HA Safety Manual

Infection Control
(Chapter 5)

Hospital Authority
March 2002

Prepared By

Ms Patricia Ching, SNO, QMH

Ms Sony So, NO, PMH
Dr T L Que, Cons(Microbiology), TMH
Mr Charles Chan, M(Envn & OSH) HAHO- Coordinator
 HA Safety Manual
Infection Control
(Chapter 5)

Page

1. Objective 3

2. Management Structure 3-4

3. Guidelines / Good Practices 4

4. Risk Assessment & Self Audit 4-8

5. Training 8

6. References 9

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1. Objective

Health care workers have the potential for exposure to infectious materials,
including body substances, contaminated medical supplies and equipment,
contaminated environmental surfaces or contaminated air. Sound control of the
risk of infection among health care workers with appropriate quality assurance
should be implemented at all levels, taking into consideration factors unique to
individual hospital setting. This chapter outlines the program for protecting all
healthcare workers from the risk of infection during their course of work.

Biological hazards which are of most concerned in the health care services
include

(a) exposure to blood borne pathogens, such as hepatitis B virus (HBV),

hepatitis C virus (HCV), and human immunodeficiency virus (HIV), and

(b) Mycobacterium tuberculosis which can be spread through airborne route .

2. Management Structure

2.1 Management Responsibilities

Under the Occupational Safety and Health Ordinance (Chapter 509), a

person in charge of a workplace (usually the employer or his
representative), has a duty to ensure, as far as reasonably practicable,
the safety and health at work of all his employees.

2.2 Employee Responsibilities

Every employee has a duty to

1. take care of his/her own safety and health at work

2. take care of those who may be affected by his/her action or inaction
3. cooperate with the employer and others and to comply with the
safety and health rules and regulations
4. attend safety training
5. report irregularities to his/her supervisor.

2.3 HAHO Task Force in Infection Control

The role of the HAHO Task Force in Infection include:

To develop and promulgate broad policy on issues relating to

infection control throughout HA hospitals / institutions.
To provide expert advice and support to the HA on matters relating to
infection control issues
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 To provide a forum for exchange of views, expertise and information
for hospital-based experts in infection control. This includes providing
the infrastructure for surveillance, policy on occupational health
where infection is of concern and reporting and coordinating both
internal and external responses to significant infection outbreaks.

2.4 Infection Control Committee in Hospitals

All hospital must have an infection control committee (or an equivalent

mechanism) to oversee the development, implementation and review of
their infection control policies and programs.

3. Guidelines / Good Practices

3.1 Written Infection Control Policy and Guidelines

Written infection control policy and guidelines should be developed and

periodically reviewed by infection control committees or equivalents.
Hospital Infection Control Policy and Guidelines should be accessible by
all relevant staff.

4. Risk Assessment & Self Audit

4.1 Pre-employment Health Assessment

This evaluation should include childhood diseases, medical history,

physical examination immunization record/status, tuberculin test record/
status and appropriate laboratory tests. Such information will assist in
decisions about immunizations or post-exposure management.

4.2 Immunizations of health care workers

4.2.1 Hepatitis B Vaccination

All staff members belonging to the “High Risk Group” should be

offered free Hepatitis B screening / vaccination with effect from
1.4.1997 unless refused by the staff for personal reasons. It is
suggested that all new recruits belonging to the "high risk group"
should be offered free hepatitis B screening / vaccination within 6
months after appointment.

List of Staff Group belonging to "High Risk Group” under the HA’s
Hepatitis B Vaccination Program include:

Doctors (including medical students/interns/externs/dental officers)

Nurses (including midwives and student nurses)
Health Care Assistants
Medical Laboratory Technicians
Radiologists
Occupational Therapists
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 Physiotherapists
Prosthetist - Orthotist
Ward Attendants
Artisans
Workmen I & II
Staff working in mortuary (i.e. Mortuary Officers, Mortuary
Technician, Mortuary Attendants)
Staff Working in operating theatre (i.e. Operating Theatre
Assistants, Operating Theatre Technician)

(NB Please also refer to circular (24) in L/M (17) to

HA/HR/4/426/1 dated 3.4.1997)

Any other staff grades who may be exposed to blood, body

fluids and other infectious materials in their work as
determined by the Consultant Microbiologist / Infection
Control Nurse.

4.2.2 Rubella and Measles Vaccination

Rubella vaccination is to be offered on a voluntary basis to new

staff in HA. Criteria for offering Rubella and Measles vaccines are

a) front-line staff up to the age of 40,

b) who do not have documentation of physician diagnosed
measles, laboratory evidence of measles immunity,
contraindications to vaccine; and
c) who have not received 2 doses of measles vaccines
previously.

(NB Please also refer to circular HA/752/10/38 III dated

22.8.1997)

Staff will be offered the choice of having MMR (Measles, Mumps

and Rubella) rather than just rubella.

4.2.3 BCG

The following recommendations are proposed for hospital'

s/
institution’s consideration :

a) health care staff who has been vaccinated with BCG before
will not need to have a tuberculin test or BCG revaccination;
and
b) health care workers who have never received BCG before
could be tested with a tuberculin test, and if negative, given
BCG vaccination after staff counseling.

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 4.2.4 Chickenpox Vaccination

Chickenpox vaccines may be considered for healthcare personnel

caring for patients of the high risk group e.g. paediatrics,
haematology, bone marrow transplants.

