Δείτε τι έκανε το Hong Kong για την προστασία των ξενοδοχείων και του Τουρισμού, από μεταδοτικές ασθένειες και τον κορωνοϊό|Οδηγός 83 σελίδων|ΚΕΙΜΕΝΑ

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Με έναν οδηγό 83 σελίδων, που συντάχθηκε με την συνεργασία όλων των εμπλεκόμενων μερών, τόσο του Ιδιωτικού, όσο και του Δημοσίου Τομέα, με συντονιστή το Κέντρο Προστασίας της Υγείας, η κυβέρνηση του Χονγκ Κονγκ, παρέχει πλήρεις οδηγίες για την αντιμετώπιση των μεταδοτικών ασθενειών και του κορωνοϊού, στον τομέα των Ξενοδοχείων και του Τουρισμού, παρουσιάζοντας ακόμη και τον τρόπο με τον οποίο πρέπει να καθαρίζονται τα διάφορα μέρη του δωματίου, αλλά και οι κοινόχρηστοι χώροι.

Η κυβέρνηση του Χονγκ Κονγκ προχώρησε στην κυκλοφορία οδηγίας ειδικά για τον κορωνοϊό (Health Advice on Prevention of Coronavirus disease (COVID19) for Hotel Industry (Interim)), ο οποίος παραπέμπει και στον γενικό οδηγό για την πρόληψη μολυσματικών ασθενειών στα ξενοδοχεία.

Η σημασία του Τουρισμού
Όπως αναφέρεται στην εισαγωγή, «Η αποτελεσματική πρόληψη και ο έλεγχος των μεταδοτικών ασθενειών στα ξενοδοχεία μπορεί να προστατεύσει την υγεία των επισκεπτών και του προσωπικού του ξενοδοχείου. Προκειμένου να διατηρηθεί η η φήμη του Χονγκ Κονγκ ως προορισμός παγκόσμιας κλάσης για τουρίστες στο εξωτερικό,
εναπόκειται σε κάθε προσωπικό του ξενοδοχείου να μάθει πώς να αποτρέπει τις μεταδοτικές
ασθένειες. Αυτή η κατευθυντήρια γραμμή αποσκοπεί στην παροχή πρακτικών πληροφοριών σχετικά με το προληπτικά μέτρα μεταδοτικών ασθενειών για όσους εργάζονται σε ξενοδοχεία».
Και συνεχίζει: «Κάθε υπάλληλος του ξενοδοχείου έχει την ευθύνη να κατανοήσει την κατευθυντήρια γραμμή και να φροντίζει τους επισκέπτες του ξενοδοχείου, σύμφωνα με αυτές. Σε περίπτωση αμφιβολίας ή όταν υπάρχουν περισσότερες πληροφορίες
σχετικά με συγκεκριμένες μεταδοτικές ασθένειες, απαιτείται η παροχή συμβουλών
το τμήμα καταπολέμησης της μόλυνσης του Κέντρου για την Προστασία της Υγείας του
Τμήμα Υγείας».

Λόγω της έκτασης των κειμένων, δεν είναι δυνατόν να μεταφραστούν και ως εκ τούτου τα παραθέτουμε αυτούσια.

Οι ειδικές οδηγίες
Οι ειδικές οδηγίες, έχουν ως εξής:

