Table 3.
Rapid infection control response to the first patient with hospital-acquired viruses or multiple-drug-resistant bacteria
| Nosocomial acquisition with epidemiologically important respiratory and gastrointestinal viruses in the clinical area | Nosocomial acquisition with epidemiologically multiple-drug-resistant bacteria that are not yet endemic in our locality | |
|---|---|---|
| Timely and appropriate patient isolation | Single-room isolation and contact precautions are required for patients with respiratory syncytial virus, parainfluenza virus, norovirus, and rotavirus. For influenza A virus, single-room isolation, if available, is preferred. Otherwise, corner bed in open cubicle with droplet precautions is required. If the cluster of respiratory virus infections involved > 1 case where a single room is not available, cohort nursing according to World Health Organization guideline on acute respiratory diseases (WHO/CDS/EPR/2007.6) | Single-room isolation and contact precautions are mandatory for patients colonized or infected with VRE and CPE |
| Environmental disinfection | A specialized cleansing team performs cleaning and disinfection of patient care area, toilet facilities, and the entire ward using sodium hypochlorite 1,000 ppm. Thereafter, ward-based cleaning team performs cleaning and disinfection of the single room or corner bed holding the index case at least twice daily with sodium hypochlorite 1,000 ppm | |
| Directly observed hand hygiene | Alcohol-based handrub is administered to all health care workers, patients, and visitors once every 2-3 hours by a health care assistant | |
| Specialized measures | Dashboard monitoring of clinical symptoms of exposed patients: Hospitalized patients are divided into 3 groups. Group 1 is the index case. Group 2 comprises of patients who have been exposed to the index case. Group 3 comprises patients admitted after the isolation of the index case. Infection control nurses observe patient's symptomatology daily for 2 incubation periods in the affected clinical area. Appropriate clinical specimens such as nasopharyngeal specimens or stool samples are collected from patients in groups 2 and 3 if they develop clinical symptoms suggestive of respiratory or gastrointestinal infections |
Extensive contact tracing for potential secondary cases8, 24, 25: All hospitalized patients staying with the index case are screened for VRE or CPE by fecal samples (rectal swab with visible fecal staining or stool). Patients discharged home are tagged in the hospital computer system and screening is performed upon readmission. Patients discharged to residential care homes for elderly will be screened by community geriatric assessment team. Infection control team monitors the compliance of screening |
| Reporting hospital outbreak | When 3 or more nosocomial-acquired cases with epidemiologic link are found in the same clinical area, the infection control officer should report the outbreak to the Centre for Health Protection, Department of Health and the Hospital Authority head office. A press release is issued to inform the public. The hospital infection control team collaborates with epidemiologists from the Centre for Health Protection to control the hospital outbreak | |
VRE, vancomycin-resistant enterococci; CPE, carbapenemase-producing Enterobacteriaceae.