Dr. Tonny NGMBBS (HK) DFPH (UK)

M Med (Public Health) (Singapore)FHKCCM FHKAM (Community Medicine)

Elderly Health Service, Department of Health

-Residential Care Services for Elderly in Hong Kong

Types of residential care homes for elderly (RCHEs)(i) nursing homes(ii) care and attention homes for the elderly(iii) homes for the aged, (iv) hostels for the elderly(v) contract RCHEs(vi) private care and attention homes for the elderly participating in the

Enhanced Bought Place Scheme (vii) nursing homes under the Nursing Home Place Purchase Scheme and (viii) private RCHEs

Licensing authority Social Welfare Department

Related legal provision Law of Hong Kong Chapter 459 Residential Care Homes (Elderly

Persons) Ordinance (Cap 459)

Non-private homes

Private homes

Section 8 (3) (c), Cap 459◦ The Director may refuse to issue a license if it appears to him that such

premises do not comply with any requirements relating to …., health, sanitation etc. set out in any Code of Practice issued by the Director

Section 17 Cap 459◦ Appointment of Inspectors (compliance check)

Section 18, CAP 459A Residential Care Homes (Elderly Persons)◦ Regulation Report suspected infectious disease case

Code of Practice (COP), Chapter on Infection Control◦ Implement control of infectious diseases in accordance with the Guidelines

on Prevention of Communicable Diseases in Residential Care Homes for the Elderly

◦ Designate an Infection control officer (ICO)◦ Report suspected outbreak◦ Arrange isolation of person with infectious disease

Integrated Assessment for Residential Care Homes for Elderly (RCHEs)

2003 March-June 72 RCHE Residents infected by SARS, 52 died

August Infection control checklist began

October Infection control checklist completed

Issued infection control guidelines- Input from Hospital Authority, Department of Health and Social Welfare Department

November Introduction of Infection Control Officer in RCHEs

2003-2004

Training for Infection Control Officers- Briefing forum- Training workshop- On-site training- Sharing Forums

2005 Evaluation of infection control survey

Free vaccination programme for RCHE staff

Annual Infection Control Officers Training by CHP

2007 September 2nd edition of infection control guidelines

2009 July Incorporated with health education needs assessment- drug management- fall prevention- other health needs

2015 January 3rd edition of infection control guidelines

To collect data for assessment of RCHEs’ staff training need

Rectify irregularities during the course with health advice and skill training

Information sharing with stakeholder to facilitate planning◦ Infection Control Branch of Centre for Health Protection◦ Hospital Authority◦ Social Welfare Department (the regulatory authority)

A cross-sectional survey Self-administered questionnaire◦ Residents’ profile◦ Manpower◦ Infrastructure

Inspection and interview◦ Environmental hygiene◦ Hardware and software for infection control, among

other areas

Target population◦ All RCHEs in Hong Kong according to the updated list keep

by Social Welfare Department – 740 (as at June 2015)

A total of 730 RCHEs were recruited (response rate 98.6%)◦ 3 refused◦ 6 ceased operation before survey◦ 1 closed for renovation

Completion rate◦ 100%

544

186

0100200300400500600700800900

2011 2012 2013 2014 2015

non-Private

Private

38811

21883

0

10000

20000

30000

40000

50000

60000

70000

2011 2012 2013 2014 2015

non-Private

Private

3.60%

16%

36%

44%

Private homes

<60

60-74

75-84

85 orabove

0.20%

8.60%

30.70%60.5

0%

Non-private homes

0%

10%

20%

30%

40%

50%

Prev

alen

ce

Dementia Bedridden

non-PrivatePrivate

On tube feeding

To resident ratioPrivate homes Non-Private homes

Nurse 1:71 1:10Health care

worker 1:16 1:17

Personal careworker 1:7 1:4

Nurse: Professionally trainedHealth worker: completed training authorized by Director of Social Welfare, Secondary 5 or equivalentPersonal care worker: Anyone employed for personal care

