Hospital Authority

Communication Kit –
Monkeypox ( 猴痘 )
Version 1.0
10 Jun 2022

Prepared by Chief Infection Control

Officer (CICO) Office

1
 Content
1. Introduction
2. Epidemiology of Monkeypox
3. Global situation
4. Clinical features
5. Incubation period and route of transmission
6. Vaccination
7. HA Preparedness for Monkeypox
8. Case reporting criteria
9. Notification
10. Laboratory diagnosis
11. GCRS Request for Monkeypox
12. Clinical management
13. Infection Control Measures
14. Patient Care Equipment
15. Environmental Control
16. Linen Handling
17. Waste Management
18. Cleaning of Spillage of blood, body fluids, or other potentially infectious materials
19. Handling of dead body
20. Patient Transport
21. Recommended visiting and volunteer service policies in HA Hospitals
22. Recommended volunteer services and clinical attachment in HA hospitals
23. Recommended other service providers in HA hospitals
24. Staff Early Sickness Alert System (SESAS)
25. Risk communication 2
 What is Monkeypox?
• Monkeypox (MPX) is a rare zoonotic disease caused by
monkeypox virus.
• Monkeypox virus (MPXV) is an enveloped double-
stranded DNA virus with a genome size of around 190 kb.
• MPXV belongs to the genus Orthopoxvirus in the family
Poxviridae. It is one of the human orthopoxviruses that
includes variola (VARV), cowpox (CPX), and vaccinia
(VACV) viruses.
• Two phylogenetically distinct clades of MPXV have been
identified through genomic sequencing: the Central
African (Congo Basin) clade and the West African clade.
• Human infections with the West African clade appear to
cause less severe disease compared to the Congo Basin
clade, with a case fatality rate of 3.6% compared to
10.6% for the Congo Basin clade.

Source: Monkeypox outbreak, UPDATE AND ADVICE FOR HEALTH WORKERS, WHO, 26 May 2022
3
 Epidemiology of Monkeypox
• MPXV was first discovered in 1958 during an outbreak at an animal facility
in Denmark which used monkeys for polio vaccine research.
• First human case was reported in 1970 in the Democratic Republic of
Congo.
• Since then, monkeypox is endemic in central and west Africa. Animal hosts
include a range of rodents and non-human primates.
• In 2002, the first monkeypox outbreak outside of Africa was reported in
the US affecting 70 cases which was linked to contact with infected pet
prairie dogs. These prairie dogs had been kept at an animal vendor
together with some infected rodents imported from Ghana.
• Since 2017, Nigeria has been experiencing the largest documented
outbreak of human monkeypox caused by the West African clade of the
virus. As of Apr 2019, more than 300 cases have been reported in the
outbreak and the outbreak is still ongoing.

4
 Recent monkeypox multi-country outbreak
• On 7 May 2022, the United Kingdom WHO - Cases of monkeypox in non-endemic
reported an imported case of monkeypox countries (13 May to 2 June 2022)
in a person travelling from Nigeria.

• Starting from 18 May 2022, cases were

reported from an increasing number of
countries and regions, predominantly in
Europe, but also in North and South
America, Asia, Africa, and Australia.

• As of 2 June 2022, a cumulative total of

780 laboratory confirmed cases and
around 1408 suspected cases have been
reported from 27 non-endemic countries.
No deaths have been reported.

5
Source: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390
 Phylogenetic tree of monkeypox virus sequences
from West African clade as of 8 June 2022

All the cases whose samples

were confirmed by PCR have
been identified as being infected
with the West African clade.

