The University of Hong Kong Infection Control Plan for Influenza Pandemic Version 1.1 Author University Health Service, The University of Hong Kong Approved By Task Force on Infectious Diseases, The University of Hong Kong Effective Date May 20, 2013 Version 1.1 Review Date Version 1 (May 20, 2013)
Page Page 1 of 12 Table of Content Section Page 1 Alert Response Level 2 A. Advice on Hygiene Measure A1. Personal Hygiene 2 A2. General Cleaning Guideline 3 B. Travel Advice 4 C. Examination Guideline 4 2 Serious Response Level 5 A. Advice on Hygiene Measure A1. Personal Hygiene 5 A2. General Cleaning Guideline 6 B. Travel Advice 6 C. Examination Guideline 7 3 Emergency Response Level 8 A. Advice on Hygiene Measure Personal Hygiene 8 General Cleaning Guideline 9 B. Travel Advice 9 C. Examination Guideline 10 4 References 11
Page Page 2 of 12 HKU There are Three Response levels in HKSAR Government s Preparedness Plan for Influenza Pandemic (2014) 1 : 1. Alert Response Level 2. Serious Response Level 3. Emergency Response Level 1. Alert Response Level Alert Response Level corresponds to a situation where the risk of a novel influenza virus causing new and serious health impact in Hong Kong is LOW 1. HKU Infection Control Plan at Alert Response Level Advice on Hygienic Measure Observe good personal, food and environmental hygiene practices as usual 2. Personal Hygiene Keep hands clean, wash hands frequently with liquid soap, especially before eating, touching the mouth, nose, or eyes, handling food or eating, and after going to toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretion after coughing or sneezing. Cover the mouth and/or nose with tissue paper when coughing or sneezing. Dispose of the soiled tissues properly into a lidded rubbish bin, and then wash hands thoroughly. Wear a mask if developing fever or respiratory symptoms, going to a hospital or clinic, or if caring for a patient with fever or respiratory symptoms. If flu-like symptoms develop, stay at home and avoid going to crowded or poorly ventilated places. Good body resistance helps prevent infections including influenza. This can be achieved through a balanced diet, regular exercise and adequate rest, reducing stress and not smoking. Normally, extra supplement is not required. When buying and handling live chickens, try not to touch them or their droppings. Do not blow at their bottoms. Wash eggs with household detergent if they are soiled with faecal matter or stained with dirt. Washed eggs should be consumed immediately. Observe food hygiene when cooking chickens and eggs. Always wash the hands thoroughly with liquid soap and water after handling chickens and eggs.
Page Page 3 of 12 Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce containing raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red in colour, the poultry should be cooked again until fully done. There is no evidence so far that avian influenza can be transmitted through eating poultry or eggs. However, it is important to make sure poultry and eggs have been thoroughly cooked. General Cleaning Guideline 3 Maintain good indoor ventilation, open windows wide (if appropriate) and turn on fans or exhaust fans. Make sure air-conditioning system are well-maintained. Clean air-filters regularly and keep them clean. Clean and disinfect the institution premises including classrooms, toilets, and school buses with 1 in 99 diluted household bleach (mixing 1 part of 5.25% bleach with 99 parts of water), wait until the disinfectant dries up, then rinse with water and keep dry. Clean and disinfect frequently touched surfaces, such as commonly shared items (such as computer keyboards) at least daily by using appropriate disinfectant (e.g. 1 in 99 diluted household bleach by mixing 1 part of 5.25% bleach with 99 parts of water for non-metalic surfaces; or 70% alcohol for metallic surfaces), leave for 15-30 minutes, and then rinse with water and keep dry. Use absorbent disposable towels to wipe away obvious contaminants such as respiratory secretions, vomitus or excreta, then disinfect the surface and neighbouring areas with appropriate disinfectant (e.g. 1 in 49 diluted household bleach by mixing 1 part of 5.25% bleach with 49 parts of water for non-metalic surfaces; or 70% alcohol for metallic surfaces), leave for 15-30 minutes and then rinse with water and keep dry. Keep toilets, changing rooms, and bathrooms clean and hygienic. Provide liquid soap and disposable tissue towels or hand dryers for hand washing. Ensure the flushing system of the toilet is in proper function. Make sure that the drain pipes are built with U-shaped water traps and do not alter the pipelines without authorisation. 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 to prevent the spread of micro-organisms. Make sure that the soil pipes are unobstructed and the sewage drains are functioning properly without leakage so as to avoid breeding of infective agent.
