseases would be the keys to successful development of the corresponding measures and thus effectively preventing spread of the infectious outbreak within the ward.
Objectives :
(i) To reduce the spread of infectious diseases among patients in ward. (ii) To reduce the frequency of outbreak in ward.
Methodology :
Identification of the contributing factors: Firstly, daily activities of each individual infected patient were analyzed in details. Secondly, the common activities were found out in infected patients. Thirdly, discussion with ICNs to confirm which of the activities, were the possible contributing factors under outbreak analysis. Lastly, two contributing factors were noted in infectious outbreak: (i) the first onset of febrile case was detected after visiting by relatives, and (ii) most of the infected patients were those having chest physiotherapy. Development of corresponding measures with ICNs: (1) Relocation of patient’s beds was done in November 2018 according to the following criteria: 1.1 Patients who received chest physiotherapy and/or frequent suction needed were grouped together. 1.2 Patients who were frequently visited by relatives were also grouped together. (2) Number of patient’s bed was decreased from ten beds to eight beds at high risk area of two dormitories (total five dormitories in ward) in order to enforce more spacious between beds. (3) Extra sessions for mopping over bedside rails and table surface of patient’s locker was carried out after 20:30 by specific posting of supporting staff to strengthen the disinfection of patient’s items. (4) Soiled linen trolley stands were purchased and kept in every dormitory to avoid shared use among dormitories for prevention of cross infection. (5) Commonly used items such as suction catheters were rearranged to keep at one site (next to PPE trolley) and served to avoid shared use from bedside items among patients. (6) Limited visiting parties in dayroom This measure was aimed at decreasing the risk of cross infection by limiting the visiting parties to ‘three parties’ each time by using plastic transparent screen to separate different parties for easy observation and convenient disinfection after used. All relatives showed understanding and accepted.
Result & Outcome :
Results: RSV with onset on 7/8/2017 involving 22 patients of 5 dormitories -> Rhinovirus with onset on 26/7/2018 involving 14 patients of 4 dormitories -> Parainfluenza Virus 3 with onset on 2/11/2018 involving 11 patients of 4 dormitories -> Rhinovirus with onset on 30/3/2019 involving 6 patients of 2 dormitories -> Human metapneumovirus with onset on 6/5/2019 involving 2 patients only in 1 dormitory.
Conclusion: (1) Outbreak was minimized at the time being since improvement measures implemented. (2) Relatives reflected that they were satisfied with the rearrangement of beds and visiting. They showed understanding on the importance on the prevention of cross infection.