1 Infection Control Branch Health Advice on Prevention of Coronavirus disease (COVID
– 19) for Hotel Industry (Interim)
I. Disease information
Please visit the website of Centre for Health Protection for disease information, affected areas and updated information related to COVID – 19 :
https://www.chp.gov.hk/en/features/102465.html
The Department of Health advises staff working in hotel industry should take the following precautionary measures at their workplaces to minimise the risk of contracting and spreading COVID-19.
II. Preventive measures
A.
Advice Upon Check – in At Reception
(a) Staff should wear a surgical mask when required to work face to face with public or in crowded area.
(b) Guests are reminded to wear surgical mask and maintain good personal hygiene.
(c) Provide 70 – 80% alcohol – based handrub to guests in public areas and prepare
adequate amount for surgical mask for use.
2
(d) Conduct a brief check on the guests’ travel history in the past 14 days to ascertain travel history to the affected areas.
B. For Guests with Positive Travel History
(a) Advise to observe good personal hygiene, especially on hand hygiene and proper cough manners (Please refer to Annex I & Annex II).
(b) Guest(s) is/are advised to stay in the room if feeling unwell, wear a surgical mask and call the hotel operator at once for arrangement of medical consultation.
(c) Guest(s) is/are advised not to take public transport if developed respiratory symptoms.
(d) The hotel should make any arrangement deemed necessary for the guest to seek medical care to help prevent the spread of infection.
C. For Guest with Respiratory Symptom(s)
(a) Advise the guest to seek medical care immediately.
(b) Before the guest could receive medical care:
i. Advise the symptomatic guest to stay in his/her room and put on a surgical mask, while relocating any asymptomatic roommate(s) to another room.
ii. Advise other asymptomatic guests travelling along with the symptomatic guest to stay in their own rooms as far as possible.
iii. Open the windows of the rooms for better ventilation if possible.
iv. Minimise contact among staff and the symptomatic guest, his / her roommates and other guests travelling along with the symptomatic guest as far as possible.
(c) Staff should put on a surgical mask, disposable gown and gloves, and face shield if in contact with the symptomatic guest, his/her roommate(s), or other guests travelling along with the symptomatic guest. Minimise contact with symptomatic guests as far as practicable.
(d) N95 respirators are generally not recommended for use by the general public in community settings because special training is required for proper wearing and removal of the mask. Otherwise the infective risk due to inadequate protection and contamination may be ironically increased.
(e) Hotel management should always keep a list of staff and guests who had stayed in the hotel, their period of stay (check-in and check-out dates), identification / passport number, age, sex, nationality, contact telephone number, for possible public health action in case the patient is confirmed to be infected with COVID-19.
(f) Disinfect all the surfaces that are potentially contaminated immediately with 1in 49 diluted household bleach (mixing 1 part of household bleach containing 5.25% sodium hypochlorite with 49 parts of water), leave for 15 – 30 minutes, and then rinse with water and wipe dry. The disinfection should include any potentially contaminated installations, equipment or traffic pathways used by the symptomatic guest, such as elevator control panels and the lobby. Responsible staff should put on a surgical mask, disposable gown and gloves, and face shield.
(g) If the place is contaminated with blood, secretions, vomitus or excretions, disinfect with 1 in 4 diluted household bleach (mixing 1 part of household bleach containing 5.25% sodium hypochlorite with 4 parts of water), leave for 10 minutes, and then rinse with water and wipe dry.
(h) Depending on the situation, hotel management may need to suspend any mass gathering or social activities in the hotel.
D. For Guest who have been to the Mainland in the past 14 days preceding arrival at Hong Kong