Source: 6
https://www.ecdc.europa.eu/en/news-events/epidemiological-update-monkeypox-multi-country-outbreak-8-june
Distribution of monkeypox

7
 Information on current outbreak
• Investigations into past cases show that the outbreak in our region was certainly
underway as early as mid-April.
• Rapid, amplified transmission has occurred in the context of the recent lifting of
pandemic restrictions on international travel and events.
• Based on the case reports to date, this outbreak is currently being transmitted
through social networks connected largely through sexual activity, primarily
involving men who have sex with men. Many - but not all cases - report fleeting
and/or multiple sexual partners, sometimes associated with large events or
parties.
• It is unknown whether the monkeypox virus can spread from one person to
another through semen or vaginal fluids, nor whether the virus could persist in
these bodily fluids for longer periods of time.
• Atypical symptoms appearing in some of the cases - lack of a fever or a pervasive
rash.
• In Canada, a young man had sexual contact with someone who tested
positive for monkeypox. Over the next several days, lesion on his genitals
grew in size and more lesions appeared, but weren't painful. He had no
Sources: fever.
1. WHO Multi-country monkeypox outbreak: situation update -
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390
2. ECDC Interim advice on Risk Communication and Community Engagement during the monkeypox outbreak in Europe. https://
www.ecdc.europa.eu/sites/default/files/documents/Joint-ECDC-WHO-interim-advice-on-RCCE-for-Monkeypox-2-June-2022.pdf
3. Why the Atypical Symptoms in the Latest Monkeypox Cases? 8
https://www.medpagetoday.com/special-reports/exclusives/98966
 WHO risk assessment
• On 4 June 2022, the WHO assessed the public health risk at the global
level as moderate considering this is the first time that many
monkeypox cases and clusters are reported concurrently in non-
endemic and endemic countries in widely disparate WHO geographical
areas.

• The probability of monkeypox transmission to healthcare workers

(HCWs) wearing appropriate personal protective equipment is very low,
with the disease having an estimated low impact, leading to an overall
low risk.

Sources:
• WHO - Multi-country monkeypox outbreak: situation update
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390
• ECDC – Monkeypox multi-country outbreak
https://www.ecdc.europa.eu/sites/default/files/documents/Monkeypox-multi-country-outbreak.pdf
9
 Clinical features
• Monkeypox is usually a self-limited disease and typically lasts 2 to 4 weeks
• The confirmation of monkeypox in persons who have not travelled to an endemic area is
atypical.
• The most reported clinical presentation is of localised rash, particularly around the genitals and
anus, with associated regional lymphadenopathy. Lymphadenopathy is a distinctive feature of
monkeypox compared to other diseases that may initially appear similar (chickenpox, measles).
• Infection can be divided into the invasion period and skin eruption period.
• Invasion period (0-5 days) is characterized by fever, intense headache, lymphadenopathy,
back pain, myalgia and an intense asthenia.
• Skin eruption period (within 1-3 days after appearance of fever) in which a centrifugally-
distributed rash appear often beginning on the face and then spreading elsewhere on the
body. The face (in 95% of cases), and palms of the hands and soles of the feet (in 75% of
cases) are most affected. Evolution of the rash from maculopapules to vesicles, pustules,
followed by crusts occurs in approximately 10 days. The number of the lesions varies from
a few to several thousand, affecting oral mucous membranes (in 70% of cases), genitalia
(30%), and conjunctivae (20%), as well as the cornea.

10
Source:
1. WHO Multi-country monkeypox outbreak: situation update - https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390
 Skin rash / lesions
• The skin eruption begins within 1 to 3 days after fever onset. The rash
often begins on the face, then spreads to other parts of the body.
• The rash evolves from macules (lesions with a flat base) to papules
(slightly raised firm lesions), vesicles (lesions filled with clear fluid),
pustules (lesions filled with yellowish fluid), and crusts which dry up and
fall off.

Stages of monkeypox 11
 Monkeypox and other common skin rash illness

Sources:
https://www.gmanetwork.com/news/topstories/nation/832727/what-s-the-difference-between-monkeypox-chickenpox-and-measles/story/
https://edition.cnn.com/2022/06/02/health/monkeypox-endemic-silent-spread/index.html

