Δείτε τι έκανε το Hong Kong για την προστασία των ξενοδοχείων και του Τουρισμού, από μεταδοτικές ασθένειες και τον κορωνοϊό|Οδηγός 83 σελίδων|ΚΕΙΜΕΝΑ

Με έναν οδηγό 83 σελίδων, που συντάχθηκε με την συνεργασία όλων των εμπλεκόμενων μερών, τόσο του Ιδιωτικού, όσο και του Δημοσίου Τομέα, με συντονιστή το Κέντρο Προστασίας της Υγείας, η κυβέρνηση του Χονγκ Κονγκ, παρέχει πλήρεις οδηγίες για την αντιμετώπιση των μεταδοτικών ασθενειών και του κορωνοϊού, στον τομέα των Ξενοδοχείων και του Τουρισμού, παρουσιάζοντας ακόμη και τον τρόπο με τον οποίο πρέπει να καθαρίζονται τα διάφορα μέρη του δωματίου, αλλά και οι κοινόχρηστοι χώροι.

Η κυβέρνηση του Χονγκ Κονγκ προχώρησε στην κυκλοφορία οδηγίας ειδικά για τον κορωνοϊό (Health Advice on Prevention of Coronavirus disease (COVID19) for Hotel Industry (Interim)), ο οποίος παραπέμπει και στον γενικό οδηγό για την πρόληψη μολυσματικών ασθενειών στα ξενοδοχεία.

Η σημασία του Τουρισμού

Όπως αναφέρεται στην εισαγωγή, “Η αποτελεσματική πρόληψη και ο έλεγχος των μεταδοτικών ασθενειών στα ξενοδοχεία μπορεί να προστατεύσει την υγεία των επισκεπτών και του προσωπικού του ξενοδοχείου. Προκειμένου να διατηρηθεί η η φήμη του Χονγκ Κονγκ ως προορισμός παγκόσμιας κλάσης για τουρίστες στο εξωτερικό,

εναπόκειται σε κάθε προσωπικό του ξενοδοχείου να μάθει πώς να αποτρέπει τις μεταδοτικές

ασθένειες. Αυτή η κατευθυντήρια γραμμή αποσκοπεί στην παροχή πρακτικών πληροφοριών σχετικά με το προληπτικά μέτρα μεταδοτικών ασθενειών για όσους εργάζονται σε ξενοδοχεία”.

Και συνεχίζει: “Κάθε υπάλληλος του ξενοδοχείου έχει την ευθύνη να κατανοήσει την κατευθυντήρια γραμμή και να φροντίζει τους επισκέπτες του ξενοδοχείου, σύμφωνα με αυτές. Σε περίπτωση αμφιβολίας ή όταν υπάρχουν περισσότερες πληροφορίες

σχετικά με συγκεκριμένες μεταδοτικές ασθένειες, απαιτείται η παροχή συμβουλών

το τμήμα καταπολέμησης της μόλυνσης του Κέντρου για την Προστασία της Υγείας του

Τμήμα Υγείας”.

Λόγω της έκτασης των κειμένων, δεν είναι δυνατόν να μεταφραστούν και ως εκ τούτου τα παραθέτουμε αυτούσια.

Οι ειδικές οδηγίες

Οι ειδικές οδηγίες, έχουν ως εξής:

Ο οδηγός

Στον εκτενή οδηγό “Guidelines on Infection Control & Prevention In Hotel Industry”, ο οποίος συντάχθηκε με την συνεργασία της Ένωσης Ξενοδοχείων Χονγκ Κονγκ, του τμήματος Ξενοδοχειακής Ασφάλειας & Υγιεινής Τροφίμων, του υπουργείου Υγιεινής Τροφίμων και Περιβάλλοντος, του υπουργείου Εσωτερικών, του υπουργείου  Έργων, του υπουργείου Τουρισμού και Πολιτισμού και του υπουργείου Υγείας, περιλαμβάνονται αναλυτικές οδηγίες, με τα ακόλουθα περιεχόμενα:

ACKNOWLEDGEMENTS

1. INTRODUCTION

2. CONCEPT OF COMMUNICABLE DISEASES

2.1 COMMUNICABLE DISEASES

2.2 CHAIN OF INFECTION

2.3 PATHOGENS / RESERVOIR

2.3.1 Pathogens

2.3.2 Reservoir

2.4 MODE OF TRANSMISSION

2.4.1 Contact transmission

2.4.2 Droplet transmission

2.4.3 Airborne transmission

2.4.4 Common vehicle transmission

2.4.5 Vector-borne (insects) transmission

2.5 SUSCEPTIBLE HOST

3. PREVENTIVE MEASURES AGAINST COMMUNICABLE DISEASES

3.1 PRINCIPLES OF PREVENTION AND CONTROL OF COMMUNICABLE DISEASES

3.2 GENERAL HYGIENE PRACTICES

3.3 STANDARD PRECAUTIONS AND TRANSMISSION-BASED PRECAUTIONS

3.3.1 Standard precautions

3.3.2 Transmission-based Precautions

3.4 VENTILATION

3.4.1 Purpose of ventilation

3.4.2 General ventilation design

3.4.3 Infection control measures and ventilation issues

3.4.4 Maintenance of Mechanical Ventilation Systems

3.4.5 Cooling Water Quality Monitoring

4. FACTS ABOUT COMMON COMMUNICABLE DISEASES

4.1 FOODBORNE DISEASE & SPECIFIC PREVENTIVE MEASURES

4.1.1 Foodborne disease

4.1.2 Preventive Measures of Foodborne Diseases

4.2 RESPIRATORY DISEASE & SPECIFIC PREVENTIVE MEASURES

4.2.1 Respiratory disease

4.3 CA-MRSA AND SPECIFIC PREVENTIVE MEASURES

4.3.1 CA-MRSA

4.3.2 Preventive measures of CA-MRSA

4.4 STATUTORY NOTIFIABLE COMMUNICABLE DISEASES

5. OUTBREAK OF COMMUNICABLE DISEASES

5.1 OUTBREAK OF COMMUNICABLE DISEASES

5.2 MANAGEMENT OF OUTBREAK OF COMMUNICABLE DISEASE

5.2.1 Infection control measures during outbreak

5.2.2 Disinfection of environment

5.3 RECOMMENDATIONS ON MANAGEMENT OF SPECIFIC COMMUNICABLE DISEASES

5.3.1 Food poisoning

5.3.2 Outbreak of respiratory tract infection

6. INFECTION CONTROL MEASURES IN SPECIAL FACILITIES

6.1 SWIMMING POOLS AND WHIRLPOOL SPAS

6.1.1 Environmental cleansing

6.1.2 Pool Decontamination

6.1.3 Water Standards and Testing Frequency

6.1.4 Pool Maintenance

6.2 FITNESS CENTRE OR GYMNASIUM ROOM

6.2.1 Environmental cleansing:

6.2.2 Personal hygiene for users

6.3 CHILD CARE FACILITIES

6.3.1 Diapering

6.3.2 Furnishings

6.3.3 Toileting Area

6.3.4 Toys and Ball Pool

6.3.5 Management guidance for gastroenteritis outbreak

6.4 SAUNA, MASSAGE AND BEAUTY CENTRE

6.4.1 Environmental cleansing

6.4.2 Specific requirement and practice

6.4.3 Personal hygiene of health of masseur / masseuse

6.4.4 Public showering facilities

6.5 CATERING SERVICES

6.5.1 Personal hygiene of food handlers

6.5.2 Food Hygiene

6.5.3 Premises Hygiene

6.5.4 Utensils and equipment

7. Appendix

APPENDIX A: HAND HYGIENE TECHNIQUE

APPENDIX B: NOTIFICATION OF INFECTIOUS DISEASES

APPENDIX C: COMMONLY USED OF DISINFECTANTS

APPENDIX D: THE USE OF BLEACH

APPENDIX E: MAINTAIN COUGH MANNERS

APPENDIX F: SEQUENCE OF DONNING & REMOVING PERSONAL PROTECTIVE

EQUIPMENT (PPE)

APPENDIX G: USEFUL LINKS

REFERENCES:

1. Introduction

Effective prevention and control of communicable diseases in hotels can

safeguard the health of the hotel guests and staff. In order to uphold the

reputation of Hong Kong as a world-class destination to overseas tourists,

it is incumbent on every hotel staff to learn how to prevent communicable

diseases. This guideline is intended to provide practical information on the

preventive measures of communicable diseases for those who work in hotels.

Every hotel employee has the responsibility to understand the guideline and

to take due care of the hotel guests according to what has been laid down

therein this guideline.

The guideline is divided into seven sections, individual employees may

refer to the relevant sections if necessary. However, this set of guideline is

not meant to be exhaustive. In case of doubt or when further information

on specific communicable disease is needed, advice can be sought from

the Infection Control Branch of the Centre for Health Protection of the

Department of Health. Lastly, opportunity is taken to thank the Hong Kong

Hotels Association and all the hotels who participated in the Infection Control

Survey in Hotel Industry for their invaluable comments and inputs on the

preparation of this guideline.

1. Introduction 6

2. Concept of Communicable Diseases

2.1 Communicable Diseases

Communicable diseases refer to diseases that can be transmitted and

make people ill. They are caused by infective agents (pathogens) e.g.

bacteria and viruses, which invade the body and multiply or release

toxins to cause damages to normal body cells and their functions. In

severe cases, they may lead to death. These infective agents can spread

from a source of infection (e.g. sick person) to a person through

various modes of transmission.

2.2 Chain of Infection

For an individual to acquire an infection, a number of factors crucial

to the spread of communicable diseases including the infective agents

(pathogens), source of infection (reservoir), mode of transmission, and

susceptible host must be present. This is called the chain of infection

(Figure 1).

Mode of transmission

Pathogens +

Reservoir

Susceptible

hosts

Infection

Figure 1. Chain of Infection

2.3 Pathogens / Reservoir

2.3.1 Pathogens

The pathogens/infective agents responsible for infectious

diseases include bacteria, viruses or parasites. Some

microorganisms are part of our own body flora which can cause

infection when we are immunocompromised. These infections

are called endogenous infections. Infections which are

acquired from external sources are called exogenous infections.

However, pathogens/infective agents must achieve an infective

dose before they can infect people.

2.3.2 Reservoir

This refers to any environment or object in or on which

infective agents can survive and, in some cases, multiply.

Human beings, inanimate objects, animals, food or water can

all serve as reservoirs. Such reservoirs will normally form the

basis for the origin of the infective agents to infect humans.

A human reservoir may be either a case or a carrier. A case

is a patient with an acute clinical infection while a carrier is

a person who is incubating and/or colonized with a specific

pathogenic microorganism but shows no signs or symptoms

of infection. A carrier may have a subclinical or asymptomatic

infection e.g. Hepatitis B virus.

2.4 Mode of Transmission

Infective agents can be transmitted from a source of infection to

another person by contact, droplet, inhalation of infectious droplet

nuclei, or ingestion. Some communicable diseases can be transmitted

by more than one mode of transmission. Interruption of the mode

of transmission is the easiest way to break the chain of infection,

therefore, it is the key to prevent and control infectious diseases.

2. Concept of Communicable Diseases 8

2. Concept of Communicable Diseases

2.4.1 Contact transmission

Contact is the most common mode of transmission which can

be subdivided into direct contact or indirect contact.

Transmission through direct contact refers to person-to-

person spread of microorganisms through direct physical

body contact, such as by hands. For example, scabies.

Transmission through indirect contact occurs when a

susceptible person comes into contact with a contaminated

object or environment, such as sharing towel. For example,

acute conjunctivitis and community associated-methicillin-

resistant Staphylococcus aureus (CA-MRSA).

2.4.2 Droplet transmission

Droplet transmission occurs when the mucous membrane of

the eyes, nose and mouth of a susceptible person come into

contact with infectious droplets (> 5μm in size).

These particles do not remain suspended in the air for

extended periods of time, and usually do not travel beyond

several feet (usually 1 metre or lesser) from the source

person.

These droplets are generated when the source person

coughs, talks, sneezes, or spits. Examples of infections

transmitted by droplet route include influenza and Severe

Acute Respiratory Syndrome (SARS).

2.4.3 Airborne transmission

Airborne transmission occurs when the airborne droplet

nuclei ( ≤ 5μm in size) or dust particles containing

microorganisms remain suspended in the air for a long

period of time and then inhaled by the susceptible host.