(a) People concerned shall stay at home or other accommodation for a 14-day compulsory quarantine. Persons under quarantine have to stay at home or the dwelling places all day and wear masks.
(b) Call the Centre for Health Protection (CHP) hotline (2125 1122) if there are guests from Hubei Province checking in.
(c) Guest(s) under quarantine and those living with them have to check their body temperature every day and monitor their health condition. If they have
fever or develop other symptoms, they have to inform the Centre for Health
Protection about their health condition via dedicated hotline. After assessment, they will be sent to hospitals for treatment when necessary.
(d) Hotel staff are advised to:
(i) Minimise contact with the guests as far as possible;
(ii) Wear surgical mask if they need to enter the room of the guests;
(iii) Staff should put on a surgical mask, disposable gown and gloves, and face shield if in contact with the symptomatic guest(s).
(e) Enhance cleaning and disinfection of the premises.
III. Cleansing and Disinfection of Environment when a Suspected/ Confirmed Case of COVID-19 is Encountered
A. Cleansing staff would wear appropriate PPE including:
(a) Surgical mask
(b) Latex gloves
(c) Disposable gown
(d) Eye protection (goggles/face shield) and
(e) Cap (optional)
B. Enhanced Environmental Disinfection
(a) Disinfect all potentially contaminated surfaces or items by using 1 in 49 diluted household bleach (mixing 1 part of household bleach containing 5.25% sodium hypochlorite with 49 parts of water).
C. If There is Blood, Secretions, Vomitus or Excreta Spillage, Take Enhanced Measures:
(a) Cleansing staff should wear appropriate personal protective equipment (PPE) including surgical mask, gloves, disposable gown, eye protection (goggles/face shield) and cap (optional).
(b) Use forceps to hold the strong absorbent disposable towels to wipe away the blood, secretions, vomitus or excreta during a preliminary clean up.
(c) Then put the forceps and used absorbent disposable towels in a garbage bag carefully without contaminating oneself/the environment.
(d) Disinfect with 1 in 4 diluted household bleach (mixing 1 part of household bleach containing 5.25% sodium hypochlorite with 4 parts of water), wipe from the outside inward, leave for 10 minutes, rinse with water and wipe dry afterwards.
(e) After the procedure, put all the wastes and cleansing tools (e.g. forceps, cloth, mop head) in the garbage bag.
(f) Carefully remove PPE, put them in the garbage bag, and then perform hand hygiene. (When hands are not visibly soiled, use 70-80% alcohol-based handrub. Wash hands with soap and water when hands are visibly dirty or visible soiled with blood, body fluid.)
(g) Wear a pair of new gloves, seal the waste bag tight and dispose it properly in covered rubbish bin. Then, label the rubbish bin and put it in a safe undisturbed place until collection.
(h) Remove gloves carefully. Wash hands with liquid soap and water. If COVID-19 is suspected/confirmed, CHP will inform the Food and Environmental Hygiene Department as soon as possible to collect the wastes. On the contrary, if COVID-19 is excluded, CHP will inform the hotel to dispose the wastes as usual.
IV. Guidelines and Educational Material for Hotel Management
A. Guidelines on Infection Control and Prevention in Hotel Industry
https://www.chp.gov.hk/files/pdf/105_guideline_on_infection_controland_prevention_in_hotel_industry.pdf
B. Proper Use of Bleach
https://www.chp.gov.hk/en/static/100272.html
C. Proper Use of Mask
https://www.chp.gov.hk/en/healthtopics/content/460/19731.html
For update on the latest situation of COVID-19, please visit CHP thematic website at https://www.chp.gov.hk/en/features/102465.html
Ο οδηγός
Στον εκτενή οδηγό «Guidelines on Infection Control & Prevention In Hotel Industry», ο οποίος συντάχθηκε με την συνεργασία της Ένωσης Ξενοδοχείων Χονγκ Κονγκ, του τμήματος Ξενοδοχειακής Ασφάλειας & Υγιεινής Τροφίμων, του υπουργείου Υγιεινής Τροφίμων και Περιβάλλοντος, του υπουργείου Εσωτερικών, του υπουργείου Έργων, του υπουργείου Τουρισμού και Πολιτισμού και του υπουργείου Υγείας, περιλαμβάνονται αναλυτικές οδηγίες, με τα ακόλουθα περιεχόμενα:

ACKNOWLEDGEMENTS

  1. INTRODUCTION
  2. CONCEPT OF COMMUNICABLE DISEASES
    2.1 COMMUNICABLE DISEASES
    2.2 CHAIN OF INFECTION
    2.3 PATHOGENS / RESERVOIR
    2.3.1 Pathogens
    2.3.2 Reservoir
    2.4 MODE OF TRANSMISSION
    2.4.1 Contact transmission
    2.4.2 Droplet transmission
    2.4.3 Airborne transmission
    2.4.4 Common vehicle transmission
    2.4.5 Vector-borne (insects) transmission
    2.5 SUSCEPTIBLE HOST
  3. PREVENTIVE MEASURES AGAINST COMMUNICABLE DISEASES
    3.1 PRINCIPLES OF PREVENTION AND CONTROL OF COMMUNICABLE DISEASES
    3.2 GENERAL HYGIENE PRACTICES
    3.3 STANDARD PRECAUTIONS AND TRANSMISSION-BASED PRECAUTIONS
    3.3.1 Standard precautions
    3.3.2 Transmission-based Precautions
    3.4 VENTILATION
    3.4.1 Purpose of ventilation
    3.4.2 General ventilation design
    3.4.3 Infection control measures and ventilation issues
    3.4.4 Maintenance of Mechanical Ventilation Systems
    3.4.5 Cooling Water Quality Monitoring
  4. FACTS ABOUT COMMON COMMUNICABLE DISEASES
    4.1 FOODBORNE DISEASE & SPECIFIC PREVENTIVE MEASURES
    4.1.1 Foodborne disease
    4.1.2 Preventive Measures of Foodborne Diseases
    4.2 RESPIRATORY DISEASE & SPECIFIC PREVENTIVE MEASURES
    4.2.1 Respiratory disease
    4.3 CA-MRSA AND SPECIFIC PREVENTIVE MEASURES
    4.3.1 CA-MRSA
    4.3.2 Preventive measures of CA-MRSA
    4.4 STATUTORY NOTIFIABLE COMMUNICABLE DISEASES
  5. OUTBREAK OF COMMUNICABLE DISEASES
    5.1 OUTBREAK OF COMMUNICABLE DISEASES
    5.2 MANAGEMENT OF OUTBREAK OF COMMUNICABLE DISEASE
    5.2.1 Infection control measures during outbreak
    5.2.2 Disinfection of environment
    5.3 RECOMMENDATIONS ON MANAGEMENT OF SPECIFIC COMMUNICABLE DISEASES
    5.3.1 Food poisoning
    5.3.2 Outbreak of respiratory tract infection
  6. INFECTION CONTROL MEASURES IN SPECIAL FACILITIES
    6.1 SWIMMING POOLS AND WHIRLPOOL SPAS
    6.1.1 Environmental cleansing
    6.1.2 Pool Decontamination
    6.1.3 Water Standards and Testing Frequency
    6.1.4 Pool Maintenance
    6.2 FITNESS CENTRE OR GYMNASIUM ROOM
    6.2.1 Environmental cleansing:
    6.2.2 Personal hygiene for users
    6.3 CHILD CARE FACILITIES
    6.3.1 Diapering
    6.3.2 Furnishings
    6.3.3 Toileting Area
    6.3.4 Toys and Ball Pool
    6.3.5 Management guidance for gastroenteritis outbreak
    6.4 SAUNA, MASSAGE AND BEAUTY CENTRE
    6.4.1 Environmental cleansing
    6.4.2 Specific requirement and practice
    6.4.3 Personal hygiene of health of masseur / masseuse
    6.4.4 Public showering facilities
    6.5 CATERING SERVICES
    6.5.1 Personal hygiene of food handlers
    6.5.2 Food Hygiene
    6.5.3 Premises Hygiene
    6.5.4 Utensils and equipment
  7. Appendix
    APPENDIX A: HAND HYGIENE TECHNIQUE
    APPENDIX B: NOTIFICATION OF INFECTIOUS DISEASES
    APPENDIX C: COMMONLY USED OF DISINFECTANTS
    APPENDIX D: THE USE OF BLEACH
    APPENDIX E: MAINTAIN COUGH MANNERS
    APPENDIX F: SEQUENCE OF DONNING & REMOVING PERSONAL PROTECTIVE
    EQUIPMENT (PPE)
    APPENDIX G: USEFUL LINKS
    REFERENCES:

Introduction
Effective prevention and control of communicable diseases in hotels can
safeguard the health of the hotel guests and staff. In order to uphold the
reputation of Hong Kong as a world-class destination to overseas tourists,
it is incumbent on every hotel staff to learn how to prevent communicable
diseases. This guideline is intended to provide practical information on the
preventive measures of communicable diseases for those who work in hotels.
Every hotel employee has the responsibility to understand the guideline and
to take due care of the hotel guests according to what has been laid down
therein this guideline.
The guideline is divided into seven sections, individual employees may
refer to the relevant sections if necessary. However, this set of guideline is
not meant to be exhaustive. In case of doubt or when further information
on specific communicable disease is needed, advice can be sought from
the Infection Control Branch of the Centre for Health Protection of the
Department of Health. Lastly, opportunity is taken to thank the Hong Kong
Hotels Association and all the hotels who participated in the Infection Control
Survey in Hotel Industry for their invaluable comments and inputs on the
preparation of this guideline.

  1. Introduction 6
  2. Concept of Communicable Diseases
    2.1 Communicable Diseases
    Communicable diseases refer to diseases that can be transmitted and
    make people ill. They are 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. sick person) to a person through
    various modes of transmission.
    2.2 Chain of Infection
    For an individual to acquire an infection, a number of factors crucial
    to the spread of communicable diseases including the infective agents
    (pathogens), source of infection (reservoir), mode of transmission, and
    susceptible host must be present. This is called the chain of infection
    (Figure 1).
    Mode of transmission
    Pathogens +
    Reservoir
    Susceptible
    hosts
    Infection
    Figure 1. Chain of Infection
    2.3 Pathogens / Reservoir
    2.3.1 Pathogens
    The pathogens/infective agents responsible for infectious
    diseases include bacteria, viruses or parasites. Some
    microorganisms are part of our own body flora which can cause
    infection when we are immunocompromised. These infections
    are called endogenous infections. Infections which are
    acquired from external sources are called exogenous infections.
    However, pathogens/infective agents must achieve an infective
    dose before they can infect people.
    2.3.2 Reservoir
    This refers to any environment or object in or on which
    infective agents can survive and, in some cases, multiply.
    Human beings, inanimate objects, animals, food or water can
    all serve as reservoirs. Such reservoirs will normally form the
    basis for the origin of the infective agents to infect humans.
    A human reservoir may be either a case or a carrier. A case
    is a patient with an acute clinical infection while a carrier is
    a person who is incubating and/or colonized with a specific
    pathogenic microorganism but shows no signs or symptoms
    of infection. A carrier may have a subclinical or asymptomatic
    infection e.g. Hepatitis B virus.
    2.4 Mode of Transmission
    Infective agents can be transmitted from a source of infection to
    another person by contact, droplet, inhalation of infectious droplet
    nuclei, or ingestion. Some communicable diseases can be transmitted
    by more than one mode of transmission. Interruption of the mode
    of transmission is the easiest way to break the chain of infection,
    therefore, it is the key to prevent and control infectious diseases.
  3. Concept of Communicable Diseases 8
  4. Concept of Communicable Diseases
    2.4.1 Contact transmission
    Contact is the most common mode of transmission which can
    be subdivided into direct contact or indirect contact.
    Transmission through direct contact refers to person-to-
    person spread of microorganisms through direct physical
    body contact, such as by hands. For example, scabies.
    Transmission through indirect contact occurs when a
    susceptible person comes into contact with a contaminated
    object or environment, such as sharing towel. For example,
    acute conjunctivitis and community associated-methicillin-
    resistant Staphylococcus aureus (CA-MRSA).
    2.4.2 Droplet transmission
    Droplet transmission occurs when the mucous membrane of
    the eyes, nose and mouth of a susceptible person come into
    contact with infectious droplets (> 5μm in size).
    These particles do not remain suspended in the air for
    extended periods of time, and usually do not travel beyond
    several feet (usually 1 metre or lesser) from the source
    person.
    These droplets are generated when the source person
    coughs, talks, sneezes, or spits. Examples of infections
    transmitted by droplet route include influenza and Severe
    Acute Respiratory Syndrome (SARS).
    2.4.3 Airborne transmission
    Airborne transmission occurs when the airborne droplet
    nuclei ( ≤ 5μm in size) or dust particles containing
    microorganisms remain suspended in the air for a long
    period of time and then inhaled by the susceptible host.
    Examples of airborne infections are pulmonary tuberculosis
    and chickenpox.

2.4.4 Common vehicle transmission
Common vehicle transmission occurs when microorganisms
are spread from contaminated food, water, or equipment.
Examples of diseases transmitted through this route include
food poisoning, cholera and Hepatitis A.
2.4.5 Vector-borne (insects) transmission
Vector-borne (insects) transmission occurs when an
invertebrate vector bites or touches a person. Examples
of diseases transmitted through vector-borne (insects)
transmission are dengue fever or malaria.
2.5 Susceptible Host
Human body normally has many defense mechanisms for resisting the
entry and multiplication of pathogens. However, some people are at
higher risk for infection because of their declined or immature immune
systems. Examples of these susceptible hosts are elderly and newborn
baby, immunocompromised people, steroid user, or patient who is
recovering from serious trauma or after surgery.

