GRON 3112

Basic Care in Gerontology

Week 4
27 Sept 2022
Infection control
Occupational safety
Mr. CP Chiu
Content
• 1. Infection control
• 2. Occupational safety (further discussion in week 7)
Laboratory session and grouping(Group 1) (Group 2)

Lab: Wed 1:30-3:15pm (Group 1);

3:30-5:15pm (Group 2)
Basic Medical Sciences Building (BMSB)
Nursing Laboratory

First lab: 28 Sept 2022 (Wed)

Venue: BMSM 414+A

All Laboratory sessions are compulsory.

No mark-up lab session will be available.
 1. Infection control
• Communicable diseases refer to diseases that can be transmitted and
make people ill.

• 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. patients,
sick animals) to a person through various routes of transmission .

(DH, 2022)
Chain of Infection

(Ottawa Public Health, 2022)

1. Infective agent (germs)
• 1. Bacteria
• e.g Staphylococcus aureus
• -30% of people carry in their noses
• -skin infection, sepsis, pneumonia,

• Other e.g Escherichia coli (E.coli), Salmonella,

Mycobacterium tuberculosis (MTB), Vibrio
cholerae.

Photo credit: Jennifer Oosthuizen - Medical Illustrator,

Accessed CDC, https://phil.cdc.gov/Details.aspx?pid=19059
1. Infective agent (germs)
• 2. Viruses
• e.g Coronavirus
• -SARS-CoV
• -MERS-CoV
• - SARS-CoV-2 (COVID-19)
Photo credit: Alissa Eckert, MSMI; Dan Higgins, MAMS,
Accessed CDC, https://phil.cdc.gov/Details.aspx?pid=23313
• Influenza
• Norovirus
• Viral hepatitis
• HIV
Photo credit: CDC/ Charles D. Humphrey,
• Ebola Accessed CDC PHIL, Norovirus,
• HPV https://phil.cdc.gov/Details.aspx?pid=10709
• Zika & Dengue
1. Infective agent (germs)
• 3. Parasites
• Helminths / worm
• Plasmodium (Malaria)
Chain of Infection
• 2. Reservoir
• The reservoir of an infectious agent is the habitat in which the agent normally lives, grows, and multiplies.
Reservoirs include humans, animals, and the environment.

• Human reservoirs
• Many common infectious diseases have human reservoirs.
• e.g. measles and many respiratory pathogens.

• Animal reservoirs
• The term zoonosis refers to an infectious disease that is transmissible from vertebrate animals to humans.
• e.g. plague (rodents), rabies (dogs)
• ?? Ebola, SARS are thought to have emerged from animal hosts, but not yet been identified.

• Environmental reservoirs
• Soil, and water in the environment are also reservoirs for some infectious agents.
• e.g. Outbreaks of Legionnaires disease are often traced to water supplies in cooling towers
(CDC, 2012)
Chain of Infection
• 3. Portal of Exit
• Portal of exit is the path by which a pathogen leaves its host. The portal of exit
usually corresponds to the site where the pathogen is localized. For example,
influenza viruses exit the respiratory tract.

(CDC, 2012)
Chain of Infection
• 4. Modes of transmission
• An infectious agent may be transmitted from its natural reservoir to a
susceptible host in different ways. (CDC, 2012)

• Contact transmission
• Droplet transmission
• Airborne transmission
• Blood / Body Fluid transmission
• Food borne / fecal oral transmission
• Vector borne transmission (DH, 2022)
Contact transmission
• Through direct body contact with the infected
person
• e.g. Lifting client or assisting in taking bath

• Through indirect contact with objects

contaminated by infective agents
• e.g. Flu can be spread by people sneezing and
touching door handles, sharing of towels /
bedding

• e.g. scabies, head lice

(DH, 2022)
Droplet transmission
• Refers to spray with relatively large, short-range aerosols produced by
sneezing, coughing, or even talking.
• Direct spray can travel over a few feet, before the droplets fall to the ground.
(CDC, 2012)
• e.g. Influenza, SARS

Photo credit: James Gathany, Accessed CDC PHIL, sneezing, https://phil.cdc.gov/Details.aspx?pid=11160

 Airborne transmission
• When infectious agents are carried by
dust or droplet nuclei suspended in air.

