dr. tonny ngicidportal.ha.org.hk/home/file?path=/training... · section 18, cap 459a residential...
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Dr. Tonny NGMBBS (HK) DFPH (UK)
M Med (Public Health) (Singapore)FHKCCM FHKAM (Community Medicine)
Elderly Health Service, Department of Health
-Residential Care Services for Elderly in Hong Kong
Types of residential care homes for elderly (RCHEs)(i) nursing homes(ii) care and attention homes for the elderly(iii) homes for the aged, (iv) hostels for the elderly(v) contract RCHEs(vi) private care and attention homes for the elderly participating in the
Enhanced Bought Place Scheme (vii) nursing homes under the Nursing Home Place Purchase Scheme and (viii) private RCHEs
Licensing authority Social Welfare Department
Related legal provision Law of Hong Kong Chapter 459 Residential Care Homes (Elderly
Persons) Ordinance (Cap 459)
Non-private homes
Private homes
Section 8 (3) (c), Cap 459◦ The Director may refuse to issue a license if it appears to him that such
premises do not comply with any requirements relating to …., health, sanitation etc. set out in any Code of Practice issued by the Director
Section 17 Cap 459◦ Appointment of Inspectors (compliance check)
Section 18, CAP 459A Residential Care Homes (Elderly Persons)◦ Regulation Report suspected infectious disease case
Code of Practice (COP), Chapter on Infection Control◦ Implement control of infectious diseases in accordance with the Guidelines
on Prevention of Communicable Diseases in Residential Care Homes for the Elderly
◦ Designate an Infection control officer (ICO)◦ Report suspected outbreak◦ Arrange isolation of person with infectious disease
Integrated Assessment for Residential Care Homes for Elderly (RCHEs)
2003 March-June 72 RCHE Residents infected by SARS, 52 died
August Infection control checklist began
October Infection control checklist completed
Issued infection control guidelines- Input from Hospital Authority, Department of Health and Social Welfare Department
November Introduction of Infection Control Officer in RCHEs
2003-2004
Training for Infection Control Officers- Briefing forum- Training workshop- On-site training- Sharing Forums
2005 Evaluation of infection control survey
Free vaccination programme for RCHE staff
Annual Infection Control Officers Training by CHP
2007 September 2nd edition of infection control guidelines
2009 July Incorporated with health education needs assessment- drug management- fall prevention- other health needs
2015 January 3rd edition of infection control guidelines
To collect data for assessment of RCHEs’ staff training need
Rectify irregularities during the course with health advice and skill training
Information sharing with stakeholder to facilitate planning◦ Infection Control Branch of Centre for Health Protection◦ Hospital Authority◦ Social Welfare Department (the regulatory authority)
A cross-sectional survey Self-administered questionnaire◦ Residents’ profile◦ Manpower◦ Infrastructure
Inspection and interview◦ Environmental hygiene◦ Hardware and software for infection control, among
other areas
Target population◦ All RCHEs in Hong Kong according to the updated list keep
by Social Welfare Department – 740 (as at June 2015)
A total of 730 RCHEs were recruited (response rate 98.6%)◦ 3 refused◦ 6 ceased operation before survey◦ 1 closed for renovation
Completion rate◦ 100%
544
186
0100200300400500600700800900
2011 2012 2013 2014 2015
non-Private
Private
38811
21883
0
10000
20000
30000
40000
50000
60000
70000
2011 2012 2013 2014 2015
non-Private
Private
3.60%
16%
36%
44%
Private homes
<60
60-74
75-84
85 orabove
0.20%
8.60%
30.70%60.5
0%
Non-private homes
0%
10%
20%
30%
40%
50%
Prev
alen
ce
Dementia Bedridden
non-PrivatePrivate
On tube feeding
To resident ratioPrivate homes Non-Private homes
Nurse 1:71 1:10Health care
