Communicable diseases in RCHEs
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1. detect such changes carers should familiarize themselves with the daily physical conditions and behavioural patterns of the elders As such proper personal health records should be maintained for each resident and their temperatures checked regularly In addition carers should pay more attention to elders who have special health conditions or with medical devices attached to their bodies since they are more vulnerable to infection than others For details please refer to the checklist of signs and symptoms of communicable diseases in Appendix C The checklist is a reminder to help infection control officers ICOs to carry out preliminary health assessment on individual residents for early detection of infections and prompt medical treatment 2 44 Management of suspected cases of communicable diseases among residents or staff The operator of RCHE should appoint either a nurse or a health worker as an Infection Control Officer ICO who is the key person responsible for dealing with matters related to infection control and prevention of the spread of infectious diseases in the residential care home ICOs should observe the following principles in preventing the spread of communicable diseases e Medical surveillance maintain and keep proper personal health records of residents and carefully assess their signs and symptoms e Early treatment to avoid secondary spread by the infected residents or staff e Spread prevention appr2. Larvae of flies Flies lay their Larvae crawl out Maintain good s eggs on mucous from the mouth oral hygiene for D 3 membranes or wo ound etc and residents To wounds there are especially for a purulent and those requiring smelly nasogastric discharges tubes for feeding Wounds should be properly treated Maintain good environmental hygiene Install appropriate fly screen and repellent devices SARS Coronaviruses_ Droplets Fever fatigue Have adequate rest and nutrition to build up body headache chill cough Shortness of touching of mucous membranes of the mouth nose breath difficulty immunity Observe good personal hygiene Wear Surgical masks Perform hand hygiene before and after resident contact Maintain good ventilation and environmental hygiene in breathing diarrhoea and eyes with hands contaminated with the infective agents Note For detailed guidelines on the prevention of SARS please visit the following websites www info gov hk info sars eindex htm www elderly gov hk www swd gov hk q SE on Prevention of Communicable Diseases in RCHEs 2 3 1 Although most elders develop the above common symptoms when infected 2 3 2 some elders especially those older and feeble ones may have less obvious symptoms When they are infected it would be more difficult to detect and treatment would be delayed thus increase the risk of transmission For those with cogn
3. Communicable diseases in RCHEs SJHDY Ul Saseasip jqe runw wo 2 L Common communicable diseases in RCHEsS Information shows that the most common infections in elderly homes are respiratory tract infections urinary tract infections and skin or subcutaneous tissue infections Other common infections include infectious gastrointestinal diseases and acute conjunctivitis The typical signs and symptoms of these communicable diseases are listed as follows for staff reference Mode of transmission Preventive measures Signs and symptoms Upper respiratory tract infections e g influenza Viruses e g influenza viruses bacteria e g Droplets touching of MUCOUS membranes of Fever fatigue cough sneeze running nose sore throat Maintain good ventilation and personal hygiene common cold rhinitis laryngo pharyngitis Streptococcus pneumoniae the mouth nose and eyes with hands contaminated with the infective agents Guidelines on Prevention of Communicable Diseases in RCHEs muscle aches perform hand hygiene before and after caring for each resident may wear surgical masks during close contact with patients have adequate rest and nutrition to build up body immunity Mode of Signs and Preventive transmission symptoms measures Lower Viruses e g Droplets Fever fatigue Observe respiratory tract influenza touching of cough thick respiratory infections
4. PERS fed Fie os Se pe E a O5 a eae m WN e Residents should avoid exercise or having excessively cold or hot food and drinks within 30 minutes before taking temperature e To familiarize with the correct use of thermometers before taking temperature e For each particular resident it is preferable to take the daily temperature 3 ey D from the same body part at the same time of the day using the same SL U a w U M U JJ O E mi U temperature taking method to avoid deviations caused by changes in the surroundings or the use of different measurement methods 2 5 4 Choice of thermometers In general there are mercury digital chemical LCD and infrared ear thermometers etc for taking oral rectal armpit ear and forehead temperature Before using a specific thermometer read the instructions carefully for the proper procedures of using the thermometer and the reference range of the readings Accuracy suitability and convenience Should all be taken into account when choosing the appropriate thermometer RCHEs that require rapid temperature taking because of the setting and working conditions may use infrared forehead thermometers Such devices however are less accurate in reflecting the true core body temperature Hence unless absolutely necessary it should be avoided as far as possible as the only type of thermometer used for taking temperature 2 5 5 Me