Examples of airborne infections are pulmonary tuberculosis

and chickenpox.

2.4.4 Common vehicle transmission

Common vehicle transmission occurs when microorganisms

are spread from contaminated food, water, or equipment.

Examples of diseases transmitted through this route include

food poisoning, cholera and Hepatitis A.

2.4.5 Vector-borne (insects) transmission

Vector-borne (insects) transmission occurs when an

invertebrate vector bites or touches a person. Examples

of diseases transmitted through vector-borne (insects)

transmission are dengue fever or malaria.

2.5 Susceptible Host

Human body normally has many defense mechanisms for resisting the

entry and multiplication of pathogens. However, some people are at

higher risk for infection because of their declined or immature immune

systems. Examples of these susceptible hosts are elderly and newborn

baby, immunocompromised people, steroid user, or patient who is

recovering from serious trauma or after surgery.

2. Concept of Communicable Diseases 10

3. Preventive Measures against Communicable Diseases

Apart from the general hygienic practice, hotel staff should also adopt

basic infection control measures to prevent and control communicable

diseases. These include Standard Precautions and Transmission-based

Precautions.

3.1 Principles of Prevention and Control of

Communicable Diseases

To prevent or control communicable diseases, appropriate infection

control measures should be implemented promptly to control the

infective agents (pathogens), source of infection (reservoir), mode

of transmission, and the susceptible hosts so as to break the chain of

infection. Examples of control measures are as follows:

Chain of Infection Infection Control Measures

Infective agents Disinfection and killing of all infective agents

Source of infectionEarly detection, isolation and treatment of sick and

removal of breeding sites

Mode of transmission

Maintain good environmental, personal and food

hygiene; adopt infection control measures appropriate

to the different modes of transmission

Susceptible host Build up personal immunity by immunization and

healthy lifestyles

3.2 General Hygiene Practices

Building up immunity by having a well balanced diet, adequate rest

and sleep, regular exercise and being a non-smoker are all vital to the

prevention of communicable diseases. Hotel staff should observe strict

personal hygiene practice as follows:

3. Preventive Measures against Communicable Diseases

Perform hand hygiene frequently with soap and water, or 70%

alcohol-based handrub.

Do not spit.

Cover nose and mouth with tissue paper when sneezing or coughing

and have the tissue paper discarded into lidded garbage bins

afterwards.

Individuals with signs and symptoms of respiratory infections (such

as coughing, sneezing, headache etc.), respiratory hygiene/ cough

etiquette (please refers to section 3.3.1 II) should be observed.

If you feel unwell, you should seek medical advice promptly to

prevent spreading the infection in hotel.

Change and wash uniform frequently or whenever it is grossly

contaminated.

Do not share personal items such as towels and razors.

Cover wound or cut with waterproof dressing.

3.3 Standard Precautions and Transmission-based Precautions

There are two tiers of precautions to prevent the transmission of

infectious agents. Standard Precautions are intended to be applied

to the care of all people regardless of the suspected or confirmed

presence of an infectious agent. Transmission-based Precautions are

for people who are known or suspected to be infected or colonized

with infectious agents which require additional control measures to

effectively prevent transmission (transmitted through contact, droplet

or airborne notions etc as described in Section 2.4).

3. Preventive Measures against Communicable Diseases

3.3.1 Standard precautions

Standard precautions should be implemented when we have to

contact blood; all body fluids, secretions and excretions except

sweat; non-intact skin; and mucous membranes. Standard

precautions include the following infection control measures:

Hand hygiene

Respiratory hygiene/cough etiquette

Environmental hygiene and decontamination

Personal protective equipment (PPE)

Linen management

I. Hand hygiene

Hand hygiene is a general term referring to any action of hand

cleansing. The common hand hygiene practices recommended

include handwashing and use of alcohol-based handrub (hand

antisepsis). Since many communicable diseases are transmitted

through direct contact, performing hand hygiene properly

is a basic infection control measure to prevent the spread of

communicable diseases in hotels setting. When hands are visibly

soiled, handwashing should be performed. When hands are not

visibly soiled, application of alcohol-based handrub is equally

effective.

Hand hygiene should be performed:

Before touching mouth, nose and eyes,

Before handling, preparing or serving food,

After using tissue paper to cover the mouth and nose

while sneezing or coughing,

After using the toilet, or

After touching public installations or equipment, such as

escalator handrails, elevator control panels or door knobs.

Hand hygiene technique

To achieve the best hand washing results, before performing

hand hygiene, hotel staff should take off their watches, rings

and accessories on hands and wash their hands properly

according to the following procedures and make reference to

Appendix A for the proper hand hygiene technique.

Wet hands under running water.

Apply liquid soap and rub hands together to make a soapy

lather.

Away from the running water. Rub the palms, back of

hands, between fingers, backs of fingers, thumbs, finger

tips and wrists for at least 20 seconds (same procedure also

applies to disinfection of hands with alcohol hand rub).

Rinse hands thoroughly under running water after

rubbing.

Dry hands thoroughly with clean cotton towel, paper

towel or hand dryer. Towels for drying hands should never

be shared.

If necessary, turn off the tap by wrapping the faucet with

paper towel. Avoid touching the faucet again with washed

hands.

Provision of resources

Hotel management should ensure that materials for adhering

to hand hygiene are available in hotel:

Provide lidded receptacles for used tissue paper disposal.

Provide conveniently-located dispensers of alcohol-based

handrub; where sinks are available, ensure that supplies

for handwashing (i.e., liquid soap and disposable towels)

are consistently available.

3. Preventive Measures against Communicable Diseases

II. Respiratory hygiene/ cough etiquette

Respiratory hygiene / cough etiquette is regarded as a kind

of source control measures. Hotel staff/ hotel guests should

be educated to perform the followings when they cough or

sneeze:

Source control measures

Cover mouth and nose when coughing or sneezing.

Use tissue paper to contain respiratory secretions and

dispose them promptly in lidded receptacles.

Perform hand hygiene after hands have been in contact

with respiratory secretions.

Offer surgical masks to persons with respiratory symptoms

when tolerated, especially during epidemic.

Encourage persons with respiratory symptoms to sit away

from others, ideally > 1 metre (or 3 feet).

Provision of resources:

Hotel management should ensure that materials for adhering

to respiratory hygiene/cough etiquette are available in hotel:

Provide lidded receptacles for used tissue paper disposal.

Provide surgical masks when in need.

III. Environmental hygiene and decontamination

Since infective agents can survive in the environment for a

period of time, it is vital to observe environmental hygiene

from time to time and environmental decontamination should

be strengthened, in particular during outbreak situation.

3. Preventive Measures against Communicable Diseases

Environmental hygiene includes the followings:

General cleaning

Rooms should be maintained at a reasonable standard of

cleanliness.

Cleaning should start in the clean areas and progress to

the dirty areas.

All surfaces should be cleaned at least daily with detergent

and water or disinfectants (e.g., 1 in 99 diluted household

bleach (5.25%) solution), if necessary.

Frequently touched area such as escalator handrails,

elevator control panels or door knobs should be cleaned

more often subject to the frequency of use.

Hands should be washed after undertaking cleaning

activities.

Regular pest control should be carried out.

Supervisors should undertake regular monitoring to ensure

that existing hygienic standards are strictly observed.

Handling of spillage

Disposable gloves should be used if the cleaning involves

contact with body fluids, such as respiratory secretions,

urine, feces etc. Eye protection (i.e., goggles and

faceshield) or body protection may be considered when

substantial splash of blood or body fluids is anticipated.

Use highly absorptive materials to preliminarily clean up

the contaminated surfaces first.

If the surface is contaminated with vomitus or other body

fluids, disinfect with 1 in 49 diluted household bleach

(5.25%) solution, leave for 15-30 minutes and then rinse

with water; if the surfaces are contaminated with blood,

use 1 in 4 diluted household bleach (5.25%) solution for

disinfection of the contaminated surface and leave for 10

minutes before rinsing with water. [28]

3. Preventive Measures against Communicable Diseases

Floors and floor coverings

Carpets or rugs/mats may be vacuumed using a cleaner

that does not throw dust into the air or steam cleaned if

soiled with body fluids.

Do not hang up and swat carpets or rugs/mats as this will

create aerosols.

Hard floor surfaces should be cleaned with wet vacuum

systems. If wet vacuum systems are not available, hard

floor surfaces should be damp mopped using detergent

and water or disinfectant if necessary.

Furnishing

These include items such as curtains, drapes, screens,

lampshades and furniture items which should be washed/

cleaned or steam cleaned regularly.

Lift cars and escalators

Wipe lift cars and escalators, particularly the call buttons

and handrails with detergent and water, or disinfected

with 1 in 99 diluted household bleach (5.25%) solution, if

necessary.

Clean lift ventilation vans regularly.

Hotel lobby

Regularly wash and wipe building entrances, door knobs/

handles with detergent and water, or 1 in 99 diluted

household bleach (5.25%) solution, if necessary.

3. Preventive Measures against Communicable Diseases

Public toilets and toilets of the guest rooms

Clean public toilets with 1 in 99 diluted household bleach

(5.25%) solution frequently.

Every public washroom should be equipped with liquid

soap, paper towels or hand dryer(s).

Clean toilets of the guest rooms at least once a day. Wipe

the rim, seat and lid of the toilet bowl with 1 in 99 diluted

household bleach (5.25%) solution, rinse with water and

then wipe dry.

Make sure that the drain pipes are built with U-shaped

water traps; do not alter the pipelines without

authorization.

Clean floor drain outlets at least once a week to prevent

putrid air and insects in the soil pipes from entering the

premises. Pour about half a litre of water into each drain

outlet regularly (about once a week) so as to maintain the

water column in the pipe as water lock.

Environment decontamination is crucial when:

Under outbreak situation

Disinfect the environment with 1 in 49 diluted household

bleach (5.25%) solution, leave for 15-30 minutes before

rinsing with water and mopping dry. [28]

Special attention should be paid to the disinfection of

toilets, kitchens and objects which are frequently touched

such as light switches, door knobs and handrails. [28]

3. Preventive Measures against Communicable Diseases

IV. Personal protective equipment (PPE)

Personal Protective Equipment (PPE) is specialized clothing

or equipment worn by an employee for protection against

infectious materials. It should serve as a last resort that

should not replace any other risk control and infection control

measures. However, sufficient stock of PPE should be kept to

ensure its provision to protect employees from exposure to

infectious agents in the workplace. The common PPE used for

prevention of infectious diseases transmission are as follows:

Surgical mask

Wear a surgical mask to protect mucous membranes of

the nose and mouth during procedures that are likely

to generate splashes or sprays of blood, body fluids,

secretions, and excretions, (for example, in case of

handling or segregating heavily soiled linen sheets or

laundering items of hotel guests.)

Particulate respirator

Put on a particulate respirators (e.g., N95 respirator) for

conducting of maintenance work for cooling tower such

as testing and commissioning, inspection, water sampling

and high pressure spraying etc.

Gloves

Wear disposable gloves when touching blood, body

fluids, secretions, excretions, or mucous membrane or

contaminated items.

Remove gloves promptly after use and perform hand

hygiene immediately.

Gloves do not replace hand hygiene.

3. Preventive Measures against Communicable Diseases

Gown or apron

Wear gown or apron to protect skin or trunk and to

prevent soiling of clothing during procedures that are

likely to generate splashes or sprays of blood, body fluids,

secretions, or excretions.

Wear a coverall for conducting high pressure water

spraying during ventilation system maintenance or when

substantial whole body contamination is anticipated.

Remove soiled gown as promptly as possible and perform

hand hygiene to avoid transfer of microorganisms to other

people or environments.

Goggles / Face shield

Wear a goggles / face shield to protect the mucous

membrane of the eyes when carrying out procedure

that are likely to generate splashes or sprays of blood or

body fluids of the guests (e.g., handling of heavily soiled

linen sheets or cleaning or changing dust filters of the

ventilation system).

Wear goggles / face shield when conducting high pressure

water spraying for ventilation system maintenance.

Ordinary spectacles do not provide adequate protection.

Goggles / face shield should be changed after procedure

or whenever contaminated. Reusable goggles / face shield

should be washed and decontaminated in accordance with

manufacturer’s instructions.

In order to reduce the chance of cross contamination,

please also make reference to Appendix E for the

suggested sequences of putting on and removing

personal protective equipment after use.