worker 1:16 1:17
Personal careworker 1:7 1:4
Nurse: Professionally trainedHealth worker: completed training authorized by Director of Social Welfare, Secondary 5 or equivalentPersonal care worker: Anyone employed for personal care
3.80%
96.20%
Non-Private
70.90%
29.10%
Private
No nurse
20%
94%
80%
6%
0%
25%
50%
75%
100%
Private homes Non-private homes
Health worker
Nurse
0%
10%
20%
30%
40%
50%
2011 2012 2013 2014 2015
No hand dryingfacilities
Uncovered rubbishbin
Soap not available
0%
20%
40%
60%
80%
2011 2012 2013 2014 2015
Com
plia
nce
Refrigerator temperature
91% 91.40%96.80%98.90%98%
40%
60%
80%
100%
2011 2012 2013 2014 2015
Avai
labi
lity
non-Private homes
Private homes
0%
20%
40%
60%
80%
100%
Mainentrance
Commonarea
Isolationarea
Corridor
Non-private
Private
85.80%
3% 11%
Private homes
Correctconcentration,not expiredIncorrect/uncertiainconcentrationExpired/uncertainexpiry date
98.40%
0.50%
1.10%
Non-private homes
COP s4.5◦ Shall provide isolation facility/room
COP 12.4.3 ◦ A designated area or room ◦ With good ventilation◦ Space for equipment for disposal of clinical waste◦ Basic hand hygiene and hand drying facilities
*Not necessarily an isolation room
0%
25%
50%
75%
100%
Private homes Non-private homes
Types of Isolation Area available
No isolation room
Others
3/4 partition
Single room
Examples of Isolation Area
¾ partition
Half height partition
Single room
0%
5%
10%
15%
20%
Ventilationsystem
Handwashingfacilities
Liddedrubbish
bin
Changingarea
Pirvate homes
Non-private homes
With
out t
he p
rovi
sion
0%
1%
2%
3%
4%
5%
6%
Occupied by otherresidents
Occupied by otherstuff
Pirvate homes
Non-private homes
Isolation area is being used as store room
33.50%
69.90%
22.80%
50.50%
0% 20% 40% 60% 80%
Private homes
Non-private homes
Correctly name the 5 moments for hand hygiene
other staff Infection control officers
Source: WHO Guidelines on Hand Hygiene in Health Care
0%
20%
40%
60%
80%
100%
Non-private homes Private homes
Proper disinfection of feeding funnel
0%
20%
40%
60%
80%
100%
Non-private Private
Proper knowledge of management of blood stained surface
0%
20%
40%
60%
80%
Non-private homes Private homes
Can tell all correct management of contaminated articles
55%
65%
75%
85%
95%
105%
Isolate suspected case Cohorting asymptomaticcontacts
Correct management of suspected cases and contacts
non-Privatehomes
Private homes
0% 25% 50% 75% 100%
Staff sick records
Visitor record
Regular body temperature
Regular body temperature for frail…
Residents' fever record
Infection control training record
Compliance
Non-private homes Private homes
0%
20%
40%
60%
80%
100%
2011 2012 2013 2014 2015
Com
plia
nce
Demonstration of proper hand hygiene technique
non-private
private
A new standard was adopted
0%
20%
40%
60%
80%
100%
2011 2012 2013 2014 2015
Com
plia
nce
Demonstration of proper donning and doffing technique
non-private
private
New standard
0%
20%
40%
60%
80%
100%
2011 2012 2013 2014 2015
Com
plia
nce
Demonstration of proper bleach dilution technique
non-private
private
The performance observed is not representing that for all staff in the RCHE as a whole
Only assess the infection control measure at one particular point in time
0%
20%
40%
60%
80%
100%
2011 2012 2013 2014 2015
Com
plia
nce/
Kno
wle
dge
Refrigerator temperature -Knowledge vs Compliance
Knowledge
Compliance
20% difference
0%
50%
100%
0
100
200
300
400
500
Know
ledg
e on
Isol
atio
n an
d Co
hort
Num
ber o
f Out
brea
ks
Influenza-like-illness Scabies
Gastroenteritis+ Norovirus Upper Respiratory Tract Infection
Isolation of suspected cases Cohorting asymptomatic contacts
Resource implication
High staff turnover rate
Failure to engage all front-line staff intraining
Enhancement in education programmes◦ Sustainable behaviour modification◦ Encourage self-auditing
Review the policy of residential care service