• Droplet nuclei are dried residue of less

than 5 microns in size and may
remain suspended in the air for long
periods of time and may be blown
over great distances. (e.g. measles,
chickenpox, pulmonary tuberculosis)

Photo credit: Debora Cartagena, Accessed CDC PHIL, N95

(CDC, 2012) https://phil.cdc.gov/Details.aspx?pid=11160
 Food-borne & water-borne transmission
• Vehicles that may indirectly transmit an infectious
agent include food, water.
• Through ingestion of contaminated food / water
• Through using contaminated eating utensils
• e.g. Hepatitis A & E, Norovirus, Food Poisoning

(CDC, 2012)
 Blood / Body Fluid transmission
• Through injury by
contaminated needles, sharps

• Through unprotected sex

• e.g. Hepatitis B, C, HIV
(Human immunodeficiency
virus)

(DH, 2022)
 Vector-borne transmission
• Vectors such as mosquitoes, and
ticks may carry an infectious agent
• (e.g. Dengue fever, malaria, zika,)

Photo credit: James Gathany, Accessed CD PHIL,

Hong Kong Free Press, Aedes albopictus :
08 Aug 2022 https://phil.cdc.gov/Details.aspx?pid=2165
Chain of Infection
• 5. Portal of entry
• The portal of entry refers to the manner in which a pathogen enters a
susceptible host.

• Use the same portal to enter a new host that they used to exit the source
host. For example, influenza virus exits the respiratory tract of the source
host and enters the respiratory tract of the new host.

• In contrast, many pathogens that cause gastroenteritis follow a so-called

“fecal-oral” route because they exit the source host in feces, are carried
on inadequately washed hands to a vehicle such as food, water, or
utensil, and enter a new host through the mouth.
• (e.g. hepatitis A, E, cholera)
(CDC, 2012)
Chain of Infection
• 6. Susceptible Host
• The final link in the chain of infection is a susceptible host.

• Specific immunity refers to protective antibodies that are directed against a specific agent.
• Such antibodies may develop:
• 1. In response to infection or vaccine,
• 2. By transplacental transfer from mother to fetus;
• 3. By injectionof antibodies.

• Nonspecific factors that defend against infection include the skin, mucous membranes,
gastric acidity, cilia in the respiratory tract and the cough reflex.
• Factors that may increase susceptibility to infection by disrupting host defenses include
malnutrition, and disease or therapy that impairs the nonspecific immune response.
(CDC, 2012)
 Why are residential care homes for the elderly more
vulnerable to outbreaks of communicable diseases?
• 1. Collective living places where communicable diseases can easily spread through
close person-to-person contact, leads to cross-infection.

• 2. The frailty of the residents also aids the spread by showing less obvious
symptoms. This makes the infection more difficult to detect resulting in potential
delay of treatment and risk of transmission within residential care home.

• 3. The source of infection can be staff, visitors or residents

• e.g. Staff who fail to perform hand hygiene before and after caring for each
resident may spread the infective agents from one resident to another.

• 4. Subtle presentation of infection & communication obstacles of cognitive

impaired residents (such as dementia) leads delay identification and management.
(DH, 2022)
Principles of controlling communicable diseases
Break the chain
Disinfection to kill the infective agents

Building up immunity
Healthy lifestyle
Vaccination

Early detection, isolation and

treatment of the sick person

Good personal, environmental & food hygiene

Standard precaution
Transmission-based precautions (Ottawa Public Health, 2022) (DH, 2022)
Infection control measures
• 1. Standard precautions
• 2. Transmission-based precautions
• 3. Isolation measures
• 4. Advice for visitors
• 5. Vaccination
1.1 Hand hygiene
• Two hand hygiene practices are recommended: hand washing
with liquid soap and using alcohol-based handrub.

• Hand washing with liquid soap (Practice on lab day)

• -When hands are visibly soiled or likely contaminated with body
fluid.