12
 Incubation period and route of transmission
• Incubation period: usually 6 - 13 days (range from 5 to 21 days)
• The longest documented chain of transmission in a community has risen in recent years from 6
to 9 successive person-to-person infections.
• Modes of transmission:
• Human-to human transmission: Close contact with respiratory secretions, skin lesions of an
infected person or contaminated objects.
• Animal-to-human transmission: Direct contact with body fluids, bite or scratch. Various wild
animals e.g. some species of primates, rats and squirrels etc. could transmit the virus.
• Transmission can also occur via the placenta from mother to fetus (which can lead to
congenital monkeypox) or during close contact during and after birth
• Various animal species have been identified as susceptible to the monkeypox virus. This includes
rope squirrels, tree squirrels, Gambian pouched rats, dormice, non-human primates and other
species. Eating inadequately cooked meat and other animal products of infected animals is a
possible risk factor.
• Ulcers, lesions or sores in the mouth can also be infectious, meaning the virus can spread
through saliva
• People who closely interact with someone who is infectious, including health workers, household
members and sexual partners are at greater risk of infection.

Source:
1. Monkeypox outbreak, UPDATE AND ADVICE FOR HEALTH WORKERS, WHO, 26 May 2022
2. Multi-country monkeypox outbreak in non-endemic countries-update, 29 May 2022 13
 Vaccination
• Smallpox and monkeypox vaccines are effective at protecting people against
monkeypox when given before exposure to monkeypox.
• Past data from Africa suggests that the smallpox vaccine is at least 85% effective in
preventing monkeypox.
• ACAM200 and JYNNEOSTM (also known as Imvamune or Imvanex) are the two currently
licensed vaccines approved by the FDA to prevent smallpox. JYNNEOS is also licensed
specifically to prevent monkeypox.

• ACAM2000 is administered as a live Vaccinia virus preparation that is inoculated into the skin
by pricking the skin surface. Following a successful inoculation, a lesion will develop at the
site of the vaccination (i.e., a “take”). The virus growing at the site of this inoculation lesion
can be spread to other parts of the body or even to other people. Individuals who receive
vaccination with ACAM2000 must take precautions to prevent the spread of the vaccine virus
and are considered vaccinated within 28 days.
• JYNNEOSTM is administered as a live virus that is non-replicating. It is administered as two
subcutaneous injections four weeks apart. There is no visible “take” and as a result, no risk
for spread to other parts of the body or other people. People who receive JYNNEOS TM are
not considered vaccinated until 2 weeks after they receive the second dose of the vaccine.

Sources:
1. CDC - Monkeypox and Smallpox Vaccine Guidance
https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html
2. UK Health Security Agency - Recommendations for the use of pre and post exposure vaccination during a monkeypox incident
https://
assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1080615/Recommendations-for-pre-and-post-exposur 14
e-vaccination-during-a-monkeypox-incident-1-june-2022.pdf
 Pre-exposure vaccination to people at high risk
• Personnel who may expose to monkeypox should get pre-exposure
vaccination, including:
• HCWs caring for with confirmed patients (WHO and UK PHE)
• HCWs assessing suspected cases in sexual health services (UK PHE)
• Clinical laboratory personnel performing diagnostic testing for
monkeypox
(WHO and US CDC)
• Research laboratory workers handling cultures OR animals
contaminated / infected with monkeypox virus (WHO and US CDC)
• Individuals undertaking environmental decontamination (UK PHE)
• Reponses team members designated by public health authorities
(WHO and US CDC)