5. e g viruses mucous Sputum sputum hygiene cough acute bronchitis bacteria e g membranes of with blood etiquette any pneumonia Streptococcus the mouth nose shortness of individual pneumoniae and eyes with breath including hands residents contaminated Should put ona with the infective surgical mask agents when there Is respiratory symptom if applicable and tolerable SJHDY Ul Saseasip jqe lunwwop Urinary tract Bacteria e g Usually caused Fever urination Maintain good Infections E coli by bacteria with stabbing personal which move pain frequent hygiene from the large urination women should Intestine to the urinary urgency wipe their urinary tract nocturia urinary genitalia from More commonly incontinence the front to the found in lower back after women people abdominal pain urination with urinary low back pain ensure catheters hematuria adequate fluid diabetic etc cloudy urine intake avoid etc holding back urine avoid putting urinary bags at high position for people with urinary catheters maintain good hygiene when changing urinary bags Guidelines on Prevention of Communicable Diseases in i o a SJHDY UI SOUSeOVSIP jqe runw wo Skin and subcutaneous tissue infections Infectious gastrointestinal diseases Acute conjunctivitis Parasites e g scabies head lice bacteria e g Staphylococcus aureus St
6. fluenza like illnesses and SARS e When residents develop symptoms of infection please refer to Appendix C for details e Residents newly discharged from hospital What should be done when residents develop fever The normal temperature of human body oral temperature ranges from 36 TC to 37 2 C If a resident is found to have fever or have a temperature being IC higher than his usual one staff should be alert and note it down on the fever record for residents see Appendix D and the resident s personal health record The ICO should read the fever record everyday for early detection of residents with health problems and check against the checklist of signs and symptoms of communicable diseases in Appendix C Assistance can be sought from the Visiting Medical Officer VMO or the healthcare workers of the Community Geriatric Assessment Team CGAT when necessary 2 5 3 Accurate measurement of body temperature Body temperature can be divided into core temperature and Surface temperature Core temperature refers to the temperature of deep tissues which can be taken through the oral cavity rectum or ear whereas surface temperature is the temperature of surface skin tissues which can be taken through the armpit Surface temperature is more Susceptible to changes in the surroundings To avoid inaccuracy in measurement the following should be noted Guidelines on Prevention of Communicable Diseases in RCHEs 15 ok na
7. itive impairment Such as elders with dementia communication problems with carers may arise leading to late detection of infection Carers should carefully look for the following signs and symptoms which may indicate infection in the elders e The body temperature is TC higher than the usual temperature Most elders have fever when severely infected but the body temperature for some may not exceed the normal range If the temperature is TC higher than his her usual body temperature he she may have underlying infection e Disoriented confusion restlessness Many diseases may cause such symptoms in the elders Infection is one of the important causes for such symptoms If the elders especially the frail ones with chronic illnesses are found to develop such symptoms carers should arrange them to seek medical advice promptly e Unexplained changes in behaviours and body functions Unexplained behavioural changes may be caused by mental confusion Changes of body functions like loss of bladder control may be due to infection like urethritis or secondary to confusion e Loss of appetite and or unexplained weight loss e Weaker than usual e Lethargy e Fall e Shortness of breath e Palpitation SL U MO fan U MD U J O T mi U O 3 3 O ot o D o Ta Oo o Fa oS Wc 5 5 S O JI v omer Io m WN 14 2 3 3 The above are the common bodily changes among the infected elders To
8. ive diseases agents transmission symptoms measures Hepatitis B Viruses Blood body fluid Fever jaundice Ditto transmission fatigue loss of Staff may also appetite consider vaccination against hepatitis B Pulmonary Mycobacterium Airborne Persistent fever Have adequate tuberculosis tuberculosis transmission cough sputum rest and Smear positive with blood nutrition maintain fatigue weight good ventilation loss night and environmental sweating hygiene Do not Spit Observe respiratory hygiene cough etiquette any individual including residents should put on a surgical mask when there is respiratory symptom if applicable and tolerable Never share toothbrushes razors or other objects likely contaminated by blood Standard precautions Should be strictly followed when clearing up objects contaminated by blood Avoid unprotected unsafe sex Cannot resist the invasion of infective agents because of impaired body immunity No specific symptoms May have persistent fever uncommon Infections and or tumors etc Blood body fluid transmission Guidelines on Prevention of Communicable Diseases in RCHEs oz a w U a U J O T mi U O 3 c O ey Si D Types of Infective Mode of Signs and Preventive o diseases agents transmission symptoms measures PERS ow D Myiasis