Page Page 4 of 12 For details of Recommendations on Cleaning/ Disinfection for Infection Control, please visit: http://intraweb.hku.hk/reserved_1/pandemicflu/doc/7957/recommendations_on_cleaning_eng_v1.pdf Travel Advice 2 Avoid touching birds, poultry or their droppings and visiting poultry markets or farms when travelling outside Hong Kong Travellers if feeling unwell when outside Hong Kong, especially if having a fever or cough, should wear a mask and inform the hotel staff or tour leader and seek medical advice at once Travellers returning from affected areas with avian influenza outbreaks should consult doctors promptly if they have flu-like symptoms, and inform the doctor of the travel history and wear a mask to help prevent spread of the disease Examination Guideline Students with respiratory symptoms, e.g. coughing, sneezing should wear surgical mask inside the examination venue 2. Students with fever (>38 ) should not attend the examination, and should consult a doctor promptly 2, 4. Students just returning from any of the affected areas should closely observe for any flu symptoms for 10 days. If fever or flu-like symptoms appear, students should NOT attend the examination 4. Surgical mask and hand rub facilities outside should be available at the entrance of the examination venue. Tables, chairs, floor, doors of the examination venue should be cleansed and disinfected thoroughly on a daily basis with 1:99 diluted household bleach. They should then be rinsed with water and wipe dry 5. For details of the measures to prevent Avian Influenza, please refer to Centre for Health Protection: http://www.chp.gov.hk/en/index.html HKU Pandemic and Influenza: http://www.uhs.hku.hk/pandemicflu/index.php
Page Page 5 of 12 2. Serious Response Level Serious Response Level corresponds to a situation where the risk of a novel influenza virus causing new and serious impact to human health in Hong Kong is MODERATE 1. HKU Infection Control Plan at Serious Response Level Advice on Hygienic Measure 2 Personal Hygiene Keep hands clean, wash hands frequently with liquid soap, especially before eating, touching the mouth, nose, or eyes, handling food or eating, and after going to toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretion after coughing or sneezing. Cover the mouth and/or nose with tissue paper when coughing or sneezing. Dispose of the soiled tissues properly into a lidded rubbish bin, and then wash hands thoroughly. Wear a mask if developing fever or respiratory symptoms, going to a hospital or clinic, or if caring for a patient with fever or respiratory symptoms. If flu-like symptoms develop, stay at home and avoid going to crowded or poorly ventilated places. Good body resistance helps prevent infections including influenza. This can be achieved through a balanced diet, regular exercise and adequate rest, reducing stress and not smoking. Normally, extra supplement is not required. When buying and handling live chickens, try not to touch them or their droppings. Do not blow at their bottoms. Wash eggs with household detergent if they are soiled with faecal matter or stained with dirt. Washed eggs should be consumed immediately. Observe food hygiene when cooking chickens and eggs. Always wash the hands thoroughly with liquid soap and water after handling chickens and eggs. Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce containing raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red in colour, the poultry should be cooked again until fully done. There is no evidence so far that avian influenza can be transmitted through eating poultry or eggs. However, it is important to make sure poultry and eggs have been thoroughly cooked.
Page Page 6 of 12 General Cleaning Guideline 3 Maintain good indoor ventilation, open windows wide (if appropriate) and turn on fans or exhaust fans. Make sure air-conditioning system are well-maintained. Clean air-filters regularly and keep them clean. Clean and disinfect the institution premises including classrooms, toilets, and school buses with 1 in 99 diluted household bleach (mixing 1 part of 5.25% bleach with 99 parts of water), wait until the disinfectant dries up, then rinse with water and keep dry. Clean and disinfect frequently touched surfaces, such as commonly shared items (such as computer keyboards) at least daily by using appropriate disinfectant (e.g. 1 in 99 diluted household bleach by mixing 1 part of 5.25% bleach with 99 parts of water for non-metallic surfaces; or 70% alcohol for metallic surfaces), leave for 15-30 minutes, and then rinse with water and keep dry. Use absorbent disposable towels to wipe away obvious contaminants such as respiratory secretions, vomitus or excreta, then disinfect the surface and neighbouring areas with appropriate disinfectant (e.g. 1 in 49 diluted household bleach by mixing 1 part of 5.25% bleach with 49 parts of water for non-metallic surfaces; or 70% alcohol for metallic surfaces), leave for 15-30 minutes and then rinse with water and keep dry. Keep toilets, changing rooms, and bathrooms clean and hygienic. Provide liquid soap and disposable tissue towels or hand dryers for hand washing. Ensure the flushing system of the toilet is in proper function. Make sure that the drain pipes are built with U-shaped water traps and do not alter the pipelines without authorisation. 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 to prevent the spread of micro-organisms. Make sure that the soil pipes are unobstructed and the sewage drains are functioning properly without leakage so as to avoid breeding of infective agent. For details of Recommendations on Cleaning/ Disinfection for Infection Control, please visit: http://intraweb.hku.hk/reserved_1/pandemicflu/doc/7957/recommendations_on_cleaning_eng_v1.pdf Travel Advice 2 Avoid touching birds, poultry or their droppings and visiting poultry markets or farms when travelling outside Hong Kong. Travellers if feeling unwell when outside Hong Kong, especially if having a fever or cough, should wear a mask and inform the hotel staff or tour leader and seek medical advice at once.