Sources:
1. CDC - Monkeypox and Smallpox Vaccine Guidance - https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html
2. UK Health Security Agency - Recommendations for the use of pre and post exposure vaccination during a monkeypox incident - https://
assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1080615/Recommendations-for-pre-and-post-exposure-vaccination-during-a-monkeypox-inci
dent-1-june-2022.pdf
3. WHO - Multi-country monkeypox outbreak: situation update - https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390
4. PHE – Recommendations for the use of pre and post exposure vaccination -https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data
/file/1080838/Recommendations-for-pre-and-post-exposure-vaccination-during-a-monkeypox-incident-6-june-2022.pdf
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 Post-exposure vaccination
• All identified close contacts of a monkeypox case should conduct medical surveillance
for 21 days after their exposure.
• Vaccination after exposure to monkeypox virus is possible. However, the sooner an
exposed person gets the vaccine, the better.
• The vaccine should be given within 4 days from the date of exposure in order to
prevent onset of the disease. If given between 4 – 14 days after the date of exposure,
vaccination may reduce the symptoms of disease, but may not prevent the disease.
• Some countries consider for higher-risk close contacts, such as sexual partners, family
members in the same household and health workers. ECDC suggested vaccine can be
considered for prophylaxis of close contacts at increased risk for severe disease.
• Post-exposure prophylactic (PEP) vaccination should be offered after a careful
risk/benefit ratio assessment for the individual person, including the type and timing
of last exposure, their age group, their medical history particularly as regards their
immune status and other underlying conditions that would indicate that they are at
increased risk for severe monkeypox disease.
Sources:
1. CDC - Monkeypox and Smallpox Vaccine Guidance
https://www.cdc.gov/poxvirus/monkeypox/clinicians/smallpox-vaccine.html
2. UK Health Security Agency - Recommendations for the use of pre and post exposure vaccination during a monkeypox incident
https://
assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1080615/Recommendations-for-pre-and-post-exposure-vaccination-during-a-monkeypox-
incident-1-june-2022.pdf
3. WHO - Multi-country monkeypox outbreak: situation update
https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON390
4. PHE – Recommendations for the use of pre and post exposure vaccination 16
https://
 Ring vaccination
• Ring vaccination is an effective strategy with an
aim to prevent the spread of a highly infectious
disease.
• The strategy can provide a “ring of immunity” Contacts of Contacts
around each case and minimize adverse events
and enable efficient use of vaccine supplies. Contacts of Case(s)
• Ring vaccination was used to eradicate smallpox
and has been used to contain Ebola virus disease
(EVD).
Case(s)
• Ring vaccination principle:
1. As soon as a case of monkeypox is
confirmed, the patient and their close
contacts are interviewed to identify
possible exposures.
2. Vaccination is offered to all close contacts.
3. Vaccination is also offered to those who
had close contact with the infected
person’s contacts.
Sources:
1. WHO - https://
cdn.who.int/media/docs/default-source/blue-print/day-2_ira-longini_vaccine-trial-design_monkeypox-meeting_03june2022.pdf?sfvrs 17
n=c92e13ef_3
HA Preparedness for Monkeypox

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 HA Preparedness Plan for Infectious Disease Pandemic
HA’s response to infectious disease pandemic generally follows the HK Government
response system. A 3-tier system is differentiated according to the risk of the
infectious disease causing significant public health impact to HK.

HA will activate the same response

levels according to response levels
activated by the Government.

Coordinated by Food and

Health Bureau (FHB) and steer
Government response
Alert
Low Risk
Serious or Emergency level
Convene Ad hoc CCIDER

HA Central Command
Steering Committee chaired by
Secretary for Food and Health
(SFH)
Serious
Moderate Risk
Committee (CCC) chaired by
CE of HA

Emergency Executive
Committee (EEC) delegated by
Steering Committee chaired by
the Chief Executive with FHB Emergency HA Board.
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High and Imminent Risk
 Risk Assessment
• HK Government and HA’s preparedness plans are based on a comprehensive
risk assessment.
• Risk assessment can help to initiate the right response actions at the right
time.
• Areas of concern in the risk assessment as follow:

 Transmissibility

 Geographical spread


Infections in humans / animals

Clinical severity of the illness

Vulnerability of population

Availability of preventive measures

20
 Response Levels

Alert Serious Emergency

• Situation where the • Risk of infectious disease • Risk of infectious disease
immediate health impact causing serious health causing serious health
in HK is low impact in HK is moderate impact in HK is high and
• There is an imported • There is evidence of imminent
human case and/or apparently unlinked • There is evidence of
epidemiological linked sporadic cases/clusters of spread in a healthcare
cases or an imported cases in the community facility or imminent risk of
animal case or infected animals sustained transmission in
epidemiological linked to the community; finding of
human or imported infected animals in the
animal cases community which are not
epidemiological linked to
human cases or imported
animal cases
Source:
The Government of the Hong Kong Special Administrative Region - Preparedness and Response Plan for Monkeypox (2022)
https://www.chp.gov.hk/files/pdf/preparedness_and_response_plan_for_monkeypox_eng.pdf 21
 Command Structure
Food & Health Emergency Executive Committee (EEC)*
Command Bureau (FHB)

