Table 2.

Regular and proactive infection control measures to prevent hospital outbreaks

1.	Promotion of hand hygiene practice using alcohol-based handrub by regular open staff forums, and audits with immediate feedback to staff demonstrating suboptimal practice.4, 7
2.	Practice of “entry and exit” control by implementing directly observed hand hygiene for conscious patients before oral hygiene, ingestion of meals and medications, and after using the toilet.8, 9
3.	Daily visit (patrol) by infection control nurse during office hours to the wards with 3 or more episodes of sporadic cases of nosocomial transmission per year as syndromic surveillance for influenza-like illnesses and diarrheal illnesses.
4.	Active surveillance of high-risk patients for early identification of patients with asymptomatic colonization by MDROs, and use of “added test” as opportunistic screening for both epidemiologically important virus4 and MDROs.8, 10
5.	Provision of rapid laboratory diagnostics: Use of chromogenic agar plate with or without MALDI-TOF MS for MDROs,8 and molecular testing for viruses.4, 7, 11
6.	Daily monitoring of computer data (a computer program to transform microbiology laboratory data into an infection control format) by infection control team for early detection of patients with nosocomial acquisition of epidemiologically important pathogens.
7.	Priority use of single-room isolation for patients requiring contact precautions.12
8.	Decolonization of patients with MDROs if necessary.13, 14
9.	Environmental disinfection of frequently and mutually touched surfaces or items by health care workers, patients, and visitors by sodium hypochlorite 1,000 ppm in general wards, and 2:1 disinfection system (Tristel wipe Tristel, Cambridgeshire, UK) in single rooms and isolation wards caring for patients with MDROs.15
10.	Antimicrobial stewardship programs to reduce antibiotic selective pressure and emergence of MDROs.16
11.	Provision of pamphlets for hospitalized patients and visitors to enhance compliance with infection control measures for personal protection against nosocomial acquisition of pathogens.
12.	Timely education and reminder to frontline staff when there is hospital outbreak reported from another public hospital in Hong Kong.

MALDI-TOF MS, matrix-assisted laser desorption ionization-time of flight mass spectrometry; MDROs, multiple-drug-resistant organisms, which include vancomycin-resistant enterococci, multiple-drug-resistant Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and carbapenem-resistant Enterobacteriaceae.