Page Page 7 of 12 Travellers returning from affected areas with avian influenza outbreaks should consult doctors promptly, preferably to attend the nearest designated flu clinic of Hospital Authority if available, if they have flu-like symptoms, and inform the doctor of the travel history and wear a mask to help prevent spread of the disease. Examination Guideline All students should preferably to have their temperature checked before leaving for the examination venue 6. Students with respiratory symptoms, e.g. coughing, sneezing should wear surgical mask inside the examination venue 2. Students with fever (>38 ) should not attend the examination, and should consult a doctor promptly 3,6. They should attend the nearest designated flu clinic of Hospital Authority. Students just returning from any of the affected areas should closely observe for any flu symptoms for 10 days. If fever or flu-like symptoms appear, should NOT attend the examination 4 and seek medical care accordingly, preferably to attend the nearest designated flu clinic of Hospital Authority if available. Surgical mask and hand rub facilities outside the entrance of the examination venue. Tables, chairs, floor, doors of the examination venue should be cleansed and disinfected thoroughly a daily basis with 1:99 diluted household bleach. They should then be rinsed with water and wiped dry 5. The cleansing and disinfection of tables and chairs should preferably be done after each examination if feasible. For details of the measures to prevent Avian Influenza, please refer to Centre for Health Protection: http://www.chp.gov.hk/en/index.html HKU Pandemic and Influenza http://www.uhs.hku.hk/pandemicflu/index.php
Page Page 8 of 12 3. Emergency Response Level Emergency Response Level corresponds to a situation where the risk of a novel influenza virus causing new and serious impact to human health in Hong Kong is HIGH and IMMINENT 1. HKU Infection Control Plan at Emergency Response Level Advice on Hygienic Measure 2 Personal Hygiene Keep hands clean, wash hands frequently with liquid soap, especially before eating, touching the mouth, nose, or eyes, handling food or eating, and after going to toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretion after coughing or sneezing. Cover the mouth and/or nose with tissue paper when coughing or sneezing. Dispose of the soiled tissues properly into a lidded rubbish bin, and then wash hands thoroughly. Wear a mask if developing fever or respiratory symptoms, going to a hospital or clinic, or if caring for a patient with fever or respiratory symptoms. If flu-like symptoms develop, stay at home and avoid going to crowded or poorly ventilated places. Good body resistance helps prevent infections including influenza. This can be achieved through a balanced diet, regular exercise and adequate rest, reducing stress and not smoking. Normally, extra supplement is not required. When buying and handling live chickens, try not to touch them or their droppings. Do not blow at their bottoms. Wash eggs with household detergent if they are soiled with faecal matter or stained with dirt. Washed eggs should be consumed immediately. Observe food hygiene when cooking chickens and eggs. Always wash the hands thoroughly with liquid soap and water after handling chickens and eggs. Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce containing raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red in colour, the poultry should be cooked again until fully done. There is no evidence so far that avian influenza can be transmitted through eating poultry or eggs. However, it is important to make sure poultry and eggs have been thoroughly cooked.