Central Command Committee (CCC)*

Coordination Ad hoc Central Committee

on Infectious Diseases
CHP and Emergency Response HO MICC
(CCIDER)*
Command
Communication

Cluster MICCs CICO Office

HA Laboratory Network HO Departments
Response & control IDCTC
HAIDC
ICTs
Specialties such as adult ICU and paediatric ICU

22
Case Reporting & Notification

23
Case reporting criteria for Monkeypox (Last updated on 10 Jun 2022)
Clinical criteria Epidemiological criteria
Presented with Fulfilling (a), (b) or (c) within 21 days of illness onset:
• Unexplained acute rash (a) History of travel to country where monkeypox is endemic 2
AND
one of the following signs / OR
symptoms: (b) History of travel to non-endemic country with confirmed
• Acute onset of fever (>38 °C) cases of monkeypox 3
• Chills and/or sweats • Had contact with a person or people who have a
• New lymphadenopathy AND similar appearing rash or received a diagnosis of
(periauricular, axillary, confirmed or probable monkeypox; or
cervical, or inguinal) • Man who regularly has close or intimate in-person
contact with other men
• A case may be excluded if an OR
alternative diagnosis can fully (c) Contact with a dead or live wild animal or exotic pet that is
explain the illness 1 an African endemic species or used a product derived such
animals (e.g., game meat, creams, lotions, powders, etc.)

1 According to WHO, common causes of acute rash include varicella zoster, herpes zoster, measles, Zika, dengue, chikungunya, herpes simplex, bacterial skin infections, disseminated gonococcus

infection, primary or secondary syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, molluscum contagiosum, allergic reaction (e.g. to plants); and any other locally relevant

common causes of papular or vesicular rash. According to the Centers for Disease Control and Prevention of the United States, the rash associated with monkeypox can be confused with other

diseases that are more commonly encountered in clinical practice (e.g., secondary syphilis, herpes, chancroid, and varicella zoster). Historically, there had been sporadic reports of patients co-

infected with monkeypox virus and other infectious agents (e.g., varicella zoster, syphilis).

2 According to WHO, monkeypox endemic countries are: Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Côte d’Ivoire, Liberia, Nigeria, the Republic of the

Congo, and Sierra Leone. In Ghana, the monkeypox virus was identified in animals only. Benin and South Sudan have documented importations in the past. Countries currently reporting cases of

the West African clade are Cameroon and Nigeria, and of the Congo Basin clade are Cameroon, Central African Republic and Democratic Republic of the Congo.
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Case classification for Monkeypox
(Last updated on 10 Jun 2022)

Laboratory criteria
Any one of the following:
• Isolation of monkeypox virus in culture from a clinical specimen; OR
• Detection of unique sequences of viral DNA either by real-time
polymerase chainreaction and/or sequencing from a clinical specimen.

Case Classification
• Confirmed case
• A clinically compatible illness that is laboratory confirmed.

• Suspected case
• A case that meets both the clinical and epidemiologic criteria.

Source:
https://cdis.chp.gov.hk/CDIS_CENO_ONLINE/ceno.html 25
 Notification
• Monkeypox is listed as a
statutorily notifiable
infectious disease under
the Prevention and Control
of Disease Ordinance (Cap
599) on 10 June 2022.

• Clinicians should report any

suspected or confirmed
case to CENO of CHP and
HAHO via NDORS, and call
the Medical Control Officer
(MCO) of CHP (Pager:
71163300 call 9179) Effective on 10 June 2022 18:30
immediately.