4.2.5 Influenza Vaccination

According to the Infection Control Task Force guidelines, influenza

vaccines are recommended for healthcare personnel of the high
risk groups e.g. institutionalized elderly of age >65, children with
chronic cardiac and pulmonary abnormally (NB Please also refer
to circular (30) to HA/752/10/38 VIII dated 20.10.2000) on the
guidelines on influenza vaccination)

4.3 Protection of Health Care Workers from Nocosomial Infections

4.3.1 Blood borne pathogens

The best way to reduce the occupational risks of infection with

blood borne pathogens such as HIV, hepatitis B and C and others,
is to practice Universal Precautions. Universal Precautions should
be applied to all persons regardless of their infectious status and all
blood and body fluids are treated as potentially infectious. Deep
body fluids including seminal, vaginal, peritoneal, amniotic,
pericardial, pleural, cerebrospinal, synovial and other body fluids
that is visibly contaminated with blood. Some of the essential
guidance are as follows :

a) Adopt good hygienic washing practices with regular hand

washing.
b) Cover wounds or skin lesions with dressings.
c) Wear protective devices (e.g. gloves, gown, mask, goggle)
when anticipating contact with blood or deep body fluids
d) Institute safe procedures for handling and disposal of needles
and other sharps. Sharps must be disposed into puncture
resistant and waterproof sharp boxes and should be put in
RED BAGS for incineration (Code of Practice for the
Management of Hospital Wastes, 8/1993). Needles must not
be recapped, bend or broken.
e) Institute proper procedures for sterilization and disinfection of
contaminated instruments and equipment in accordance with
policy established in the hospital.

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 f) Wipe down spillage of blood and other body fluids promptly
with disposable towel soaked in sodium hypochlorite , 10000
ppm (household bleach) then clean surfaces thoroughly.
g) Articles heavily contaminated with blood and/or deep body
fluid should be disposed in accordance with the Code of
Practice for the management of Hospital Wastes, August 1993.

4.3.2 Other infectious pathogen

For other infectious diseases, apply precautions described in the

current "Guidelines on Isolation Precautions" and other guidelines
for specific infection.

Unit heads should look into the infection control practices of their
respective context and ensure that staff adhere to it.

4.4 Prophylaxis and follow-up after exposure

4.4.1 General guidelines

Ensure that when health workers are exposed to particular

infectious agents, they are informed of the recommended post-
exposure management based on current knowledge about the
infections.

Ensure that when health care workers are offered necessary

prophylactic treatment with drugs, vaccines or immune globulins,
they are informed of

(a) options of prophylaxis,

(b) risks (if known) of infection when treatment is not accepted,
(c) the degree of protection provided by the therapy, and
(d) the potential side effects of therapy.

4.4.2 Needle stick Injury or mucosal contact with blood or body

fluids

Protocols for reporting and management of needle stick injuries

and mucosal exposures with blood or body fluids should be in
place in all hospitals / institutions. The protocol should include post-
exposure prophylaxis and follow-up management. Reference
should be made to guidelines in the appendices.

4.5 Recommendation on Work restrictions for healthcare workers

exposed to, or infected with, selected infectious diseases

It is recommended that the Infection Control Unit and Staff Clinic would
formulate the work restrictions protocols for healthcare workers.

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 4.6 Reporting of Accidents, Exposures and Infections Acquired at Work

Employees are responsible for reporting all injuries by contaminated

sharps and mucosal exposures to infectious materials. Exposure to blood
borne pathogens should be regarded as a matter of urgency and the
person injured or exposed should seek medical advice immediately.

Employees must also report to the infection control unit and hospital
management all infections suspected or confirmed that have been
acquired at work, especially those listed in “NOTIFIABLE
OCCUPATIONAL DISEASES” (OSHO Cap 509 Schedule 2). Notifiable
Occupational Diseases of particular relevance to healthcare workers
include
i. Tuberculosis and
ii. Parenterally Contracted Viral Hepatitis and HIV/ AIDS.
Please also refer to IOD reporting system and accident investigation for
the reporting and investigation policy and procedures.

Regular review on the causes of infection related injuries and exposures

by the Infection Control Unit and OS&H staff in-charge for prevention and
engineer control.

5. Training

5.1 Personnel Health and Safety Training

Hospital management has the responsibility to provide all health care

workers with adequate training to protect themselves and others form the
hazards associated with their work. Safety training should be given at the
commencement of employment or re-assignment, and whenever the need
arises. Regular in-service training and refresher training shall be
conducted to reinforce and maintain up-to–date knowledge in infection
control methods and procedures.

Basic infection control training should cover the following topics:

modes of transmission of infection

‘Universal Precautions’
isolation precautions
clinical waste management
appropriate use of protective apparels
importance of - reporting incidence of infectious diseases
reporting exposure to blood and body fluids
Importance of reporting infectious diseases acquired by staff on duty
personnel screening and immunization programs

Female staff of childbearing age should be provided with information on

the risk and protection for infectious diseases that if acquired, may have
adverse effects on the fetus.

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6. References

(a) “Management of Needle Stick Injury or Mucosal Contact with Blood or

Body Fluids" Scientific Committee on Aids and Scientific Working Group
on Viral Hepatitis Prevention (1997).

(b) "General Guidelines for Hepatitis B, C and HIV Prevention" Scientific

Committee on Aids and Scientific Working Group on Viral Hepatitis
Prevention (1997).

(c) Information on the Management of Influenza in hospital by Infection

Control Task Force. (current guideline revised before December every
year)

(d) “Guidelines for Control of Tuberculosis Transmission in Health Care

Settings in Hong Kong” dated 1994

(e) “General Guidelines and Recommendations on Control of Transmission

of Tuberculosis in Health Care Setting” dated 1997

(f) “Control and Prevention of Tuberculosis in the United Kingdom: Code of

Practice 2000”

(g) “The role of ventilation in preventing nosocomial transmission of

tuberculosis, 1988”

(h) Guideline on Control of Transmission of Tuberculosis in the Healthcare

Settings in the Hospital Authority. Guideline on TB

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