  1. Concept of Communicable Diseases 10
  2. Preventive Measures against Communicable Diseases
    Apart from the general hygienic practice, hotel staff should also adopt
    basic infection control measures to prevent and control communicable
    diseases. These include Standard Precautions and Transmission-based
    Precautions.
    3.1 Principles of Prevention and Control of
    Communicable Diseases
    To prevent or control communicable diseases, appropriate infection
    control measures should be implemented promptly to control the
    infective agents (pathogens), source of infection (reservoir), mode
    of transmission, and the susceptible hosts so as to break the chain of
    infection. Examples of control measures are as follows:
    Chain of Infection Infection Control Measures
    Infective agents Disinfection and killing of all infective agents
    Source of infectionEarly detection, isolation and treatment of sick and
    removal of breeding sites
    Mode of transmission
    Maintain good environmental, personal and food
    hygiene; adopt infection control measures appropriate
    to the different modes of transmission
    Susceptible host Build up personal immunity by immunization and
    healthy lifestyles
    3.2 General Hygiene Practices
    Building up immunity by having a well balanced diet, adequate rest
    and sleep, regular exercise and being a non-smoker are all vital to the
    prevention of communicable diseases. Hotel staff should observe strict
    personal hygiene practice as follows:
  3. Preventive Measures against Communicable Diseases
    Perform hand hygiene frequently with soap and water, or 70%
    alcohol-based handrub.
    Do not spit.
    Cover nose and mouth with tissue paper when sneezing or coughing
    and have the tissue paper discarded into lidded garbage bins
    afterwards.
    Individuals with signs and symptoms of respiratory infections (such
    as coughing, sneezing, headache etc.), respiratory hygiene/ cough
    etiquette (please refers to section 3.3.1 II) should be observed.
    If you feel unwell, you should seek medical advice promptly to
    prevent spreading the infection in hotel.
    Change and wash uniform frequently or whenever it is grossly
    contaminated.
    Do not share personal items such as towels and razors.
    Cover wound or cut with waterproof dressing.
    3.3 Standard Precautions and Transmission-based Precautions
    There are two tiers of precautions to prevent the transmission of
    infectious agents. Standard Precautions are intended to be applied
    to the care of all people regardless of the suspected or confirmed
    presence of an infectious agent. Transmission-based Precautions are
    for people who are known or suspected to be infected or colonized
    with infectious agents which require additional control measures to
    effectively prevent transmission (transmitted through contact, droplet
    or airborne notions etc as described in Section 2.4).
  4. Preventive Measures against Communicable Diseases
    3.3.1 Standard precautions
    Standard precautions should be implemented when we have to
    contact blood; all body fluids, secretions and excretions except
    sweat; non-intact skin; and mucous membranes. Standard
    precautions include the following infection control measures:
    Hand hygiene
    Respiratory hygiene/cough etiquette
    Environmental hygiene and decontamination
    Personal protective equipment (PPE)
    Linen management
    I. Hand hygiene
    Hand hygiene is a general term referring to any action of hand
    cleansing. The common hand hygiene practices recommended
    include handwashing and use of alcohol-based handrub (hand
    antisepsis). Since many communicable diseases are transmitted
    through direct contact, performing hand hygiene properly
    is a basic infection control measure to prevent the spread of
    communicable diseases in hotels setting. When hands are visibly
    soiled, handwashing should be performed. When hands are not
    visibly soiled, application of alcohol-based handrub is equally
    effective.
    Hand hygiene should be performed:
    Before touching mouth, nose and eyes,
    Before handling, preparing or serving food,
    After using tissue paper to cover the mouth and nose
    while sneezing or coughing,
    After using the toilet, or
    After touching public installations or equipment, such as
    escalator handrails, elevator control panels or door knobs.

Hand hygiene technique
To achieve the best hand washing results, before performing
hand hygiene, hotel staff should take off their watches, rings
and accessories on hands and wash their hands properly
according to the following procedures and make reference to
Appendix A for the proper hand hygiene technique.
Wet hands under running water.
Apply liquid soap and rub hands together to make a soapy
lather.
Away from the running water. Rub the palms, back of
hands, between fingers, backs of fingers, thumbs, finger
tips and wrists for at least 20 seconds (same procedure also
applies to disinfection of hands with alcohol hand rub).
Rinse hands thoroughly under running water after
rubbing.
Dry hands thoroughly with clean cotton towel, paper
towel or hand dryer. Towels for drying hands should never
be shared.
If necessary, turn off the tap by wrapping the faucet with
paper towel. Avoid touching the faucet again with washed
hands.
Provision of resources
Hotel management should ensure that materials for adhering
to hand hygiene are available in hotel:
Provide lidded receptacles for used tissue paper disposal.
Provide conveniently-located dispensers of alcohol-based
handrub; where sinks are available, ensure that supplies
for handwashing (i.e., liquid soap and disposable towels)
are consistently available.

  1. Preventive Measures against Communicable Diseases

II. Respiratory hygiene/ cough etiquette
Respiratory hygiene / cough etiquette is regarded as a kind
of source control measures. Hotel staff/ hotel guests should
be educated to perform the followings when they cough or
sneeze:
Source control measures
Cover mouth and nose when coughing or sneezing.
Use tissue paper to contain respiratory secretions and
dispose them promptly in lidded receptacles.
Perform hand hygiene after hands have been in contact
with respiratory secretions.
Offer surgical masks to persons with respiratory symptoms
when tolerated, especially during epidemic.
Encourage persons with respiratory symptoms to sit away
from others, ideally > 1 metre (or 3 feet).
Provision of resources:
Hotel management should ensure that materials for adhering
to respiratory hygiene/cough etiquette are available in hotel:
Provide lidded receptacles for used tissue paper disposal.
Provide surgical masks when in need.
III. Environmental hygiene and decontamination
Since infective agents can survive in the environment for a
period of time, it is vital to observe environmental hygiene
from time to time and environmental decontamination should
be strengthened, in particular during outbreak situation.

