Nosocomial Infections & Ward Procedures. Saturday, 23 Aug 2003, 9:00 am.
Seminar Room 1, M/F Hospital Authority Building, 147B Argyle Street, Kowloon.
HA SARS R&D Roundtable 2 Nosocomial Infections & Ward Procedures Saturday, 23 Aug 2003, 9:00 am Seminar Room 1, M/F Hospital Authority Building, 147B Argyle Street, Kowloon
Summary of discussion Introductory remarks Dr Vivian Taam Wong, Hospital Authority Head Office !
A special note of thanks was extended to the Electrical & Mechanical Service Dept (EMSD) colleagues for attending this meeting in preparation for the next roundtable, focusing on facilities, equipment and personal protective equipment (PPE).
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The focus of the previous Roundtable 1 was on epidemiology of SARS outbreak in the community, which set the scene for this Roundtable 2, bringing together experts to share their experience in the clinical management of nosocomial infections and ward procedures.
1.
MODE OF TRANSMISSION
Some lessons learnt from the unsuspected cases Prof PL Ho, Dept of Microbiology, HKU An evaluation of risk factors in SARS-infected health care workers (HCW) was performed during the first week of April 2003. This involved a survey conducted in all HA hospitals, except PWH, with a return rate of 95%. !
Of the health care related infection, 69% were identified as cluster cases, and 31% isolated cases, thus demonstrating the importance of cluster prevention.
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Staff infection rates (as % of the work force) were similar for doctors, nurses, health care assistants and allied health members.
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The source of contact reported by the 199 infected staff with health-care related infection showed 38% of SARS cases in staff was related to unsuspected SARS cases.
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The following were risk factors for staff infection: # Reuse of disposable gowns # No change of uniform clothes after work # Taking part in feeding of patients
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SARS cases already existed before the WHO global alert was issued. These cases were diagnosed, then, as “atypical pneumonias”.
Floor discussion !
Clinical vigilance (via thorough history taking by clinicians e.g. about previous overseas traveling) was of more importance that surveillance. (Please click to see “Epidemiology Strengthening” presentation by Prof. P L Ho in Roundtable 1 meeting summary.)
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Differentiation between failure of surveillance vs. failure of control of infection.
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“Super-spreader” is an imprecise term and should be replaced by “super-spreading event” which described a group of factors involved in the spread of infection.
Why hospital workers came down with SARS? Prof Joseph TF Lau, Centre for Epidemiology & Biostatistics, CUHK A retrospective, case-control study of 72 hospital workers who contracted SARS and 144 controls matched for job rank and clinical setting, was conducted to determine why many hospital workers experienced breakthrough transmission of SARS despite the implementation of stringent infection control measures. 1
Conclusions !
Inconsistent use of the following PPE were associated with risk of SAR infection: goggles (ORunadj=3.5-6.9, p