• Steps for hand washing with liquid soap

• 1. Take off watch, ring and bracelet
• 2. Wet hands under running water.
• 3. Away from the running water, apply liquid soap on hands to
make a soapy lather.
• 4. 7 steps in handwashing
• 5. Rinse hands thoroughly under running water.
• 6. Dry hands thoroughly with paper towel
• 7. Do not re-contaminate washed hands by touching the faucet
directly. The tap may be turned off by wrapping the faucet with
the paper towel.
(DH, 2022)
1.1 Hand hygiene
• Use of alcohol-based handrub (Practice on lab day)
• When hands are not visibly soiled.
• Using 70-80% alcohol-based handrub
• Need to check the expiry date of alcohol-based handrub before using it.
• Steps same as hand washing with liquid soap (see previous slide)
• Allow alcohol to evaporate naturally for maximum effect and no need to
use paper towels to dry the hands.

(DH, 2022)
When to perform hand hygiene?
For staff, “5 moments for hand hygiene”
• Before touching a resident;
• Before a clean or aseptic procedure;
• After blood, body fluid, secretion, excreta, wound or
mucous membrane exposure risk, e.g. after
changing diaper;
• After touching a resident;
• After touching contaminated items or resident
surrounding environment.

(DH, 2022)
When to perform hand hygiene?
For residents, “5 moments for hand hygiene”
• Before handling or eating food /
medications;
• After using the toilet;
• After coughing or sneezing;
• After touching public installations or
equipment, such as escalator handrails,
elevator control panels or door knobs
• Before and after touching eyes, nose and
mouth (not recommend to touch eyes, nose
indeed). (DH, 2022)
1.2 Use of Personal Protective Equipment (PPE)
• To minimise the risk of infection or
further transmission.

• Surgical mask / N95 respirator

• Goggles and face shield
• Cap
• Gown
• Gloves

• Practice PPE on lab day.

(DH, 2022)
1.3 Environmental cleaning and disinfection
• 1 : 99 diluted household bleach: Clean and disinfect frequently touched surfaces,
furniture, rehabilitation aids, floor, toilets and bathrooms regularly.

• 1 : 49 diluted household bleach : For places soiled by vomitus, excreta or secretions

• 1 : 4 diluted household bleach: For spillage of blood. leave for 10 minutes and then
rinse with water and keep dry.

*(For 1:99, 1:49 and 1:4, mixing 1 part of household bleach containing 5.25% sodium
hypochlorite with 99, 49 & 4 parts of water respectively)

**Care should be taken to avoid its use on metal surfaces since sodium hypochlorite is
corrosive to metal. Use 70% alcohol to disinfect metal surfaces. (DH, 2022)
 1.3 Environmental cleaning and disinfection
• Always keep the windows open for good indoor ventilation.

• Keep appropriate distance between beds or groups of beds (not less than
1 metre as far as possible or with partitioned barrier between beds) to
reduce the chance of transmission of infective agents by droplets.

(DH, 2022)
1.4 Proper handling of used or soiled linen
• Infective agents can be transmitted through contact with linen.
Therefore, all linen should be washed thoroughly after use.

• Soiled linen should be handled separately.

• Immerse in 1 in 49 diluted household bleach for 30 minutes before
routine treatment.

• Appropriate PPE should be used during the process of handling.

(DH, 2022)
1.5 Proper clinical waste disposal
(Lab practice)
• Separate clinical waste from domestic waste.
• Clinical waste includes used needles and gauze with.
• Pack and label clinical waste properly in colour-coded bags
with biohazard signs.
• Red bag: clinical waste
• Yellow bag: human and animals tissues or organs
• Black bag: domestic waste
• Wear gloves before handling clinical waste and wash hands
thoroughly afterwards.
• Store clinical waste securely before collected by licensed
clinical waste collector.
• Keep a record of the clinical waste consigned.
(DH, 2022)
1.5 Proper clinical waste disposal
(Lab practice)