3. Preventive Measures against Communicable Diseases

V. Linen management

Used linen should be handled as little as possible with minimum

agitation to prevent possible contamination of the handler or

environment. [6, 7, 9] Clean linen should be stored in the closed

cabinet [42] and handled, processed & transported separately

from the used linen, [9] and linen should be changed regularly

and whenever a guest has checked out.

Packing

Bagged at point of generation.[6]

Rolling technique: wrap up the soiled part to the centre of

the bundle. [7]

Volume of each load should not exceed 2/3 of the laundry

bag.If linen is to be sent for outsource treatment,

Packed with a leak resistant bag for soiled linen.[ 6, 7]

Tied at the neck of the bag tightly.

Linen laundering – Standard laundering procedure

For washable items

Examples of washable items include bed sheets, pillowcases,

towels & cotton blankets.

Pre-wash

Allows warming and mixing up the content of washing

machine to remove the soiled matter. [6]

Main wash

Hot temperature wash: 71°C for ≥ 3 minutes or 65°C for ≥

10 minutes.[5, 6, 8, 10 ] OR

Cold temperature wash: 20°C with bleach (60-150 parts

per million (ppm) available chlorine). [7, 11, 12 ] OR

Ozone washing is a relatively new method that allows

ambient temperature washing cycle, that is 32°C to 35°C.

[13, 14] Please refer to manufacturer’s recommendation

for set up of ozone concentration.

3. Preventive Measures against Communicable Diseases

Rinsing

Rinsing removes all of the detergent and additives from

linen by dilution. [15]

For non-washable items

Examples of non-washable items include mattresses &

pillows.

The plastic cover should be wiped with 1 in 99 diluted

household bleach (5.25%) solutions. The integrity of the

plastic cover should be checked before wiping.

In case of being contaminated with body fluid, mattress

without plastic cover should be steam-cleaned, pillow

without plastic cover should be washed as standard

laundering procedure or dry-cleaned. [9]

For woollen blankets, it should be washed in warm water,

and then dried under the sun or in dryers under cool

temperature, or dry-cleaned. [9]

For quilts, it should be washed in hot water and detergent,

then rinsed and dried preferably in a dryer or under the

sun, or dry-cleaned.

Handling of the soiled linen

Solid and bulky waste should be cautiously removed first.

It should hence be handled as standard laundering

procedure.

Disposable gloves should be used when handling the soiled

linen contaminated with blood, excreta or body fluids.[ 7]

Gown / apron should be worn if cleaning procedure poses

any risks of contamination of skin or working cloths.[ 7]

3. Preventive Measures against Communicable Diseases

3.3.2 Transmission-based Precautions

There are three categories of Transmission-based Precautions:

Contact Precautions, Droplet Precautions, and Airborne

Precautions. For some diseases that have multiple routes of

transmission (e.g., SARS), more than one Transmission-based

Precautions category may be used. When used either singly or

in combination, they are always used in addition to Standard

Precautions.

Contact precautions are designed to reduce the risk of

infectious diseases transmission by direct or indirect contact

when handling of infective materials such as changed linen

sheets. Appropriate PPE should be worn, in accordance

with Part IV in the above, when contact with sick guests or

contaminated environmental surface or items is anticipated.

Droplet precautions are designed to reduce the risk of droplet

transmission of infectious agents (e.g., influenza, rubella,

SARS etc) while airborne precautions are designed to reduce

the risk of infectious diseases, such as pulmonary tuberculosis

and chicken pox, transmitted by small droplet particulates (i.e.

droplet nuclei).

3. Preventive Measures against Communicable Diseases

For sick guests who present respiratory symptoms such as

coughing, sneezing and fever, place a surgical mask on the sick

guest if he/she could tolerate in order to minimize the dispersal

of droplet or droplet nuclei. Advise the sick guests to seek

medical attention and avoid any mass assembling activities.

It is recommended to ask the guest with airborne infectious

diseases (e.g., pulmonary tuberculosis and chicken pox) to put

on a surgical mask, stay in a single room, stop participating any

mass assembling, and immediately seek medical help. If it is

practically possible, it is also recommended to minimize contacts

between the sick guest and hotel staff. Hotel staff should

wear a surgical mask for attending the sick guest, if necessary.

Thorough decontamination (see part III under section 3.3) of

the room housing the sick guest should be performed upon the

guest check out. For personal protection of staff members in

hotels, please refer to Part IV in the above.

3.4 Ventilation

This refers to the process of supplying and removing air to and from a

building, which could be achieved by natural and mechanical means.

Natural ventilation is usually characterized by uncontrolled inward and

outward air leakage through cracks, windows, doorways and vents.

Premises relying entirely on natural ventilation should have openings

of at least 5 to 10% of the floor area to obtain adequate ventilation

in the summer. [1] Mechanical ventilation is provided by air movers

or fans in the wall, roof or air-conditioning system, which promotes

supply and exhaust air flow in a controllable manner.

3. Preventive Measures against Communicable Diseases

3.4.1 Purpose of ventilation

Provide fresh and clean air to maintain a thermally

comfortable work environment, and to remove or dilute

airborne contaminants.

Maintain the temperature and humidity within acceptable

range.

3.4.2 General ventilation design

Good air flow is very important.

Adequate ventilation can maintain the freshness of air,

prevent accumulation of heat and control the level of

airborne contaminants.

Carbon dioxide level of higher than 1,000 ppm may indicate

the insufficiency of indoor ventilation. [1, 2]

The location of fresh air intake points should be carefully

designed to prevent intake of contaminated air.

Optimum temperature of 20°C – 26°C. [3]

Optimum humidity of 40% – 70%. [3]

Avoid blocking of air flow from the supply registers.

Too much air movement causes draughts which are annoying,

if too little, people may complain of stuffiness.

Adjust diffusers and return air grilles properly.

Regular maintenance to keep the ventilation system clean

and functioning properly.

3. Preventive Measures against Communicable Diseases

3.4.3 Infection control measures and ventilation issues

Microorganism such as mould or fungi, bacteria, viruses,

protozoa etc can be found indoors.

Mould or fungal growth on structural materials is a sign that

biological growth in the area is flourishing.

High air humidity, stagnant water, filters packed with dusts

and building structures that have been damaged by moisture

all provided favorable conditions for biological growth.

Use efficient filters in ventilation unit to remove airborne

particulates and spores of microorganisms from the

ventilation system.

Remove potential water sources that may encourage fungal

growth, especially stagnant water in ventilation systems.

Repair and maintain all water pipes and draining systems.

Repair areas that have been affected by flood or seepage.

Remove and replace contaminated porous materials, such as

heavily deposited ventilation unit filters, moldy ceiling tiles

and mildewed carpets.

Disinfect all smooth surfaces (such as wall tiles) that have

been contaminated by fungi.

Provide dehumidifier units for control of humidity within the

optimum range.

3. Preventive Measures against Communicable Diseases

3.4.4 Maintenance of Mechanical Ventilation Systems

Proper inspection, cleaning, testing and maintenance

schedules should be drawn up and followed.

Replace air filters regularly.

Inspect all components of the ventilation system for

cleanliness and microbial growth regularly, and clean them

as required.

Test the performance of the system against the design

specification and make necessary adjustment or repair.

If water cooling towers are used, they should be so

maintained, e.g., use of biocides as appropriate, as to prevent

the growth of micro-organisms (please refer to the Table 1

and 2 below for the water quality of water cooling towers).

Ventilation system should function properly and be regularly

maintained.

Air-conditioning systems should be cleaned according to the

manufacturer’s instructions.

Filters should be changed or cleaned according to the

manufacturer’s instructions. Staff should put on appropriate

PPE (such as goggles and gloves etc) when changing the

filter. [4]

Grilles and air ducts should be cleaned regularly.

3.4.5 Cooling Water Quality Monitoring

Regular monitoring of specific water quality parameters

can provide an early signal before abnormal condition is

detected. This monitoring should be conducted on regular

basis. Indicative freshwater and sea water quality criteria are

provided in the Table 1 and 2 below. However, the owners

/ operators of the cooling tower system shall develop their

own quality monitoring schedules to suit their systems.

3. Preventive Measures against Communicable Diseases

Parameters Cooling Water Quality Criteria

Heterotrophic colony countLess than 100,000 cfu/mL

Legionella bacteria countLess than 10 cfu/mL

Conductivity Less than 1500 μS/cm

Total dissolved solids Less than 1500 ppm

Suspended solids Less than 180 ppm

Calcium hardness Less than 500 ppm

pH 8 ~ 10

Total alkalinity 80 ~ 500 ppm

Oxidizing biocide Follow manufacturer’s specifications

Inhibitor level Follow manufacturer’s specifications

Temperature Optimal temperature for the system design and

current operating conditions

Chlorine as mg/L Cl Less than 200 mg/L

Sulphate as mg/L SO4Less than 200 mg/L

Total iron as mg/L Fe Less than 1.0 mg/L

Residual Cl Less than 0.3 ppm

BOD5

COD

Metal ions

Refer to EPD’s Technical Memorandum on

Standards for Effluent Discharged into Drainage

and Sewerage Systems, Inland and Costal Water

Table 1: Indicative cooling water quality table for fresh water type

cooling tower [4]

3. Preventive Measures against Communicable Diseases

Parameters Cooling Water Quality Criteria

Heterotrophic colony countLess than 100,000 cfu/mL

Legionella bacteria countLess than 10 cfu/mL

Total dissolved solids Less than 100,000 ppm

Suspended solids Less than 180 ppm

pH 8 ~ 10

Total alkalinity 200 ~ 350 ppm

Oxidizing biocide Follow manufacturer’s specifications

Inhibitor level Follow manufacturer’s specifications

Temperature Optimal temperature for the system design and

current operating conditions

Chlorine as mg/L Cl Less than 70,000 mg/L

Total iron as mg/L Fe Less than 1.0 mg/L

BOD5

COD

Metal ions

Refer to EPD’s Technical Memorandum on

Standards for Effluent Discharged into Drainage

and Sewerage Systems, Inland and Costal Water

Table 2: Indicative cooling water quality table for sea water type

cooling tower [4]

3. Preventive Measures against Communicable Diseases

29

Guidelines on Infection Control & Prevention in Hotel Industry 衞生署

Department of Health

4. Facts About Common Communicable Diseases

4.1 Foodborne Disease & Specific Preventive Measures 4.1.1 Foodborne disease

I. Norovirus

Acute gastroenteritis in humans is usually caused by a group

of viruses known as Norwalk-like viruses, also known as small

round structured viruses (SRSVs).

Food can also be contaminated at its source, and oysters

from contaminated waters. Noroviruses are relatively

resistant to environmental challenge: they are able to survive

freezing, temperatures as high as 60°C, and have even been

associated with illness after being steamed in shellfish.

Moreover, noroviruses can survive in up to 10ppm chlorine,

well in excess of levels routinely present in public water

systems.

Clinical features Usually self-limiting.

With symptoms of acute-onset vomiting, watery non-

bloody diarrhea with abdominal cramps, and nausea.

Low-grade fever also occasionally occurs, and vomiting is

more common in children.

The incubation period is usually between 24 and 48 hours

(median in outbreaks 33 to 36 hours), but cases can occur

within 12 hours of exposure.

Often cause outbreaks of gastroenteritis in common

settings including restaurants and catered meals. Isolated

cases of the disease also occur among people of all age

groups.

4. Facts About Common Communicable Diseases

Mode of transmission

Primarily through the fecal-oral route, either by

consumption of fecally contaminated food or water or by

direct person-to-person spread.

Environmental and fomite contamination may also act as a

source of infection.

Transmission is also due to aerosolization of vomitus that

presumably results in droplets contaminating surfaces or

entering the oral mucosa and being swallowed.

Waterborne outbreaks of norovirus disease in community

settings have often been caused by sewage contamination

of wells and recreational water.

II. Salmonella

Food Poisoning is usually caused by Salmonella. Approximately

2000 serotypes cause human disease. Salmonella bacteria

live in the intestines of human and many food animals, such

as cows and chickens, and commonly contaminate foods of

animal origin. People get Salmonella infection by ingesting

these germs, usually in contaminated food or water, but also by

putting objects or fingers contaminated with these germs into

the mouth.

Clinical features Common symptoms include vomiting, diarrhoea and

abdominal pain, with or without fever.

Serious complications, such as dehydration and septicaemia

leading to death may occur when appropriate treatment is

delayed, but these are rare.