26
 Laboratory diagnosis
• Specimen should be sent to the PHLSB for Monkeypox virus PCR
• TAT for negative result: usually within next day
• TAT for preliminary positive result: may require up to two days for confirmation

• Specimen types:
①Dry swab in sterile container
AND / OR
②Vesicle fluid in plain sterile bottle or syringe (with needle
removed and syringe capped)

Remark:
• Prior arrangement should be made with Microbiologist of PHLSB before sending of specimen.
27
GCRS Request for Monkeypox
Effective on
22 Jun 2022

28
Clinical Management

29
 Treatment
• Clinical care for monkeypox should be fully optimized to alleviate symptoms,
manage complications and prevent long-term sequelae.
• The mainstay of treatment for monkeypox is supportive. Ensure adequate
hydration and nutritional status. Secondary bacterial infections should be
treated as indicated. The current outbreaks as of May 2022 involves the milder
West African clade with most cases presented with mild symptoms and
recovered with supportive care.
• Specific antiviral treatment:
• Several antiviral agents may be useful for treatment of monkeypox based
on their activity against other pox viruses in animal and human studies.
Except cidofovir, these drugs are not registered in Hong Kong.
• The US CDC considers that smallpox vaccine, cidofovir, tecovirimat (ST-246),
and vaccinia immune globulin (VIG) can be used to control a monkeypox
outbreak.
• Treatment should be made in consultation with local infectious disease
physician or clinical microbiologist.
• For details, please refer to HA Interim recommendation on clinical management
of Monkeypox virus infection.

30
Infection Control Measures

31
 Patient Placement
• Suspected or confirmed monkeypox cases should be placed in
a single airborne infection isolation room (AIIR) en-suite with
toilet facility (i.e. with negative pressure and at least 12 ACH)

• Confirmed cases should not be nursed in the same room with

suspected cases.

• Confirmed cases should be centrally isolated and managed at

Hospital Authority Infectious Disease Centre (HAIDC).

32
 Isolation Precautions
• A combination of standard, contact, and droplet
precautions should be adopted for routine patient
care. Because of the theoretical risk of airborne
transmission of MPXV, airborne precautions should
also be applied.

• PPE: Surgical respirator, eye protection (goggles /

face shield), isolation gown, gloves, and cap
(optional) for routine patient care and aerosol-
generating procedures (AGPs)

• Isolation precautions should be maintained until all

scabs have fallen off and new skin is present.

33
 Personal Protective Equipment (PPE)
PPE at triage / fever room / fever consultation Recommended PPE for suspected / confirmed
room monkeypox cases
Eye visors / goggles /
face shield Face shield / goggles

Surgical mask / Surgical respirator

Surgical respirator

Isolation gown Isolation gown

Disposable gloves as Disposable

indicated.# gloves
#
For example, when
presence of skin lesions
or contact with blood and
body fluids

Shoe covers are not recommended. Shoe covers are not recommended.
34
Workflow for patient triage and segregation in AED setting

35
 Respiratory Protection Program for
Healthcare Workers
• Before initial use of surgical respirator respirator, fit test should
be performed to select a suitable type, model and size of
respirator for individual respirator user. Test results should be
maintained according to local hospital protocol.
• Qualitative Fit Test (QLFT) and Quantitative Fit Test (QNFT)
• Maintain Fit Test results record

36
* 每次配戴外科呼吸器後 , 要做正壓及負壓密合檢查。
*Perform positive and negative seal check every time after
Seal Check
wearing surgical respirator

• Positive Seal Check:

Place both hands completely over the respirator
and exhale sharply. If air leaks around respirator
edges, adjust the straps back along the sides of
your head. Perform seal check again if an
adjustment is made.

• Negative Seal Check:

正壓檢查 : Place both hands completely over the respirator.
以雙手遮著口罩，然後大力呼氣。
如空氣從口罩邊緣溢出，表示配戴
Inhale sharply and the respirator will collapse
不當，必須再次調校頭帶。 slightly. If inward leakage of air is detected, the
seal of the respirator is considered
負壓檢查 : unsatisfactory. Reposition it by adjusting the
以雙手遮著口罩，然後大力吸氣。
straps. If you cannot achieve a proper seal, do
口罩中央會凹陷，如空氣從口罩邊
緣進入，表示配戴不當，必須再次
not enter the contaminated area.
調校頭帶。在未將口罩校至適合位
置前，切勿進入空氣污染地區。
37
 Repeat of Surgical Respirator Fit Test

Under the following circumstances, retest of fit test should be

done:
• A significant change on facial contour affecting the respirator fit
• A significant increase or decrease in weight (10%)
• Change in facial structure or scarring due to dental work,
cosmetic surgery or accidents
• When no supply of appropriate model or size of respirator
• Any other condition that may interfere with face-piece sealing