(DH, 2022)
1.6 Proper handling of sharps (Lab practice)
• Do not recap used needles.
• Syringes and sharps must be disposed of in a
puncture-proof and spill-proof container labelled
‘Biohazard’ on the outside, generally named “Sharp
box”
• A sharp box should not be overloaded and should be
disposed of properly when it is 70% to 80% full.
• Seal the sharp box and dispose in a Red bag by using
‘swan-neck’ sealing method with a warning sign
reading ‘Biohazard’ or ‘Beware of Sharps’ to alert
others during disposal.
(DH, 2022)
2. Transmission-based precautions
• In addition to standard precautions, additional precautions should be
adopted when dealing with diseases with different modes of
transmission.
• 2.1 Contact precautions
• 2.2 Droplet precautions
• 2.3 Airborne precautions

(DH, 2022)
 2.1 Contact precautions
• Perform hand hygiene properly.
• Use of PPE depends on the nature of contact.
• Clean and disinfect used items.
• Increase the frequency of environmental
cleaning and disinfect all frequently touched
surfaces.
• Do not share towels and other personal items.

• e.g scabies, fungi

(DH, 2022)
 2.2 Droplet precautions
• Maintain good indoor ventilation.
• Dispose of soiled tissue paper in a garbage bin with
lid or flush into the toilet.
• Perform hand hygiene after contact with residents
or handling respiratory secretions.
• Wear surgical masks if residents, staff and visitors
have respiratory symptoms.
• Keep a distance of at least 1 metre from the sick
resident or use partitioned barrier to separate from
the bed of sick resident.
• Adopt proper isolation measures.

• e.g: influenza, SARS (DH, 2022)

 2.3 Airborne precautions
• Identify persons with airborne infection and arrange
prompt medical consultation.
• Residents with active airborne diseases need to stay
in hospital for management.
• Perform hand hygiene properly and immediately
after contact with residents or handling respiratory
secretions.
• Adopt proper isolation measures.

• e.g chicken pox, pulmonary TB

(DH, 2022)
3. Isolation measures
• Resident is suspected to have a communicable
disease should be temporarily isolated.
• Medical consultation should be arranged promptly.

• Isolation measures include:

• Reserve some quiet, separate designated area or
rooms.
• Use of other suitable PPE when entering the
designated area or rooms.
• The separate designated rooms for isolation should
be available at any time.
(DH, 2022)
 4. Advice for visitors
• Not to visit the health care facility in case of illness.
• Proper hand hygiene before and after visits.
• Maintain respiratory hygiene and cough manners
• Take infection control measures as recommended in accordance with the
type of the disease.
• Avoid visiting the health care facility if outbreak of communicable disease
occur. Use other means to communicate with the residents, e.g.
videoconference.
• Filling the visiting record.
(DH, 2022)
5. Vaccination
• Aim: to prevent residents from acquiring vaccine-preventable communicable diseases and to
minimise the risk of outbreak occurrence in resident care home.
• Seasonal Influenza vaccination and Pneumococcal vaccination

(Photo credit: CHP)

(Photo credit: EHS)

5. Vaccination

(CHP, 2022 Sept 22)

Wrap-up
• Chain of Infection
• -6 components
• Principles of controlling communicable diseases
• Infection control measures
• -Standard precautions (Hand hygiene, PPE, Environmental cleaning, handling of
used or soiled linen, disposal of clinical waste and handling of sharps.
• -Transmission-based precautions (Contact, droplet and airborne transmission
and associated communicable diseases)
• -Isolation measures
• -Advice for visitor
• -Residential Care Home Vaccination Programme for seasonal influenza and
pneumococcal vaccinations
 Reference
• Centres for Disease Control and Prevention (CDC). (2012). Session 10: Chain of Infection.
Centres for Disease Control and Prevention
https://www.cdc.gov/csels/dsepd/ss1978/Lesson1/Section10.html#ALT119

• Centre for Health Protection. (2022). Residential Care Home for the Elderly. Department of
Health, The Government of the Hong Kong Special Administrative Region.
https://www.chp.gov.hk/en/features/21702.html

• Department of Health. (2022). Guidelines on Prevention of Communicable Diseases in

Residential Care Home for the Elderly.
https://www.chp.gov.hk/files/pdf/guidelines_on_prevention_of_communicable_diseases_i
n_rche_eng.pdf

• Ottawa Public Health. (2022). Chain of infection.

https://www.ottawapublichealth.ca/en/professionals-and-partners/chain-of-infection.aspx