The incubation period is usually between 12 and 72 hours.

The illness usually lasts 4 to 7 days.

Occasionally can establish localized infection (e.g., septic

arthritis) or progress to sepsis.

Mode of transmission By consumption of contaminated food, water, or contact

with infected animals.

III. Hepatitis A

Hepatitis A virus (HAV) is classified as a picornavirus. Primates

are the only natural host. Hepatitis means inflammation of

the liver cells. It can be caused by infection, alcohol, drugs,

chemicals and hereditary diseases. Hepatitis A is one form of

viral hepatitis caused by Hepatitis A virus.

Clinical features Usually begins with symptoms such as fever, anorexia,

nausea, vomiting, diarrhea, upper abdominal discomfort,

muscle pain, and malaise.

Jaundice, dark-colored urine, or light-colored stools

might be present at onset or might follow constitutional

symptoms within a few days.

The incubation period is usually around 28 days (range:

15–50 days).

The illness lasts a few weeks but may rarely take months.

Most patients have a complete recovery but in a few cases,

the damage on the liver may be prolonged. Immunity is

usually life-long and there is no chronic carrier state.

Mode of transmission Occurs by fecal-oral route, either by direct contact with an

HAV-infected person or by ingestion of HAV-contaminated

food or water.

4. Facts About Common Communicable Diseases

4.1.2 Preventive Measures of Foodborne Diseases

Keep the premises and kitchen utensils clean.

Dispose rubbish properly.

Keep hands clean and fingernails trimmed.

Wash hands properly with soap and water before eating or

handling food, and after toilet or changing diapers.

Drinking water should be from the mains and preferably

boiled.

Purchase fresh food from reliable sources. Do not patronize

illegal hawkers.

Avoid high risk food like shellfish, big coral reef fish, raw

food or semi-cooked food.

Wear clean washable aprons and caps during food

preparation.

Clean and wash food thoroughly.

Store perishable food in refrigerator, well covered.

Handle and store raw and cooked food separately (upper

compartment of the refrigerator for cooked food and lower

compartment for raw food) to avoid cross contamination.

Clean and defrost the refrigerator regularly and keep the

temperature at or below 4°C.

Cook food thoroughly.

Do not handle cooked and ready-to-serve food with bare

hands; wear gloves if necessary.

Consume food as soon as it is done.

If necessary, refrigerate cooked leftover food and consume

as soon as possible. Reheat thoroughly before consuming.

Discard any addled food items.

People at high risk of Hepatitis may consider receiving

Hepatitis A vaccination.

4. Facts About Common Communicable Diseases

4.2 Respiratory Disease & Specific Preventive Measures 4.2.1 Respiratory disease

I. Legionnaires/Pontiac fever

Legionellosis is an infection caused by the bacterium Legionella

species. Legionellae survive and multiply in natural fresh

water, including lakes, rivers, streams, ponds, mud and soil, as

well as man-made water systems. The optimum temperature

for proliferation of the bacteria is around 20°C to 45°C, and

particularly in the range of 35°C to 43°C. The proliferation

ceases above 46°C and below 20°C, while the survival time

decreases to a few minutes at above 60°C. At 70°C the

organism is killed virtually instantaneously. The bacteria

can hardly survive in salt water and domestic water supplies

which is chlorinated. Over 42 species of Legionellae have been

identified and the Legionella pneumophilia serogroup 1 is most

commonly responsible for Legionnaires’ disease and outbreak.

The disease has two distinct forms:

Legionnaires’ disease, the more severe form of infection

which includes pneumonia

Pontiac fever, a milder illness which is self-limiting

Clinical features Typically manifested as severe pneumonia, with symptoms

of high fever over 39°C, malaise, unproductive cough,

chills, muscle ache, headache and breathless, and

confusion, some often culminating in respiratory failure.

Pontiac fever is a milder form of Legionellosis. Patients

usually present with fever, headache and muscle ache,

which last for about two to five days. Symptoms usually

resolve and patients get well without any medical

treatment.

4. Facts About Common Communicable Diseases

The incubation period is 2 to 10 days.

Route of transmission By inhalation of airborne droplets (i.e. aerosols) or

particles in fine mist containing the bacteria into the lungs

where they are deposited.

According to the previous reported cases, the sources of

the aerosols causing an outbreak were mainly traced to

water systems in buildings including evaporative cooling

towers and humidifiers of air-conditioning systems, hot

and cold water services, fountains / sprinkler systems,

whirlpool and spas, industrial heating and cooling

processes, etc. normal range of operation temperature of

these systems is conducive to the growth of Legionellae.

There is no evidence of person to person spread.

Preventive Measures for Legionnaires/Pontiac fever In Air-conditioning System Remove all potential nourishing water source (e.g.,

stagnant water in drip pans, cooling coils and sumps).

Clean humidifiers or ventilation units regularly.

Use air cooled condensers instead of freshwater cooling

towers.

If freshwater cooling tower is used, effective dosage of

chemicals and biocides should be added to the water

tanks of the cooling tower to prevent growth of algae and

bacteria.

4. Facts About Common Communicable Diseases

For Fountains The fountains should be built with materials that make

it easy to clean and maintain, such as stainless steel.

Since the smooth surface is simple for cleaning that also

minimizes the chance for bacterial growth.

Fountain is recommended to be placed with some distance

from the unprotected furniture, electrical appliances and

food serving area services.

Replace water regularly. Complete changing of water and

cleaning the fountain periodically, usually in 1 to 4 months

intervals or as follow the instructions provided by the

manufacturer, is desirable

If the fountain is placed in direct sunlight, the frequency

of cleaning should be increased to prevent the growth of

algae.

The reservoir and the pump should be cleaned thoroughly

after the draining out of water. All debris and sludge

should be rinsed and removed before re-operation.

1 in 99 diluted household bleach (5.25%) solution can be

used for general disinfecting purpose or other cleansing

agent as suggested by the manufacturer.

II. Influenza-like illness (ILI)

Influenza-Like illness (ILI) is a nonspecific respiratory illness.

Respiratory pathogens that may present with an ILI include

viruses such as influenza virus, respiratory syncytial virus

(RSV), adenovirus, rhinovirus and parainfluenza virus, as

well as bacterial pathogens such as Chlamydia pneumoniae,

Legionella sp., Mycoplasma pneumoniae and Streptococcus

pneumoniae. Influenza, RSV and certain bacterial infections are

particularly important causes of ILI because can lead to serious

complications.

4. Facts About Common Communicable Diseases

Clinical features Characterized by clinically unexplained fever ≥ 38°C and,

respiratory symptoms of cough and / or sore throat, muscle

pain and headache.

The incubation period is 1 to 5 days.

Route of transmission Droplets of respiratory secretions are believed to be the

primary means of person-to-person influenza transmission.

Spread can also occur through direct person-to-person

contact or through fomites.

III. Avian Influenza

Avian influenza (H5N1) virus is one type of Influenza A virus. It

is known previously to infect birds only, cross species infections

have been documented in 1997 and 2003 in Hong Kong

affecting 18 and 2 human cases respectively. It then causes

millions of poultry deaths and

Clinical features Avian influenza has similar clinical presentation as human

influenza.

However, it runs a more rapid downhill course resulting in

high fever, chest infection, respiratory failure, multi-organs

failure, and even death.

Route of transmission Avian Flu is transmitted from infected live birds to man.

Transmission between humans is very inefficient.

4. Facts About Common Communicable Diseases

Preparedness Plan for Influenza Pandemic Hong Kong Government Response Systems The Government’s plan includes a three-level response

system (Alert Response Level, Serious Response Level and

Emergency Response Level).

These levels are based on different risk-graded

epidemiological scenarios relevant to Hong Kong, and

each of them prescribes a given set of public health actions

required.

They are designed to match with the World Health

Organization (WHO)’s guideline1 for pandemic influenza

planning.

According to WHO, preparedness activities for influenza

pandemic should include surveillance, investigation and

control measures, laboratory support, infection control

measures, provision of essential medical services, antiviral

stockpiling, vaccination, port health measures, and

communication.

4. Facts About Common Communicable Diseases

The three-tiered response levels for Influenza Pandemic Response Level Public health objectives Command & control structure AlertObtain timely and accurate

information from other places with a view to preventing introduction of the disease into Hong Kong and to detect local cases as early as possible.

The Food and Health Bureau (FHB), Department of Health (DH), Hospital Authority (HA),

Agriculture, Fisheries and Conservation Department (AFCD) and the Food and

Environmental Hygiene Department (FEHD) are the main parties assessing the nature and level of risks.

Serious Contain the disease as soon as possible, identify foci of infection, prevent

local transmission and exportation of disease to other places.

Steering Committee chaired by Secretary for Food and Health (SFH) will be set up to steer

Government response.

The Steering Committee will be chaired by the Chief Executive.

The Steering Committee will have as its core members the Permanent Secretary

for Food and Health (Health) (PS(Health)), Permanent Secretary for Food and Health

(Food) (PS(Food)), Permanent Secretary for Education, Permanent Secretary for Commerce and Economic Development (Commerce, Industry and Tourism), Director of Agriculture, Fisheries and Conservation, Director of Food and Environmental Hygiene, Director of Health (DoH), Controller, Centre for Health Protection (Controller, CHP), Director of Information Services (DIS), Director of Social Welfare, Commissioner for Tourism and Chief Executive of the Hospital Authority. The committee will co-opt other senior officials and non-Government experts as circumstances warrant.

• Emergency Early phase: contain the disease as soon as possible, identify foci of infection, prevent large outbreak from occurring, interrupt and stop chain of local transmission and prevent exportation of disease to other places.

Late phase: slow down progression of the epidemic and minimise loss of human lives in

order to buy time for the production of an effective vaccine against the novel

pandemic influenza strain.

• The Steering Committee will be chaired by the Chief Executive.

The Steering Committee will have the Chief Secretary for Administration, the Financial

Secretary, the Secretary for Justice, SFH, the Secretary for Commerce and Economic

Development, the Secretary for Education, the Secretary for Development, the Secretary

for Home Affairs, the Secretary for Transport and Housing, the Secretary for Environment, the Secretary for Labour and Welfare, the Secretary for Security, Director of Chief Executive’s Office, DoH and DIS as its members; and will co-opt other senior officials and non-Government experts as circumstances warrant. •

4. Facts About Common Communicable Diseases

IV. Severe Acute Respiratory Syndrome (SARS)

Severe acute respiratory syndrome (SARS) is a viral respiratory

infection caused by a coronavirus (SARS-CoV).

Clinical features The initial symptoms are influenza-like.

Usually begin with fever, which is often high (38°C or

above), and sometimes associated with chills, rigors,

headache, malaise, muscle pain or even diarrhoea.

At the onset of illness, some patients may only have mild

respiratory symptoms. After a few days, symptoms of

lower respiratory tract infection may follow, including

cough without sputum and difficulty in breathing.

In around 10% of patients, the illness may rapidly progress

to respiratory failure requiring intensive medical care.

Symptoms can be more variable among elderly patients.

Symptoms usually appear within 2 to 7 days after

contracting the disease, but the incubation period can be

up to approximately 10 days.

Mode of transmission Predominantly transmitted through close person-to-person

contact, especially via respiratory droplets produced when

an infected person coughs or sneezes.

Droplet spread can take place when droplets from the

cough or sneeze of an infected person are propelled a

short distance and deposited on the mucous membranes

of the mouth, nose, or eyes of persons who are nearby.

The virus can also spread when a person touches a surface

or object contaminated with infectious droplets and then

touches his or her mouth, nose, or eyes.

4. Facts About Common Communicable Diseases

Preventive measures of respiratory disease

I. General Practices:

Maintain good personal and environmental hygiene.

Ensure good ventilation.

Maintain proper function of toilets, drains and pipes.

Cover nose and mouth with tissue paper while sneezing or

coughing, and dispose nasal and mouth discharge properly.

Keep hands clean and wash hands properly: before touching

eyes, nose and mouth, if there is a need to do so; after

handling objects soiled by faeces, respiratory or other body

secretions; after touching public installations or equipment,

such as escalator handrails, elevator control panels or door

knobs.

People with symptoms of respiratory tract infection or fever

should wear a mask and consult a doctor promptly. Let the

doctors know the travel history

People returning from endemic areas should consult doctors

promptly if they have symptoms of respiratory diseases after

the trip.