9. not speak Avoid cold or hot food before taking temperature Not applicable to residents who are unconscious confused or who cannot close their mouths tight Taking armpit temperature Suitable for conditions when all the above are not applicable Ensure privacy and protect the residents from catching cold when taking temperature Put the thermometer under the armpit and place the forearm of the resident horizontally on the chest to keep the thermometer in position Wait for 6 to 8 minutes before checking the reading Armpit temperature is usually 0 5 C lower than oral temperature so it should be recorded as the armpit temperature Points to note The thermometer should be held tight under the armpit without clothes in between when taking temperature 2 5 6 Cleaning and disinfection of body temperature measuring Instrument after use Mercury thermometer wash with cold water and detergent first Immerse in 70 alcohol for not less than 10 minutes air dry and then store in dry place Oral and rectal thermometers should be treated separately Patients with communicable diseases should use separate personal thermometers to avoid cross infection Electronic thermometers must not be immersed in disinfectants or disinfected with high heat because it will damage the electronic components and affect the instrument s normal functioning The cleaning procedures recommended in the user manual of the electronic thermometers should be follo
10. opriate isolation precautions should be adopted with respect to the mode of transmission of respective communicable diseases to avoid outbreaks and further evolution into an epidemic For example patients with respiratory tract infections should wear masks excreta of elders should be properly disposed of the guidelines for hand hygiene should be strictly observed etc If in doubt promptly notify CENO and the Licensing Office of Residential Care Homes for the Elderly of the Social Welfare Department for follow up investigation NB The duty list of ICOs is detailed in Appendix B Ca1r1ndalinac nn Dravantinn nf CAmm iInicahla Nicancac in DCH ECc iwUIGde ines on P revention or COommunicap le JAISECASES IN RC 2 5 Measurng body temperature 2 9 1 2 9 2 The importance of taking body temperature Most elders develop fever when infected but there are exceptions Some elders have lower baseline body temperatures which rise slightly when they are infected but still within the normal range Effective surveillance of body temperature changes can only be carried out when self comparison can be made with the usual body temperature of the elders RCHE staff should thus regularly take accurate body temperature for the elders Temperature should be taken more frequently under the following circumstances e Residents with communication problems and those who are feeble e During outbreaks of communicable diseases particularly in
11. reptococcus pneumoniae fungi e g moniliasis tinea Viruses e g rotaviruses Noroviruses bacteria e g Salmonella Staphylococcus aureus Vibrio cholerae Viruses bacteria Mode of tansmission Contact transmission Consuming contaminated food or water contact with vomitus or faeces from infected persons contaminated object or aerosols in case of Norovirus infection Appendix N Contact transmission Guidelines on Prevention of Communicable Diseases in RCHEs Signs and symptoms Itching localized rash desquamation swelling scales etc suppurating or smelly wounds e g pressure sores Abdominal pain vomiting diarrhoea lack of appetite fatigue fever Redness of eyes itching eyes excessive tears abnormal secretion Preventive measures Wear gloves during patient contact and arrange early medical treatment for the patients disinfect the linen and clothing of patients with scabies following protocol or instruction Maintain good personal food and environmental hygiene wash hands after using the toilet food handlers should refrain from work and seek early medical advice if falling sick proper handling of vomitus and excreta Never share towels observe good personal hygiene perform hand hygiene before touching the eyes 2 2 Other important communicable diseases in RCHES Types of Infective Mode of Signs and Prevent
12. thods of taking body temperature Taking ear temperature It is non invasive and therefore has little limitations on its application It is particularly suitable and recommended for use in RCHEs First stabilize the head position of the resident Pull the ear backwards and upwards to make the ear canal straight Fit the probe tip covered with a plastic jacket slightly into the depth of the ear canal The temperature taken from the ear is 0 5 C higher than the oral temperature Follow the instructions to make suitable adjustments when using an ear thermometer Points to note Direction of the probe tip should be correct otherwise it will give an inaccurate reading The ear pressed against the pillow during sleeping has a higher temperature so the other ear should be used for taking temperature if one Is just awake Not applicable to elders with obstruction of ear canal caused by ear wax or otitis 16 Taking oral temperature Suitable for elders who are conscious cooperative and who can close their mouths tight Staff should place the thermometer under the tongue near the root Instruct the resident to close the mouth tight but not to bite on the thermometer or talk Wait for 3 to 5 minutes when using a mercury thermometer before checking the reading If the resident carelessly bites off the mercury thermometer he she should be sent to the hospital immediately for treatment Points to note Close the mouth when taking temperature Do
13. wed Q T a w U a U J O ag mi U 17 O 3 5 O ey er D
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