  1. Preventive Measures against Communicable Diseases

Environmental hygiene includes the followings:
General cleaning
Rooms should be maintained at a reasonable standard of
cleanliness.
Cleaning should start in the clean areas and progress to
the dirty areas.
All surfaces should be cleaned at least daily with detergent
and water or disinfectants (e.g., 1 in 99 diluted household
bleach (5.25%) solution), if necessary.
Frequently touched area such as escalator handrails,
elevator control panels or door knobs should be cleaned
more often subject to the frequency of use.
Hands should be washed after undertaking cleaning
activities.
Regular pest control should be carried out.
Supervisors should undertake regular monitoring to ensure
that existing hygienic standards are strictly observed.
Handling of spillage
Disposable gloves should be used if the cleaning involves
contact with body fluids, such as respiratory secretions,
urine, feces etc. Eye protection (i.e., goggles and
faceshield) or body protection may be considered when
substantial splash of blood or body fluids is anticipated.
Use highly absorptive materials to preliminarily clean up
the contaminated surfaces first.
If the surface is contaminated with vomitus or other body
fluids, disinfect with 1 in 49 diluted household bleach
(5.25%) solution, leave for 15-30 minutes and then rinse
with water; if the surfaces are contaminated with blood,
use 1 in 4 diluted household bleach (5.25%) solution for
disinfection of the contaminated surface and leave for 10
minutes before rinsing with water. [28]

  1. Preventive Measures against Communicable Diseases

Floors and floor coverings
Carpets or rugs/mats may be vacuumed using a cleaner
that does not throw dust into the air or steam cleaned if
soiled with body fluids.
Do not hang up and swat carpets or rugs/mats as this will
create aerosols.
Hard floor surfaces should be cleaned with wet vacuum
systems. If wet vacuum systems are not available, hard
floor surfaces should be damp mopped using detergent
and water or disinfectant if necessary.
Furnishing
These include items such as curtains, drapes, screens,
lampshades and furniture items which should be washed/
cleaned or steam cleaned regularly.
Lift cars and escalators
Wipe lift cars and escalators, particularly the call buttons
and handrails with detergent and water, or disinfected
with 1 in 99 diluted household bleach (5.25%) solution, if
necessary.
Clean lift ventilation vans regularly.
Hotel lobby
Regularly wash and wipe building entrances, door knobs/
handles with detergent and water, or 1 in 99 diluted
household bleach (5.25%) solution, if necessary.

  1. Preventive Measures against Communicable Diseases

Public toilets and toilets of the guest rooms
Clean public toilets with 1 in 99 diluted household bleach
(5.25%) solution frequently.
Every public washroom should be equipped with liquid
soap, paper towels or hand dryer(s).
Clean toilets of the guest rooms at least once a day. Wipe
the rim, seat and lid of the toilet bowl with 1 in 99 diluted
household bleach (5.25%) solution, rinse with water and
then wipe dry.
Make sure that the drain pipes are built with U-shaped
water traps; do not alter the pipelines without
authorization.
Clean floor drain outlets at least once a week to prevent
putrid air and insects in the soil pipes from entering the
premises. 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.
Environment decontamination is crucial when:
Under outbreak situation
Disinfect the environment with 1 in 49 diluted household
bleach (5.25%) solution, leave for 15-30 minutes before
rinsing with water and mopping dry. [28]
Special attention should be paid to the disinfection of
toilets, kitchens and objects which are frequently touched
such as light switches, door knobs and handrails. [28]

  1. Preventive Measures against Communicable Diseases

IV. Personal protective equipment (PPE)
Personal Protective Equipment (PPE) is specialized clothing
or equipment worn by an employee for protection against
infectious materials. It should serve as a last resort that
should not replace any other risk control and infection control
measures. However, sufficient stock of PPE should be kept to
ensure its provision to protect employees from exposure to
infectious agents in the workplace. The common PPE used for
prevention of infectious diseases transmission are as follows:
Surgical mask
Wear a surgical mask to protect mucous membranes of
the nose and mouth during procedures that are likely
to generate splashes or sprays of blood, body fluids,
secretions, and excretions, (for example, in case of
handling or segregating heavily soiled linen sheets or
laundering items of hotel guests.)
Particulate respirator
Put on a particulate respirators (e.g., N95 respirator) for
conducting of maintenance work for cooling tower such
as testing and commissioning, inspection, water sampling
and high pressure spraying etc.
Gloves
Wear disposable gloves when touching blood, body
fluids, secretions, excretions, or mucous membrane or
contaminated items.
Remove gloves promptly after use and perform hand
hygiene immediately.
Gloves do not replace hand hygiene.