Page Page 9 of 12 General Cleaning Guideline 3 Maintain good indoor ventilation, open windows wide (if appropriate) and turn on fans or exhaust fans. Make sure air-conditioning system are well-maintained. Clean air-filters regularly and keep them clean. Enhanced cleaning and disinfecting the institution premises including classrooms, toilets, and school buses with 1 in 49 diluted household bleach (mixing 1 part of 5.25% bleach with 99 parts of water), preferably with increasing frequency wait until the disinfectant dries up, then rinse with water and keep dry. Cleaning and disinfect frequently touched surfaces, such as commonly shared items (such as computer keyboards) preferably more than once daily by using appropriate disinfectant (e.g. 1 in 49 diluted household bleach by mixing 1 part of 5.25% bleach with 49 parts of water for non-metalic surfaces; or 70% alcohol for metallic surfaces), leave for 15-30 minutes, and then rinse with water and keep dry. Use absorbent disposable towels to wipe away obvious contaminants such as respiratory secretions, vomitus or excreta, then disinfect the surface and neighbouring areas with appropriate disinfectant (e.g. 1 in 49 diluted household bleach by mixing 1 part of 5.25% bleach with 49 parts of water for non-metalic surfaces; or 70% alcohol for metallic surfaces), leave for 15-30 minutes and then rinse with water and keep dry. Keep toilets, changing rooms, and bathrooms clean and hygienic. Provide liquid soap and disposable tissue towels or hand dryers for hand washing. Ensure the flushing system of the toilet is in proper function. Make sure that the drain pipes are built with U-shaped water traps and do not alter the pipelines without authorisation. Pour about half a litre of water into each drain outlet regularly (preferably more than once a week) so as to maintain the water column in the pipe as water lock to prevent the spread of micro-organisms. Make sure that the soil pipes are unobstructed and the sewage drains are functioning properly without leakage so as to avoid breeding of infective agent. For details of Recommendations on Cleaning/ Disinfection for Infection Control, please visit: http://intraweb.hku.hk/reserved_1/pandemicflu/doc/7957/recommendations_on_cleaning_eng_v1.pdf Travel Advice 2 Avoid touching birds, poultry or their droppings and visiting poultry markets or farms when travelling outside Hong Kong. Travellers if feeling unwell when outside Hong Kong, especially if having a fever or cough, should wear a mask and inform the hotel staff or tour leader and seek medical
Page Page 10 of 12 advice at once. Travellers returning from affected areas with avian influenza outbreaks should consult doctors promptly, preferably to attend the nearest designated flu clinic of Hospital Authority if available, if they have flu-like symptoms, and inform the doctor of the travel history and wear a mask to help prevent spread of the disease. Examination Guideline All students should preferably to have their temperature checked before leaving for the examination venue 6. Students with respiratory symptoms, e.g. coughing, sneezing should wear surgical mask inside the examination venue 2. Students with fever (>38 ) should not attend the examination, and should consult a doctor promptly 2,4. They should seek medical care according, preferably attend the nearest designated flu clinic of Hospital Authority if available. University may consider replacing the examination with other options, e.g. formative assessment of student performance 5. Students just returning from any of the affected areas should closely observe for any flu symptoms for 10 days. If fever or flu-like symptoms appear, should NOT attend the examination 4 and seek medical care accordingly, preferably to attend the nearest designated flu clinic of Hospital Authority if available. Surgical mask and hand rub facilities should be available at the entrance of the examination venue. Setting up of body temperature scan station at the entrance of the examination venue may be considered. Those who are found to have fever and/ or other influenza symptoms may be barred from sitting for the examinations. Tables, chairs, floor, doors of the examination venue should be cleansed and disinfected thoroughly a daily basis 5 with 1:49 diluted household bleach 3. They should then be rinsed with water and wiped dry. The cleansing and disinfection of tables and chairs should be done after each examination if feasible. Social distance should be increased, e.g. moving desks apart, or using online examination methods. Ideally, there should be at least 6 feet between people at most times 8. For details of the measures to prevent Avian Influenza, please refer to Centre for Health Protection: http://www.chp.gov.hk/en/index.html HKU Pandemic and Influenza: http://www.uhs.hku.hk/pandemicflu/index.php
Page Page 11 of 12 References 1. The Government of Hong Kong Special Administrative Region (2014). Preparedness plan for influenza pandemic. Retrieved from http://www.chp.gov.hk/files/pdf/erib_preparedness_plan_for_influenza_pandemic_2014_eng.p df 2. Centre for Health Protection (2013). Avian influenza. Retrieved from http://www.chp.gov.hk/en/content/9/24/13.html 3. Centre for Health Protection (2013). Advice on school disinfection at the height of influenza season. Retrieved from http://www.chp.gov.hk/files/pdf/advice_on_school_disinfection_eng.pdf 4. Examination Unit of the Registry, The University of Hong Kong (2009). Examination arrangements: Swine Flu. Retrieved from http://intraweb.hku.hk/reserved_1/pandemicflu/223.html 5. Education Bureau, the Hong Kong Special Administrative Region Government (2013). Handbook on prevention of avian influenza in schools. Retrieved from http://www.edb.gov.hk/attachment/en/sch-admin/admin/about-sch/diseases-prevention/handb ook_on_prevention_of_avian_flu_e_dec13_revised.pdf 6. Occupational Safety and Health Council (2009). Precautionary measures for taking the Certified Disability Management Professional (CDMP) examination against human swine influenza. 7. Centers for Disease Control and Prevention (2010). CDC Guidance for responses to influenza for institutions of higher education during the 2009-2010 academic year. Retrieved from http://www.cdc.gov/h1n1flu/institutions/guidance/