38
 Patient Care Equipment
1. Handle used/soiled patient-care equipment carefully to prevent skin
and mucous membrane exposures, contamination of clothing, and
transfer of microorganisms to other patients and environment

2. Use disposable items when those items cannot be cleaned or

disinfected properly

3. Designate non-critical patient care equipment to the patients. If

sharing is unavoidable, clean and disinfect with sodium hypochlorite
solution 1,000 ppm after each patient use

4. Respiratory therapy equipment require high-level disinfection.

Central reprocessing is preferred based on local hospital policy.
Contaminated items should be packed properly before transfer to
prevent environmental contamination
39
 Environmental Control
1. Clean and disinfect with sodium hypochlorite solution 1,000 ppm or 2-
in-1 disinfectant at least daily, or whenever visibly soiled

2. Use 70% alcohol to disinfect metal surfaces

3. Clean and disinfect the immediate patient environment promptly after

performing AGPs.

4. Perform terminal disinfection upon each patient discharge

5. Use hydrogen peroxide vapor (HPV) / ultraviolet C (UVC) for room

disinfection after risk assessment by ICO and OSH teams

40
 Linen Handling
1. All linen should be classified as infected
linen. Linen bag should be secured with
“infected linen” tag with information of
the origin.

2. Avoid sorting linens in patient-care areas.

3. Place linen into water soluble bag, then a

laundry bag with minimal manipulation or
agitation to avoid contamination of air,
surfaces and persons.

41
 Waste Management
• The majority of wastes arising from monkeypox cases such as
PPEs, paper tissues, leftover food, meal boxes, and packing
materials should be treated as general waste.

• The exceptions are those waste types defined as clinical waste

in the Waste Disposal Ordinance including used or
contaminated sharps, laboratory waste, human tissues and
dressings which should be handled according to HA Operation
Circular No. 14/2015 Implementation of Clinical Waste
Management Plan (CWMP).
http://ha.home/circular2/Ops-2015-14.pdf

• Use bedpan washer to clean and thermal disinfect the urinals

and bedpans. If bedpan washer is not available, please
consider to use the liner bag. After use, the contents are to be
solidified with high-absorbency gel and then discarded as Example:
general waste. Bedpan liner

42
Cleaning of Spillage of blood, body fluids, or other potentially
infectious materials

1. Clean the visible soils with disposable absorbent

material and discard it into the appropriate waste bag

2. Mop the area with a cloth or paper towels wetted

with sodium hypochlorite solution 10,000 ppm, leave
for 10 minutes

3. Then rinse with water and allow the area to air dry

4. 70% alcohol can be used in metal surface if household

bleach is contraindicated

43
 Handling of Dead Body
1. Handling and disposal of dead body according to Category 2

2. Use YELLOW label

3. Follow the additional precautions as recommended in “Precautions for Handling

and Disposal of Dead Bodies, 10th edition.” https://
www.chp.gov.hk/files/pdf/grp-guideline-hp-ic-precautions_for_handling_and_di
sposal_of_dead_bodies_en.pdf

44
 Patient Transport
1. Limit patient transport to essential purpose only

2. Wear appropriate PPE when handling patients

3. Provide surgical mask to patients during transportation if not

contraindicated

4. Cover patients’ lesion (e.g. long sleeves and pants) to the best extent
possible for transport

5. Inform the receiving ward/ parties before patient transport to facilitate

appropriate arrangement

6. Inform the administration to prepare the designated route for

transport. The involved area should be disinfected afterwards

7. Disinfect transport vehicles after use

45
 Recommended visiting service policies in HA Hospitals

HK Gov’t Response Systems Alert Response Level Serious Response Level Emergency Response Level
Serious Response Serious Response
HA Response Alert Response Level Emergency Response Level (ERL)
Level (S1) Level (S2)