3.80%

96.20%

Non-Private

70.90%

29.10%

Private

No nurse

20%

94%

80%

6%

0%

25%

50%

75%

100%

Private homes Non-private homes

Health worker

Nurse

0%

10%

20%

30%

40%

50%

2011 2012 2013 2014 2015

No hand dryingfacilities

Uncovered rubbishbin

Soap not available

0%

20%

40%

60%

80%

2011 2012 2013 2014 2015

Com

plia

nce

Refrigerator temperature

91% 91.40%96.80%98.90%98%

40%

60%

80%

100%

2011 2012 2013 2014 2015

Avai

labi

lity

non-Private homes

Private homes

0%

20%

40%

60%

80%

100%

Mainentrance

Commonarea

Isolationarea

Corridor

Non-private

Private

85.80%

3% 11%

Private homes

Correctconcentration,not expiredIncorrect/uncertiainconcentrationExpired/uncertainexpiry date

98.40%

0.50%

1.10%

Non-private homes

COP s4.5◦ Shall provide isolation facility/room

COP 12.4.3 ◦ A designated area or room ◦ With good ventilation◦ Space for equipment for disposal of clinical waste◦ Basic hand hygiene and hand drying facilities

*Not necessarily an isolation room

0%

25%

50%

75%

100%

Private homes Non-private homes

Types of Isolation Area available

No isolation room

Others

3/4 partition

Single room

Examples of Isolation Area

¾ partition

Half height partition

Single room

0%

5%

10%

15%

20%

Ventilationsystem

Handwashingfacilities

Liddedrubbish

bin

Changingarea

Pirvate homes

Non-private homes

With

out t

he p

rovi

sion

0%

1%

2%

3%

4%

5%

6%

Occupied by otherresidents

Occupied by otherstuff

Pirvate homes

Non-private homes

Isolation area is being used as store room

33.50%

69.90%

22.80%

50.50%

0% 20% 40% 60% 80%

Private homes

Non-private homes

Correctly name the 5 moments for hand hygiene

other staff Infection control officers

Source: WHO Guidelines on Hand Hygiene in Health Care

0%

20%

40%

60%

80%

100%

Non-private homes Private homes

Proper disinfection of feeding funnel

0%

20%

40%

60%

80%

100%

Non-private Private

Proper knowledge of management of blood stained surface

0%

20%

40%

60%

80%

Non-private homes Private homes

Can tell all correct management of contaminated articles

55%

65%

75%

85%

95%

105%

Isolate suspected case Cohorting asymptomaticcontacts

Correct management of suspected cases and contacts

non-Privatehomes

Private homes

0% 25% 50% 75% 100%

Staff sick records

Visitor record

Regular body temperature

Regular body temperature for frail…

Residents' fever record

Infection control training record

Compliance

Non-private homes Private homes

0%

20%

40%

60%

80%

100%

2011 2012 2013 2014 2015

Com

plia

nce

Demonstration of proper hand hygiene technique

non-private

private

A new standard was adopted

0%

20%

40%

60%

80%

100%

2011 2012 2013 2014 2015

Com

plia

nce

Demonstration of proper donning and doffing technique

non-private

private

New standard

0%

20%

40%

60%

80%

100%

2011 2012 2013 2014 2015

Com

plia

nce

Demonstration of proper bleach dilution technique

non-private

private

The performance observed is not representing that for all staff in the RCHE as a whole

Only assess the infection control measure at one particular point in time

0%

20%

40%

60%

80%

100%

2011 2012 2013 2014 2015

Com

plia

nce/

Kno

wle

dge

Refrigerator temperature -Knowledge vs Compliance

Knowledge

Compliance

20% difference

0%

50%

100%

0

100

200

300

400

500

Know

ledg

e on

Isol

atio

n an

d Co

hort

Num

ber o

f Out

brea

ks

Influenza-like-illness Scabies

Gastroenteritis+ Norovirus Upper Respiratory Tract Infection

Isolation of suspected cases Cohorting asymptomatic contacts

Resource implication

High staff turnover rate

Failure to engage all front-line staff intraining

Enhancement in education programmes◦ Sustainable behaviour modification◦ Encourage self-auditing

Review the policy of residential care service