II. Specific Practices -Avian Influenza

During the “flu” season, it is better to avoid crowded public

places where the ventilation is not good.

Influenza vaccine is prepared according to the prevalence of

strains in the community each year, as recommended by the

World Health Organisation.

Droppings of infected live birds and poultry may carry the

Avian Flu virus, therefore, one should avoid touching live

birds and poultry and their droppings.

If you have been in contact with live birds and poultry, wash

hands thoroughly with liquid soap and water immediately.

4. Facts About Common Communicable Diseases

If you keep live bird at home, avoid close contact with the

pet and wash hands thoroughly with liquid soap each time

after touching it or after cleaning its droppings.

Schools and nurseries should take measures to prevent

children from coming into contact with live birds.

Poultry and eggs should be thoroughly cooked before

eating.

When traveling outside Hong Kong, avoid touching live birds

and poultry.

4.3 CA-MRSA and Specific Preventive Measures 4.3.1 CA-MRSA

Staphylococcus aureus is a bacterium commonly found on

human skin and mucosa. About a third of normal healthy

people may carry this bacterium in the nose or on skin without

infection. Occasionally, this bacterium gets into the body and

causes disease, such as skin infection, wound infection, food

poisoning, urinary tract infection, pneumonia and infection of

blood stream.

Most strains of Staphylococcus aureus are sensitive to many

antibiotics and infections can be effectively treated. However,

those strains that are resistant to the antibiotic methicillin

(methicillin-resistant Staphylococcus aureus, MRSA) are usually

resistant to other commonly used antibiotics such as penicillins

and cephalosporins. It is widely recognised that indiscriminate

use of antibiotics may contribute to antibiotic resistance.

4. Facts About Common Communicable Diseases

In the past, MRSA infections commonly occurred in

institutionalised persons and hospitalised patients. In recent

years, many countries observe MRSA infections in healthy

individuals who have not been hospitalised or stayed in other

healthcare facilities or institutions, nor received medical

procedures in the past 1 year prior to symptom onset. They are

known as community associated- MRSA (CA-MRSA) infections

and usually have different patterns of antibiotic resistance. The

medical profession concerns about the emergence of CA-MRSA.

Clinical features Commonly causes skin or soft tissue infections (pimples,

boils or abscesses).

Symptoms may include redness, warmth, swelling, skin

tenderness or pus drainage.

Sometimes more serious effects such as purulent wound

infections and severe pneumonia may occur, requiring

hospitalisation and special antibiotics for treatment.

Mode of transmission Direct contact with wounds, discharge and soiled areas,

usually via hands which may then contaminate other body

sites, items or surfaces.

Risk factors include close body contact, presence of

openings in the skin such as cuts or abrasions, crowded

conditions, and poor personal hygiene.

The bacteria can be carried by healthy individuals, usually

in nasal cavity, hair and armpit regions, and these carriers

may pass the bacteria to other people.

4. Facts About Common Communicable Diseases

4.3.2 Preventive measures of CA-MRSA

Keep hands clean by washing thoroughly and frequently

with liquid soap and water, or by rubbing them properly

with alcohol handrub.

Wear gloves whenever it is necessary to touch grossly soiled

objects, (e.g. saliva, pus discharge of other household

members or pets), and wash hands thoroughly afterwards.

This is especially important for immunocompromised

persons.

Avoid sharing personal items such as unlaundered towels,

clothing or uniforms and razors.

Avoid direct contact with wounds or anything contaminated

by wound secretions.

Clean any broken skin such as abrasions or cuts immediately

and cover properly with waterproof adhesive bandages.

Wash hands before and after touching wounds. Consult a

doctor promptly if symptoms of infections develop.

Avoid contact sports and visiting public bath houses if you

have an open wound.

Maintain environmental cleanliness and sterilize reused

equipments in public places such as sports centre and public

bathroom.

Do not take antibiotics indiscriminately. Antibiotics should

be prescribed by registered medical practitioners and the

patient should complete the whole course of treatment

according to the prescribed dosage and frequency.

Observe strict hand hygiene and wear mask (for those with

respiratory symptoms) if individuals are taking antibiotics.

4. Facts About Common Communicable Diseases

4.4 Statutory Notifiable Communicable Diseases

Some communicable diseases are highly infectious and cause severe

consequences to such an extent that they threaten human lives and

affect the economy. If there are proper precautionary or control

measures in place, the disaster posed by these communicable diseases

can be averted. To safeguard public health and safety, every country

or region has legislation stipulating certain communicable diseases

as statutory notifiable diseases which warrant special precautions,

and policies are developed to prevent outbreaks and to contain their

spread.

At present, there are 45 statutory notifiable communicable diseases

under the Prevention and Control of Disease Ordinance (Cap. 599)

in Hong Kong. The list is attached in Appendix B. (The list may be

amended subject to prevailing public health need and policy).

All registered medical practitioners are required to notify the Central

Notification Office (CENO), Centre for Health Protection (CHP) of

the Department of Health all suspected or confirmed cases of these

diseases. Medical practitioners are also advised to report other diseases

and conditions that are of public health concern. The Centre for Health

Protection will conduct surveillance and control of these diseases.

4. Facts About Common Communicable Diseases

5. Outbreak of Communicable Diseases 5.1 Outbreak of Communicable Diseases The hotel management should keep a clear staff sick leave record,

and document usual number of sick staff. If the guests or staff in a

hotel develop similar symptoms one after another and the incidence

rate is higher than that at ordinary times, this is an outbreak from the

epidemiological point of view. An example is cited below for reference.

Two or more people develop similar symptoms after eating common

food items. This means that a cluster of food poisoning may have

occurred. The infective agent may be bacteria, viruses or toxins

contained in the food.

5.2 Management of Outbreak of Communicable Disease 5.2.1 Infection control measures during outbreak

If hotel guests/staff are suspected to have contracted a

communicable disease, they should be temporarily isolated

and prompt medical treatment should be arranged.

Appropriate infection control measures should be

implemented as soon as possible (e.g. hotel guests/staff

with respiratory symptoms should put on surgical mask

during respiratory outbreak) to prevent further spread of the

infection in hotel.

Group activities among sick hotel guests should be avoided.

•

•

•

•

46

Guidelines on Infection Control & Prevention in Hotel Industry 衞生署

Department of Health

5. Outbreak of Communicable Diseases 5.2.2 Disinfection of environment

During outbreak situation, disinfect the environment with

1 in 49 diluted household bleach (5.25%) solution, leave for

15-30 minutes before rinsing with water and mopping dry.

Special attention should be paid to the disinfection of toilets,

kitchens and objects which are frequently touched such as

light switches, door knobs and handrails.

Use highly absorptive materials to preliminarily clean up

surfaces contaminated with vomitus/excreta/secretions

before performing the above disinfection procedure.

5.3 Recommendations on Management of Specific Communicable Diseases 5.3.1 Food poisoning

List names of people suspected to be infected and

information on food consumed within several days before

the outbreak for use by the Department of Health during

investigation.

Save food remnants for investigation.

Disinfect articles or places soiled by excreta or vomitus.

Clean and disinfect toilets with 1 in 49 diluted household

bleach (5.25%) solution.

Ensure good personal, food and environmental hygiene in

the hotel.

Maintain a hygienic environment in the kitchen and make

sure that the refrigerator works properly.

Infected staff, especially food handlers, should be granted

sick leave to prevent spread of the disease.

5.3.2 Outbreak of respiratory tract infection

List names of people suspected to be infected.

Adjust the Mechanical Ventilation and Air Conditioning

System (MVAC) and open windows if possible, to improve

indoor ventilation and allow more fresh air intakes.

Be stringent with personal and hand hygiene and observe

for respiratory hygiene/cough etiquette.

Group / assembling activities should be suspended during the

outbreak period.

Sick staff should refrain from work until fully recovered.

5. Outbreak of Communicable Diseases

6. Infection Control Measures in Special Facilities

Hotel guests who have a fever, cough, respiratory symptoms or any signs

of infection should not use common showers, saunas, Jacuzzis or spas (such

as those provided in hotel health clubs or gyms) as moist atmosphere will

aggravate the spread of respiratory viruses.

6.1 Swimming Pools and Whirlpool Spas Acute conjunctivitis, Legionella’s diseases, Pseudomonas dermatitis and

Cryptosporidiosis are common communicable diseases that could be

transmitted in swimming pools or in whirlpool spas settings. Persons

with signs and symptoms of communicable diseases, such as fever,

cough, red eye syndrome or non-intact skin conditions should be

prohibited from using the swimming pool.

Pictorial signage should be displayed conspicuously at the entrance of

the swimming pool area to alert hotel guests of this restriction and to

advise users not to spit or urinate in the pool. Staff member should

advise any persons with signs and symptoms of communicable diseases

to leave the pool and seek medical advice as soon as possible.

Measures such as strengthening of the surveillance of the water quality

and the disinfection system of the swimming pool are of paramount

importance to prevent infectious disease transmission.

6.1.1 Environmental cleansing

I. Daily cleansing routine

The water of the pool should be completely changed by

circulation through a filtration system or by removal from

source in the frequency of not less than once in every 4 hours

for a covered swimming pool and not less than once in every

6 hours for an open air pool during which the swimming

pool is in use by bathers. [29]

Remove grease on water surface, hair and visible dirt (with

the help of vacuum where necessary).

The whole area and all the facilities of the swimming pool

and spa (including walls, floors, equipment, tables and chairs,

stepways, handrails, diving boards, chutes, changing rooms,

showers, foot baths, lockers and latrine fitment) should be

kept clean.

Regular cleansing and disinfection should be carried out at

least once a day by using diluted household bleach (e.g. 1

in 99 diluted household bleach (5.25%) solution) and hence

rinse with water and mop dry. [30]

Dry any collection of water poodles around the pool,

especially at corners and sewage exhaust, to prevent the

formation of breeding ground for mosquitoes and germs.

Scales damaged grouting and stained tiles (results of poor

pH control and impaired water balance) should be dealt

with.

The standard of water clarity should be maintained [31]

in such a way that the turbidity of water as expressed in

Nephelometric Turbidity Units should not exceed 5; and the

colour of water as expressed in Hazen Units or Pt-Co Colour

Units should not exceed 5.

Costume or towels supplied to all bathers should be

disinfected, by immersion for not less than 30 seconds in

boiling water [36] or laundering using hot water (70-80°C)

and detergent. [32]

II. Weekly cleansing routine

Backwash of the filter on weekly basis or when it is triggered

by a pressure drop.

Clean pool wall, pool floor, handrails and stairs to remove

bad marks.

Clean the shower room with cleansing powder to remove

accumulated dirt and soap.

6. Infection Control Measures in Special Facilities

6. Infection Control Measures in Special Facilities

Check tiles for any defect.

III. “When Necessary” cleansing routine

Super chlorination (addition of an extra dose of chlorine

to pool and staying overnight to achieve the Free Available

Chlorine level to 6.0ppm) is recommended [33] every 2 to

4 weeks during regular usage if the pool would not be

emptied for thorough cleansing routinely or when the

amount of combined chlorine is deviated from standard

value during routine daily test.

After super chlorination, the pool can only be used until the

chlorine residual drops below 3.0ppm. [33]

6.1.2 Pool Decontamination

I. Fecal materials found in pool

The procedure depends on whether the stool is formed and

can be removed intact. When it happens, close the pool,

remove the stools, and raise the residue chlorine level to not

less than 2 ppm for at least 1 hour with pH between 7.2 and

7.8 and wait for the chlorine level to resume normal before

the pool is reopened for use. [43]

If a loose stool is dispersed in the pool, raise the residue

chlorine level up to 3 ppm for 53 hours and take water

sample for testing the total bacterial count. Reopen the pool

after passing the test. For small pools, drain way the pool

water, completely disinfect the pool with diluted bleach (1

part of household bleach in 49 parts of water), refill water

for circulation, take water sample for test and reopen the

pool after receiving a satisfactory result. [43]

As it is always difficult to differentiate between formed or

loose stool in water, a more stringent measure should be

taken, i.e., to treat it as loose stool, whenever in doubt. [33]

II. Blood or Vomit

There is no well-documented evidence that the bloodborne

pathogens, e.g. Human Immunodeficiency Virus (HIV), Hepatitis

B Virus (HBV) or Hepatitis C Virus (HCV), are likely to be

transmitted to swimmers from a blood spill in a pool. However,

pathogens such as noroviruses (Norwalk-like viruses) are

likely to be spread by vomitus. The following procedures are

recommended for disinfecting the pool after blood, body fluid

or vomitus contamination [28]:

The pool should be temporarily cleared and the

contamination dispersed until there is no further trace.