Isolation wards No visiting unless on compassionate ground

Not more than 4 hrs Not more than 4 hrs

2 hrs per day,
Other patient areas per day, per day,
2 persons at a time
2 persons at a time 2 persons at a time
Visiting hours No visiting in general or Subject to
CCC’s decision upon CCIDER’s
Not more than 6 hrs Not more than 6 hrs advice & supported by CHP
Convalescent 4 hrs per day,
per day, per day,
hospitals 2 persons at a time
2 persons at a time 2 persons at a time

Hand Hygiene Required

Required in all
Surgical Mask Not required Not required Required in all hospital areas
patient areas

Subject to CCC’s decision upon

Temperature check Publicize the general public to take temperature check by themselves
CCIDER’s advice & supported by CHP

Registration is required for visiting suspected / confirmed case in Subject to CCC’s decision upon
Registration
isolation wards under special permission CCIDER’s advice & supported by CHP

Remarks:
• PPE for visitors should be available to the area of visit
• Health advice and information on proper infection control precautions should be available to visitors e.g. poster.
• Make arrangements for the provision of surgical masks and hand washing facilities and/ or hand rub within their hospitals and clinics. 46
 Recommended volunteer services and clinical attachment in HA
hospitals
Recommended volunteer services
Emergency Response
HK Gov’t Response Systems Alert Response Level Serious Response Level
Level
Serious Response Serious Response Emergency Response
HA Response Alert Response Level
Level (S1) Level (S2) Level (ERL)
High-risk areas# Not allowed
Volunteers for patient Allowed under directives given by Cluster Suspended in
support services Other patient areas Allowed Chief Executive and Hospital Infection Control general or Subject to
(including patient Team CCC’s decision
group activities) upon CCIDER’s
Non-patient areas and advice & supported
Allowed
Non-hospital settings by CHP

Recommended clinical attachment

Emergency Response
HK Gov’t Response Systems Alert Response Level Serious Response Level
Level
Serious Response Serious Response Emergency Response
HA Response Alert Response Level
Level (S1) Level (S2) Level (ERL)

High-risk areas# Not allowed

Clinical Attachment
• medical students Other patient areas Perform risk assessment and act as appropriate Suspended in general
• nursing students Allowed or Subject to CCC’s
• allied health students decision upon
• pharmacy students Non-patient areas and CCIDER’s advice &
Allowed
Non-hospital settings supported by CHP

Remarks:
• #High-risk areas refer to triage stations of Out-patient Clinics and Accident & Emergency department; fever rooms of Out-patient Clinics; designated clinics,
isolation rooms (including isolation rooms in ICUs and AEDs); surveillance wards; and clinical laboratories.
• The high risk areas in clinical laboratories referred to Microbiology Laboratory (the particular bench with direct handling of relevant specimen), mortuaries
(including autopsy rooms), rooms where frozen sections were performed and molecular laboratories where fresh clinical specimens were handled. (Endorsed
in Directors’ Meeting held on 14 January 2015)
47
 Recommended other service providers
in HA hospitals

Remarks:
• #High-risk areas refer to triage stations of Out-patient Clinics and Accident & Emergency department; fever rooms of Out-patient Clinics; designated clinics,
isolation rooms (including isolation rooms in ICUs and AEDs); surveillance wards; and clinical laboratories.
• The high risk areas in clinical laboratories referred to Microbiology Laboratory (the particular bench with direct handling of relevant specimen), mortuaries
(including autopsy rooms), rooms where frozen sections were performed and molecular laboratories where fresh clinical specimens were handled.
(Endorsed in Directors’ Meeting held on 14 January 2015) 48
Staff Early Sickness Alert System (SESAS)
For early detection and control of potentially
communicable infectious diseases / outbreaks

49
Risk communication

50
 Enhanced Measures

Internal communication
• Thematic webpage
• Communication kit
• Staff forums

51
 Staff Enquiry
E-mail Contact phone
number
Chief Infection Control hocicoteam@ha.org.hk 2300 7456
Officer (CICO) Team

Infectious Disease idctc@ha.org.hk 2125 2920

Control Training Centre
(IDCTC)
Human Resources 2300 6575

Update on communication means:

About the supply of PPE and linen, bed coordination and infection control issues,
please contact your respective cluster coordinators.

52