Wear appropriate PPE before cleaning up the spillage.

For blood, it should not be washed into poolside drains.

Cleanse the visible matters with disposable absorbent

material.

For blood spillage, mop the area with cloth or paper towels

soaked with 1 in 4 diluted household bleach (5.25%) solution

and leave for 10 minutes before rinsing with water; for

body fluids or vomitus, mop the are with cloth or paper

towels soaked with 1 in 49 diluted household bleach (5.25%)

solution and leave for 15-30 minutes before rinsing with

water.

Test the disinfectant levels (i.e., Chlorine level) and water

quality to ensure it is satisfactory before allowing people to

swim.

6. Infection Control Measures in Special Facilities

6.1.3 Water Standards and Testing Frequency

To ensure a good and safe water quality in swimming pools and

spa, the following water standard and test frequency should be

observed:

Pool standards Parameter Range Testing frequency

Pool Water Temperature ( ° C) 26-28 Twice daily

Spa Water Temperature ( ° C) [34]28-35 Twice daily

Room Temperature ( ° C) [34] 22-28 Once daily

Room Humidity (%) [34]] 50-75 Once daily

Free Chlorine (ppm) [35][44] 1.0-3.0 Hourly

Combined Chlorine (ppm) [35] < 1 Hourly

pH [31][44] 7.2-7.8 Hourly

Clarity [31] Floor markings on the pool bottom at its  greatest depth can be clearly visible when looking from the side of the pool.

Once daily

Total colony-forming units /ml

[31][44]

<200 Regularly and if necessary E. coli, /100 ml [31] [44] 0 Regularly and if necessary Remarks:

Owing to various methods of pool disinfection, filtration and construction, individual

departments can follow their pool manufacturer’s label directions or maintenance

authority advice for the pool parameters, provided that the pool water is safe and

hygienic.

6. Infection Control Measures in Special Facilities

6.1.4 Pool Maintenance

To ensure the proper function and acceptable water quality of

swimming pools and whirlpools, qualified contractors should be

commissioned to carry out maintenance work on pool backing,

water treatment, filters, pumping and circulation systems

regularly. Besides, the pool should be emptied at least annually,

allowing a complete change of water and thorough inspection

of the tiles, grouting and fittings. [33]

Frequency of every maintenance action is suggestive. The in-

charge has to decide according to its local situation (e.g., pool

users’ load)

6.2 Fitness Centre or Gymnasium Room The gymnasium environment and its equipments are commonly shared amongst people using the facilities, therefore, they are considered as frequently touched surfaces and common shared items. Inadequately

cleaned equipment and reusable towels are the common breeding

ground of bacteria, such as community associated methicillin resistant

Staphylococcus aureus (CA-MRSA), gymnasium users may acquire CA-

MRSA skin and soft tissues infection during contact sports or sharing

of common equipment.

Respiratory hygiene and cough etiquette should be observed from

time to time (please refer to section 3.3.1 II for details). Daily cleaning

of the gymnasium environment and its equipment, together with

keeping good personal hygiene, are very important to provide a clean

environment for both the gymnasium users, as well as the staff.

6. Infection Control Measures in Special Facilities

6.2.1 Environmental cleansing:

General facilities and areas of the fitness centre should be

washed with a 1in 99 diluted household bleach (5.25%)

solution and wiped at least once daily.

The frequency of cleaning should be stepped up if the

facilities become dirty.

To facilitate frequent cleaning, adequate disinfectant (such

as 70% alcohol) and paper towels should be made readily

accessible for gymnasium users and staff.

All towels and clothing provided by the gymnasium or fitness

centre should be laundered using hot water (70-80°C) cycle

between use. [32]

Receptables with a lid should be readily available for the

disposal of used paper towels.

Handwashing facilities and 70% alcohol handrub should be

provided for the gymnasium user and staff to wash their

hands after cleaning or wiping down equipment.

6.2.2 Personal hygiene for users

Disinfect any broken skin such as cuts or abrasions immediately and cover properly with waterproof adhesive dressing. Avoid participation in any activities in the gymnasium or

fitness centre if the draining wounds cannot be securely

covered by dressing materials.

Do not share personal items such as towels, clothing, or

water bottles.

Keeping feet dry, frequent changes of absorbent socks, and

adequate drying of shoes between uses.

Keep fingernails short.

Keep hands clean at all time.

6. Infection Control Measures in Special Facilities

Perform hand hygiene as necessary: before eating and

touching nose, mouth or eyes; after going to toilet, touching

public installations or equipment; and after the work-out

session.

Rub hands with a disinfectant containing 70-80% alcohol if

hands are not visibly soiled and liquid soap and water are

not available.

Consider to stop working out at the fitness centre and seek

medical advice if you have respiratory symptoms such as

fever, cough, sore throat, runny nose, shortness of breath or

breathing difficulties.

6.3 Child Care Facilities Infants and toddlers are highly susceptible to contagious diseases and therefore keeping the child care environment clean and orderly is very

important for health and safety of both children and service providers.

Routine cleaning with detergent and water is sufficient for removing

pathogens from surfaces in child care facilities. However, some items

and surfaces such as diaper changing area, toileting area or toys should

be disinfected regularly. [17, 21, 26]

6.3.1 Diapering

The diaper changing area or furniture that may come

to contact with faeces or urine should be cleaned and

disinfected after each diaper change or decontaminated

promptly when they are visibly soiled. [17, 20-21, 23, 25-26]

Tables or counter surfaces used for diapering should be

made of smooth, non-absorbent, non-porous materials or a

washable pad cover. It should be easily cleaned and free of

any cracks. [17, 21, 25-26]

6. Infection Control Measures in Special Facilities

Hand hygiene facilities should be located in close proximity

of the diapering area. [17, 21, 25]

Soiled diapers should be disposed properly in a lidded waste

container.

Hand hygiene should be performed immediately after each

diaper change. [17, 21, 25-26]

For soiled cloth diapers or clothing [17, 25], empty faecal

contents into the toilet and place in a leak resistant bag.

Do not wash or rinse diapers or clothes soiled with faecal

materials in child care facility as it increases the risk of

splashing, contamination of hands and environmental

surfaces.

Disposable towels should be used on top of the mat, and

they should be changed between each diaper change. [17,

20]

Diaper changing area should not be used for food service or

storage, and play area. [21, 25]

Any episodes of diarrhea discovered when changing a diaper,

the child should be separated from other children and kept

out from the child care facilities, as possible. [20, 25]

6.3.2 Furnishings

All furnishings in the child care centre should be washed or

cleaned at least daily and steam-cleaned periodically. [17, 21]

Furnishings and high-touched surfaces should be cleaned

and disinfected regularly or the frequency of cleaning and

disinfection should be increased as the circumstances require.

[27-28]

Surfaces contaminated with body fluid should be disinfected

immediately with 1 in 49 diluted household bleach (5.25%)

solution, leave for 15-30 minutes, and then rinsed with water

and dried. [28]

6. Infection Control Measures in Special Facilities

The schedule of cleaning, operation manual and training

should be established and followed. [27]

6.3.3 Toileting Area

Hand washing facilities should be made convenient in toilet

area. Toilet adapters or step stools that help children to flush

toilets are preferred. [21, 25]

Potty should be emptied immediately after use. They should

be cleaned and disinfected at least daily or when it should

visibly soiled with urine or faeces. [17, 21, 25]

Potty chairs should not be rinsed in a sink used for hand

washing. [17]

No toy is allowed to be taken to the toilet area. [21]

6.3.4 Toys and Ball Pool

Toys with suitable materials that can be easily cleaned and

disinfected should be selected. [18, 21, 24, 26]

Toys made of strong absorbents materials, such as wool or

stuffed furry toys, should not be used if they will be shared.

[17-18, 27]

Large stationary toys such as climbing equipment should be

cleaned and disinfected at least weekly and whenever visibly

soiled. [18, 26]

If toys are likely to be mouthed, it should be rinsed with

water after disinfection between uses by individual children,

or it should be alternatively washed in a dishwasher. [17-18]

Toys and equipments such as blocks or trucks that are not

put into mouths should be cleaned at least daily or when

obviously soiled. [17, 26]

6. Infection Control Measures in Special Facilities

Hard or plastic toys should be cleaned regularly e.g. daily by

washing with water and detergent, followed by thorough

rinsing and drying. [17, 21, 26]

Soft or cloth toys should be washed daily in the hot

water cycle of washing machine, taking care to follow the

manufacturers washing instructions. [17, 21, 26]

If toys are required for cleaning and disinfection, do so

immediately or they should be stored in a designated labeled

container separated from the toys that are clean and ready

for use. [18]

Toys should be decontaminated immediately when it is visibly

soiled or contaminated. [21, 26]

Hard and plastic toys should be disinfected with 1 in 49

diluted household bleach solution, then rinsed with water

and let it dry. [21, 26]

70% alcohol solution could be used on the metal surface of

any toys

Soft or stuffed toys could be cleaned by laundering process

in a hot water wash (at least 60°C) of washing machine.

Heavily contaminated toys may have to be discarded. [17, 21,

26]

Hand hygiene of the children is recommended after handling

contaminated toys or after playing in the ball pool. [21, 26]

6.3.5 Management guidance for gastroenteritis outbreak

Sick children or those who present gastroenteritis symptoms

should be excluded from child care facility. Prompt medical

treatment should be arranged. [17, 20, 23, 25, 27]

Group activities should be suspended during the period of

outbreak. [17, 21, 25]

6. Infection Control Measures in Special Facilities

Environmental surface such as toilet seats, flush handles or

door handles should be cleaned and disinfected with 1 in

49 diluted household bleach (5.25%) solution regularly or if

situation allows and requires, the frequency of cleaning and

disinfection could be increased. [17, 21, 23, 25, 27]

70% alcohol should be used for disinfecting metal surfaces,

if required. [25, 27]

If spillage occurs (please refer to section 5.2.2 for details of

spillage handling), it should be decontaminated promptly.

Procedures for cleaning and disinfecting toys should be

strictly followed. [17, 21]

Soft or stuffed toys should not be used during the period of

outbreak. [21]

Other toys should be washed and disinfected at least daily.

Stock rotation should occur to limit the number of toys

accessible at once. [21]

Ensure practice of good hand hygiene and diapering

changing in all children and care providers. [17, 21, 27]

6.4 Sauna, Massage and Beauty Centre As general good practices, sufficient dressing rooms, shower rooms,

toilet facilities and separate locker for the guests are recommended

to promote the personal hygiene. Adequate handwashing facilities

including handwashing basin, liquid soap and paper towels/hand dryer

should be provided to facilitate handwashing for the users. Adequate

showering facilities and toiletries including bathing liquid soap and

shampoo should be provided for the convenience of the guests using

the facilities. [37, 41, 42] Hand hygiene (please refer to section 3.3.1

I for details) as well as respiratory hygiene (please refer to section

section 3.3.1 II for details) should be observed from time to time.

6. Infection Control Measures in Special Facilities

Having a shower before entering and using of the facilities is

recommended. [38] Towels provided for the guests should be

laundered using hot water (70-80°C) cycle between use. [32] A covered

receptacle should be provided exclusively for soiled linens and towels

which can be readily emptied and cleaned. [37, 41, 42]

Guests with signs and symptoms of communicable diseases, such as

skin lesions, respiratory illness or diarrhea should be prohibited from

the use of the facilities. [37, 41]

6.4.1 Environmental cleansing

I. Sauna

Sweeping or vacuuming the sauna room should be

performed after each session to keep it free from dust and

hair. [37]

The environmental surface, especially the bench top, should

be disinfected with 1 in 99 diluted household bleach (5.25%)

solution after each session, then rinsed with water and

wiped dry.

If floor is covered with ceramic tile, all the duckboards should

be removed and disinfected with 1 in 99 diluted household

bleach (5.25%) solution after each session, then rinsed with

water and wiped dry. Before replacing back the duckboards

to the original position, the floor underneath should also be

cleaned with detergent, rinsed well and wiped dry at least

daily.

If bleach is used, cleaning and disinfection should be done at

room temperature and under good ventilation. The surfaces

should be thoroughly rinsed with water before subsequent

session.[38]

II. Massage & beauty centre

Separate massage room for each patron if possible. [42]

6. Infection Control Measures in Special Facilities

All walls, ceilings, floors should be in good repair and

maintained in a clean and sanitary condition. It should be

cleaned at least twice each day. [42]

The surface of massage couch should be made of durable

washable plastic or other waterproof material which is easy

for cleaning, disinfecting and maintenance.

It should be disinfected with 1 in 99 diluted household bleach

(5.25%) solution then rinsed with water and wiped dry after

each use. It should be checked for any defect regularly.

Written record of cleaning and disinfecting schedule should

be established and maintained. [42]

6.4.2 Specific requirement and practice

I. Sauna

Wooden benches should be painted with a waterproof paint

to seal and smooth the surface, facilitate drying, and reduce

areas where bacteria may grow.[38]

Stainless steel surface of the electric sauna heater should be

wiped with mild detergent and soft cloth at least daily. It

should then be rinsed with water afterwards.

Sauna stones can be washed with soapy water and rinsed

with plain water. It should be inspected from time to time

to make sure their integrity and cleanliness. It should be

changed if cracked or they are giving off a bad odor.

Clients should be encouraged to use a clean towel or clothing

to act as a barrier between the benches and bare skin.[32,

38, 39]

Maintenance check should be done yearly or as suggested by

the manufacturer for the sauna facilities.

6. Infection Control Measures in Special Facilities

II. Massage and beauty centre

All towels or linen should undergo proper laundering process

after each use. [32, 37, 41, 42]

Single-use paper coverings should be discarded into a

sanitary receptacle after use. [42]

All instruments should be kept clean, in good repair, and

capable of being disinfected and/or sanitized. For example,

hot stones used for massage should be disinfected after each

use. Disposable instruments should be used when available.

[37, 41, 42]

If clothing is provided for the guests, it should undergo

proper laundering process after each use. [32, 37, 42]If

underwear is provided, it should be disposable and for single

use only. [42]

To avoid contamination, staff should ensure any make-up,

cream, ointment, massage oil or similar substance is removed

from its original container / tube using a clean disposable

applicator. Applicators used for dispensing must not be re-

dipped into the original container and must be discarded

after each client. Single use applicators are recommended.

[39]

Leftover portion for dispensing should not be returned to

the original container and must not be used on other clients.

[39]

Pump outlets, bottles and nozzles for dispensing are a

potential source of contamination, particularly due to the

contents accumulated around the outlet. Nozzles should be

cleaned frequently and dried before replaced. Wash bottles

and nozzles in warm water and detergent, rinse them under

hot running water, and dry them using a lint-free cloth,

before refilling the bottle or replacing the pump / spray

nozzle. Pump / spray bottles should never be topped up. [39]

6. Infection Control Measures in Special Facilities

6.4.3 Personal hygiene of health of masseur / masseuse

Masseur / masseuse should maintain good personal hygiene,

such as executing proper hand hygiene, [37, 39] keeping

nail short and clean. No artificial nails, such as acrylic nails,

accessories, such as watch or ring, is allowed on providing

massage service.

Masseur / masseuse should wear clean outer garments /

uniform when serving a patron. [41, 42]

Masseur / masseuse should be refrained from work if they

have active skin lesion, nail infection or any signs and

symptoms of infectious disease, such as fever, sore throat or

cough. [37]

6.4.4 Public showering facilities

Materials such as the large tiles are recommended for ease of

maintenance. It should be checked for any defect regularly.

The shower room surface should be cleaned frequently with

detergent and water, or it should be disinfected regularly

with 1 in 99 diluted household bleach (5.25%) solution, then

rinsed with water and wiped dry, if necessary.

Grab bars and showerheads should be cleaned frequently as

these are the commonly touched area.

Floor should be kept dry after cleaning.

Handwashing facilities, including handwashing basin, liquid

soap and paper towels or hand dryer, should be provided. [37]

Eusure adequate toiletries, such as bathing liquid soap &

shampoo are provided. [37]

Towels provided for the guests should be laundered using

hot water (70-80°C) cycle between use. [32]

6. Infection Control Measures in Special Facilities

A covered receptacle which can be readily emptied and

cleaned should be provided exclusively for the soiled linens

and towels. [37]

The guests should be recommended to avoid walking with

bare foot in the shower room. [38]

About half a litre of water should be poured into each drain

outlet regularly (e.g. once a week) so as to maintain the

water column in the pipe to serve as water lock. [40]

Ensure the drain pipes are built with U-shaped water traps;

the pipelines should never be altered without authorization.

[40]

Ensure the soil pipes are unobstructed and the sewage drains

are functioning properly without leakage so as to avoid

breeding of infective agents. [40]

The ventilation system should be maintained to provide a

well-ventilated environment. The exhaust fan should be

cleaned regularly.

6.5 Catering Services To safeguard the health of guests and to ensure the satisfactory

standards are reached, guidelines and instructions on food safety

and food premises hygiene issued by the Food and Environmental

Hygiene Department (FEHD) should be complied from time to time.

Hotel management should also promote food safety and hygiene by

providing relevant trainings to food handlers and supervisors regularly.

The following advices should not be taken in any way as a substitute

for the regulations issued by the FEHD. Please refer to the most

updated guidelines and information posted on the FEHD’s website at

http://www.fehd.gov.hk for details.

6. Infection Control Measures in Special Facilities

6.5.1 Personal hygiene of food handlers

Keep all parts of bodies, clothing, hands and nails clean

at all times. Nails should be kept short and unpolished.

Cover wounds on hands completely by suitable waterproof

dressings.

Perform proper hand hygiene frequently and as required.

Wear mask when handling food and disposable gloves

especially when handling ready-to-eat food.

Refrain from smoking, spitting, chewing, eating, sneezing

or coughing over unprotected food or food contact surface,

touching ready-to-eat food with bare hands, sitting, lying

or standing on any surface liable to come into contact with

food, tasting food with fingers, touching hair or other parts

of bodies when inside food preparation areas as that may

result in contamination of food.

Food handlers suffering or suspected to be suffering from

a communicable disease should immediately report their

illness to the management and seek medical treatment. They

should be immediately suspended from engaging in any

work that may allow them to come into contact with food,

food contact surfaces, food utensils and equipment.

6.5.2 Food Hygiene

Food should be supplied from approved and reputable

sources and promptly identified and moved to proper

storage areas upon receipt to facilitate tracing products in

the event of a recall or food incident,

Food and raw materials should be stored off the floor and

first-in-first-out principle for food storage should be applied

to minimize the growth of microorganisms and to prevent

food from becoming unsafe or unsuitable during their

expected shelf-lives.

6. Infection Control Measures in Special Facilities

Ensure food be kept at proper temperature during cooling,

storage, display and transportation to suppress bacteria from

multiplying to an unsafe level in the food. The temperature

inside the refrigerator should be kept at or below 4°C and

the freezer at or below -18°C. The temperature inside the

refrigerator should be monitored regularly.

Frozen food should be thawed properly and completely to

minimize the growth of food poisoning bacteria and toxin

production.

Prevent cross-contamination between raw and cooked or

read-to-eat food by separate handling (e.g. using separate

knives and chopping boards) and storage. Food should also

be properly protected during storage, preparation, display,

service and transportation to prevent contamination by

equipment, utensils and personnel as the transfer of bacteria

from one food (usually raw) to another is one of the major

causes of foodborne illnesses.

Cook food thoroughly before consumption in order to

ensure food safety. The centre or the thickest part of the

food needs to reach 75°C for 15 seconds to kill any bacteria

causing foodborne diseases, although heating food to a

lower temperature for longer periods of time may be equally

effective.

Food that previously cooked and cooled be reheated

thoroughly be-fore consumption to minimize the time that

cooked food is exposed to the temperature danger zone

(between 4°C and 60°C) which allows pathogenic bacteria to

grow during the reheating process.

6. Infection Control Measures in Special Facilities

6.5.3 Premises Hygiene

Ensure walls, floors and ceilings are properly maintained

and kept clean, sewerage / grease trap, plumbing system

and extraction / exhaust systems in food room are in good

working condition and grease filters installed and kept clean

so as to protect food from contamination.

Ensure ventilating system in premises is functioning properly

to safeguard the health of customers and workers.

Toilets should be kept clean and free from obstruction. Water

closets should be in good working condition and wash hand

basins should be adequate, kept clean and provided with

liquid soap and hand-drying facilities to facilitate frequent

handwashing of food handlers.

Ensure adequate waste containers, properly covered and

emptied daily.

Prevent pest infestation – proper storage of food, proper

disposal of rubbish, be aware of signs of pest infestation and

arrange for pest disinfestations where necessary.

Prohibit dogs, cats, birds or pets in food rooms.

Ensure no deviation from approved layout.

6.5.4 Utensils and equipment

Food contact surfaces of equipment and utensils should be

properly maintained, kept clean and sanitized between uses.

Non-food contact surfaces of equipment should be properly

maintained and kept clean.

Cleaned equipment and utensils should be properly stored.

6. Infection Control Measures in Special Facilities

7. Appendix Appendix A: Hand Hygiene Technique 69

Guidelines on Infection Control & Prevention in Hotel Industry 衞生署

Department of Health

7. Appendix Appendix B: Notification of Infectious Diseases

In accordance with the Prevention and Control of Disease Ordinance (Cap.599),

there are 45 notifiable infectious diseases. All registered medical practitioners are

required to notify the Centre for Health Protection all suspected or confirmed cases

of these diseases. Medical practitioners are also advised to report other diseases and conditions that are of public health concern. The Centre for Health Protection will

conduct surveillance and control of these diseases.

Statutory notifiable diseases

These are the infectious diseases specified in the First Schedule to the

Prevention and Control of Disease Ordinance (Cap. 599). Notification of suspected or

confirmed cases of these diseases is required by law.

Acute poliomyelitis •

Amoebic dysentery •

Anthrax •

Bacillary dysentery •

Botulism •

Chickenpox •

Cholera •

Community-associated methicillin-

resistant Staphylococcus aureus

infection

•

Creutzfeldt-Jakob disease •

Dengue fever •

Diphtheria •

Escherichia coli O157:H7 infection •

Food poisoning •

Haemophilus influenzae type b

infection (invasive)

•

Hantavirus infection •

Influenza A (H2), Influenza A (H5),

Influenza A (H7) or Influenza A (H9)

•

Japanese encephalitis •

Legionnaires’ disease •

Leprosy •

Leptospirosis •

Listeriosis •

Malaria •

Measles •

Meningococcal infection (invasive) •

Mumps •

Paratyphoid fever •

Plague •

Psittacosis •

Q fever •

Rabies •

Relapsing fever •

Rubella and congenital rubella •

Scarlet fever •

Severe Acute Respiratory Syndrome •

Smallpox •

Streptococcus suis infection •

7. Appendix Other communicable diseases of topical public health concern

Though not specified in the First Schedule to the Prevention and Control of

Disease Ordinance, medical practitioners are urged to report suspected or confirmed

cases of the following diseases to CENO for arrangement of investigation and control

as appropriate:

Acute flaccid paralysis • Cryptosporidiosis •

Brucellosis • Enterovirus 71 infection •

Chikungunya fever • Vibrio vulnificus infection •

Suspected institutional outbreaks

Any suspected institutional outbreaks of communicable diseases can be

reported to CENO for arrangement of investigation and control as appropriate.

Some common examples are as follows:

Acute Conjunctivitis • Head Lice •

Gastroenteritis • Respiratory Tract Infections •

Hand-foot-mouth Disease • Scabies •

(Please refer to CENO on-line website @ www.chp.gov.hk/ceno for the

update list of statutory notifiable diseases)

Tetanus •

Tuberculosis •

Typhoid fever •

Typhus and other rickettsial diseases •

Viral haemorrhagic fever •

Viral hepatitis •

West Nile virus infection •

Whooping cough •

Yellow fever •

7. Appendix Appendix C: Commonly Used of Disinfectants NameConcentrationUsage Properties

Sodium

Hypochlorites

1% (10,000 ppm)

Dilution ratio 1 :5*

0. 1% (1, 000 ppm)

Dilution ratio 1 :50*

* Preparation of

Diluted should be according to the information sheet of “Preparation of Bleach”

Environmental or equipment disinfection

Mixes with water Corrosive to metals Avoid contact with skin or mucous membrane Contact with acids liberates toxic gas

Diluted solution decompose rapidly Freshly prepared diluted bleach should be used within 24 hours

Alcohols:

e.g.

– Ethyl Alcohol

– Isopropyl Alcohol

70% Skin or metal

surface

disinfection

instrumental

disinfection

Inflammable liquid Rapid

action but volatile Poor

penetration into organic

matter

Diguan ides :

e.g.

– Chlorhe x id ine :

Hib itane

aqueous 1:1000 Skin and mucous

membrane

disinfection

Wound dressing

Solution Low toxicity

– Chlorhe x id ine

+ cetrim ide/

cetavlon e. g.

Savlon

aqueous 1:100 Solution Low toxicity

Detergent properties

7. Appendix Appendix D: The Use of Bleach The Use of Bleach

Bleach is a strong and effective disinfectant. Its active ingredient, sodium

hypochlorite, denatures protein in micro-organisms and is therefore effective in

killing bacteria, fungus and viruses. Household bleach works quickly and is widely

available at a low cost. Diluted household bleach is thus recommended for the

disinfection of facilities.

As bleach irritates mucous membranes, the skin and the airway, decomposes

under heat or light and reacts readily with other chemicals, caution should be

exercised in the use of it. Improper use of bleach may reduce its effectiveness in

disinfection and also lead to accidents which can be harmful to health. Overuse of

bleach or using a bleach solution that is too concentrated results in the production

of toxic substances that pollute the environment and disturb ecological balance.

Tools and Equipment

Before cleaning, get all necessary tools and equipment ready. Cleaning tools,

cleansers/disinfectants, measuring tools and protective gear will be needed.

Cleaning tools:

Brush, mop, towel, spray can and bucket.

Cleansers/disinfectants:

Bleach and water.

Measuring tools:

Tablespoon and measuring cup.

Protective gear:

Mask, rubber gloves, plastic apron and goggles (recommended).

7. Appendix Procedures of Preparing / Using Diluted Bleach

1. Keep windows open when diluting or using bleach to ensure good

ventilation.

2. Put on protective gear when diluting or using bleach as it irritates mucous

membranes, the skin and the airway.

3. Cold water should be used for dilution as hot water decomposes the active

ingredient of bleach and renders it ineffective.

4. Bleach containing 5.25% sodium hypochlorite should be diluted as follows:

• 1 in 99 diluted household bleach (mixing 10ml of bleach with 990ml of

water) can be used for general household cleaning.

• 1 in 49 diluted household bleach (mixing 10ml of bleach with 490ml of

water) is used to

• disinfect surfaces or articles contaminated with vomitus, excreta and

secretions.

5. Make adjustments to the amount of bleach added if its concentration of

sodium hypochlorite is above or below 5.25%.

6. For accurate measurement of the amount of bleach added, a tablespoon or

measuring cup can be used.

7. Rinse disinfected articles with water and wipe dry.

8. Cleaning tools should be soaked in diluted bleach for 30 minutes and then

rinsed thoroughly before reuse.

9. Finally, wash hands with liquid soap, then dry hands with a clean towel or

disposable towel.

• Calculation: Multiplier of the amount of bleach added = 5.25

concentration of sodium hypochlorite in bleach

• For example, when diluting a bleach containing only 5% sodium

hypochlorite, the multiplier is 5.25 / 5=1.05. That means 10 x 1.05 =10.5ml

of bleach should be used when preparing a bleach solution.

7. Appendix Precautions

• Avoid using bleach on metals, wool, nylon, silk, dyed fabric and painted

surfaces.

• Avoid touching the eyes. If bleach gets into the eyes, immediately rinse

with water for at least 15 minutes and consult a doctor.

• Bleach should not be used together or mixed with other household

detergents as this reduces its effectiveness in disinfection and causes

chemical reactions. For instance, a toxic gas is produced when bleach is

mixed with acidic detergents such as those used for toilet cleaning. This

could result in accidents and injuries. If necessary, use detergents first and

rinse thoroughly with water before using bleach for disinfection.

• As undiluted bleach liberates a toxic gas when exposed to sunlight, it

should be stored in a cool and shaded place out of reach of children.

• Sodium hypochlorite decomposes with time. To ensure its effectiveness, it

is advised to purchase recently produced bleach and avoid over-stocking.

• For effective disinfection, diluted bleach should be used within 24 hours

after preparation as decomposition increases with time if left unused.

November 2007 (revised)

7. Appendix Appendix E: Maintain Cough Manners

7. Appendix Appendix F: Sequence of Donning & Removing Personal Protective Equipment (PPE) 77

Guidelines on Infection Control & Prevention in Hotel Industry 衞生署

Department of Health

7. Appendix Appendix G: Useful links Department of Health http:// www.dh.gov.hk

– Centre for Health Protection http://www.chp.gov.hk

– Central Notification Office (CENO) http://www.chp.gov.hk/ceno

– Travel Health Service http://www.travelhealth.gov.hk/

– Central Health Education Unit http://www.cheu.gov.hk

Food and Environmental Hygiene Departmenthttp://www.fehd.gov.hk

Center for Disease Control and Preventionhttp://www.cdc.gov

World Health Organization http://www.who.int

References: 1.Occupational Safety and Health Branch. Labour Department. Guidance Notes on

Ventilation and Maintenance of Ventilation Systems. 2005.

2.American Society of Heating, Refrigerating and Air-conditioning Engineers, Inc.

ANSI/ASHARE Standard 62-2001. Ventilation for Acceptable Indoor Air Quality.

2004.

3.Occupational Safety and Health Branch. Labour Department. A Simple Guide to

Health Risk Assessment. Office Environment Series OE 4/2004. Ventilation. 2004.

4.Electrical & Mechanical Services Department. Code of Practice for Water-cooled Air

Conditioning Systems. Part 2: Operation and Maintenance of Cooling Towers. 2006.

5.Barrie. Laundry hygiene and handling of contaminated linen. In: G. A. J. Ayliffe.,

A. P. Fraise., A. M. Geddes., & K. Mitchell (Eds), Control of Hospital Infection. A

Practical Handbook (4th ed.). London: Arnold. 2000. (pp239-343)

6.Maurer, I. M. Hospital Hygiene. London: Edward Arnold.1985.

7.Centers for Disease Control and Prevention. (2000). Laundry in Health Care Setting.

Retieved November 15, 2005 from http://www.cdc.gov/ncidod/dhqp/bp_laundry.html

8.Bradley, B. Physical and Chemical Disinfection In: G. A. J. Ayliffe., A. P. Fraise., A. M.

Geddes., & K. Mitchell (Eds), Control of Hospital Infection. A Practical Handbook

(4th ed.). London: Arnold. 2000. (pp75)

9.World Health Organization-Western Pacific Region. Practical Guidelines for

Infection Control in Health Care Facilities.(2003) Retrieved February 21, 2005, from

http://www.wpro.who.int/sars/docs/practicalguidelines/default.asp

10.NHS Executive. Hospital Laundry Arrangements for Used and Infected Linen. (1995)

Retrieved March 1, 2005, from http://www.dh.gov.uk/PublicationsAndStatistics/

LettersAndCirculars/HealthServiceGuidelines/HealthServiceGuidelinesArticle/fs/en?

CONTENT_ID=4017865&chk=5M eXDx

References: 11.Blaser, M. J., Smith, P. F., Cody, H. J., Wang, W. L., & LaForce, F. M. Killing of

Fabric-associated Bacteria in Hospital Laundry by Low-temperature Washing. The

Journal of Infectious Diseases, (1984)149(1). 48-57.

12.New South Wales Hospitals Planning Advisory Centre. Report on Research into

Proposed Low Temperature Water Washing in Hospital Laundries in New South

Wales. Sydney: Author. (1988).

13.Rice, R. G.. Century 21 – Pregnant with ozone. Ozone Science & Engineering, (2001)

24, 1-15.

14.Weavers, L. K., & Wickramanayake, G. B. Disinfection and sterilization using ozone.

In: S. S. Block (Ed), Disinfection , Sterilization, and Preservation. (5th Ed) USA:

Lippincott Williams & Wilkins. (2001) pp205-214

15.Barrie. Control of Hospital Infection. Laundry, Kitchen, Hygiene and Clinical Waste

Disposal. (1994) pp239-243

16.Barros AJD, Ross DA et al. Preventing acute respiratory infections and diarrhea in

child care centres. Acta Paediatr 1999; 88: 1113-8.

17.Centers for Disease Control and Prevention. A Handbook for Child Care Providers:

Safe and Healthy Child Care, 1996.

18.Centers for Disease Control and Prevention. Guideline for Isolation Precautions:

Preventing Transmission of Infectious Agents in Healthcare Settings, 2007.

19.Centers for Disease Control and Prevention. Preventing the Spread of Influenza (the

Flu) in Child Care Settings: Guidance for Administrators, Care Providers, and Other

Staff, 2006.

20.Centers for Disease Control and Prevention. Division of Bacterial and Mycotic

Diseases:Shigellosis,2005.availablefrom: http://www.cdc.gov/ncidod/dbmd/

diseaseinfo/shigellosis_g.htm

21.Health Protection Agency. Guidelines for the Control of Infection and Communicable

Disease in Nurseries and Other Institutional Early Years Settings in South West

London Sector, 2005.

22.Dartford and Gravesham National Health Service Trust. Policy on the Cleaning and

Disinfection of Toys, 2004.

23.Environ Health Associates, INC. Norovirus Outbreak Control Guidelines, 2004.

24.Randle J, Fleming K. The risk of infection from toys in the intensive care setting.

Nursing Standard 2006; 20: no. 40.

25.Community Care Facilities Branch, Ministry of Planning, Victoria, BC. Preventing

Illness in Child Care Settings, 2003.

26.Public Health Protection Division, United Kingdom. Infection Control Guidance for

Nurseries, Playgroups and other Childcare Setting, 2006.

27.Centre for Health Protection, Department of Health. Guidelines on Prevention of

Communicable Diseases in Child Care Centres, Kindergartens and Schools, 2004.

28.Infection Control Branch, Centre for Health Protection, Department of Health.

Guideline for Environmental Decontamination(Advanced Draft), 2007

29.Public Health and Manicipal Services Ordinance 132 CA: Swimming Pools

Regulation, Section 9, Changing of Water, 2000

30.Food and Environmental Hygiene Department. Guidelines on Prevention of Breeding

of Blood Worms in Swimming Pool, 2006. Available at http://www.fehd.gov.hk/

safefood/risk-pest-arthropod_mos.html on 19 December 2007.

31.Public Health and Manicipal Services Ordinance 132 CA: Swimming Pools

Regulation, Section 10, Quality of Water, 2000

32.Victorian Government Department of Human Services. Health Guidelines for

Personal Care and Body Art Industries, 2004

33.Hospital Authority. Guidelines on Management of Hydrotherapy & its Facilities.,

2007.

34.Standard Australia AS 3979 Hydrotherapy pools, the Victorian Rehabilitation, 1993

References:

35.The Chartered Society of Physiotherapy Service standards, Management of the

Hydrotherapy pool, 2000

36.Public Health and Manicipal Services Ordinance 132 CA: Swimming Pools

Regulation, Section 15, Sterilization of bathing costumes and towels, 2000

37.Greenwich Department of Health. Body Care Facilities Technical Standards and

Requirements. February 2004 Revision.

38.Los Angeles County Department of public health, Guidelines for Reducing the Spread

of Staph/CAMRSA in Non-Healthcare Settings. v. 2. February 2007

39.State Government of Victoria, Australia, Department of Human Service. Massage,

Manicure, Pedicure and Facials. Client Health Information. July 2006

40.http://www.bd.gov.hk/english/documents/code/dsg/DrainagePipeMaintenance.pdf

41.Greenwich Department of Health. Division of Environmental Services.

Massage Establishments: Technical Standards. (2002) available at:

http://greenwichct.virtualtownhall.net/Public_Documents/GreenwichCT_Environment/

GreenwichCT_HDAppsFrms/I00F4E371.0/Technical%20Standards.pdf

42.Leisure and Culture Services Department. Operations Permit: Massage Business

Chapter 6.60, November 1996

43. 康樂及文化事務署．處理公眾泳池池水受糞便或嘔吐物污染的指引．S/F (4) inLCS

3/HQ 805/00 (2007 年7 月30 日修訂)

44. 康樂及文化事務署．處理水質不符合標準的指引．S/F (1) inLCS 2/HQ 805/04 (2007

年7月30日修訂)”.