  1. Preventive Measures against Communicable Diseases

Gown or apron
Wear gown or apron to protect skin or trunk and to
prevent soiling of clothing during procedures that are
likely to generate splashes or sprays of blood, body fluids,
secretions, or excretions.
Wear a coverall for conducting high pressure water
spraying during ventilation system maintenance or when
substantial whole body contamination is anticipated.
Remove soiled gown as promptly as possible and perform
hand hygiene to avoid transfer of microorganisms to other
people or environments.
Goggles / Face shield
Wear a goggles / face shield to protect the mucous
membrane of the eyes when carrying out procedure
that are likely to generate splashes or sprays of blood or
body fluids of the guests (e.g., handling of heavily soiled
linen sheets or cleaning or changing dust filters of the
ventilation system).
Wear goggles / face shield when conducting high pressure
water spraying for ventilation system maintenance.
Ordinary spectacles do not provide adequate protection.
Goggles / face shield should be changed after procedure
or whenever contaminated. Reusable goggles / face shield
should be washed and decontaminated in accordance with
manufacturer’s instructions.
In order to reduce the chance of cross contamination,
please also make reference to Appendix E for the
suggested sequences of putting on and removing
personal protective equipment after use.

  1. Preventive Measures against Communicable Diseases

V. Linen management
Used linen should be handled as little as possible with minimum
agitation to prevent possible contamination of the handler or
environment. [6, 7, 9] Clean linen should be stored in the closed
cabinet [42] and handled, processed & transported separately
from the used linen, [9] and linen should be changed regularly
and whenever a guest has checked out.
Packing
Bagged at point of generation.[6]
Rolling technique: wrap up the soiled part to the centre of
the bundle. [7]
Volume of each load should not exceed 2/3 of the laundry
bag.If linen is to be sent for outsource treatment,
Packed with a leak resistant bag for soiled linen.[ 6, 7]
Tied at the neck of the bag tightly.
Linen laundering – Standard laundering procedure
For washable items
Examples of washable items include bed sheets, pillowcases,
towels & cotton blankets.
Pre-wash
Allows warming and mixing up the content of washing
machine to remove the soiled matter. [6]
Main wash
Hot temperature wash: 71°C for ≥ 3 minutes or 65°C for ≥
10 minutes.[5, 6, 8, 10 ] OR
Cold temperature wash: 20°C with bleach (60-150 parts
per million (ppm) available chlorine). [7, 11, 12 ] OR
Ozone washing is a relatively new method that allows
ambient temperature washing cycle, that is 32°C to 35°C.
[13, 14] Please refer to manufacturer’s recommendation
for set up of ozone concentration.

  1. Preventive Measures against Communicable Diseases

Rinsing
Rinsing removes all of the detergent and additives from
linen by dilution. [15]
For non-washable items
Examples of non-washable items include mattresses &
pillows.
The plastic cover should be wiped with 1 in 99 diluted
household bleach (5.25%) solutions. The integrity of the
plastic cover should be checked before wiping.
In case of being contaminated with body fluid, mattress
without plastic cover should be steam-cleaned, pillow
without plastic cover should be washed as standard
laundering procedure or dry-cleaned. [9]
For woollen blankets, it should be washed in warm water,
and then dried under the sun or in dryers under cool
temperature, or dry-cleaned. [9]
For quilts, it should be washed in hot water and detergent,
then rinsed and dried preferably in a dryer or under the
sun, or dry-cleaned.
Handling of the soiled linen
Solid and bulky waste should be cautiously removed first.
It should hence be handled as standard laundering
procedure.
Disposable gloves should be used when handling the soiled
linen contaminated with blood, excreta or body fluids.[ 7]
Gown / apron should be worn if cleaning procedure poses
any risks of contamination of skin or working cloths.[ 7]

  1. Preventive Measures against Communicable Diseases

3.3.2 Transmission-based Precautions
There are three categories of Transmission-based Precautions:
Contact Precautions, Droplet Precautions, and Airborne
Precautions. For some diseases that have multiple routes of
transmission (e.g., SARS), more than one Transmission-based
Precautions category may be used. When used either singly or
in combination, they are always used in addition to Standard
Precautions.
Contact precautions are designed to reduce the risk of
infectious diseases transmission by direct or indirect contact
when handling of infective materials such as changed linen
sheets. Appropriate PPE should be worn, in accordance
with Part IV in the above, when contact with sick guests or
contaminated environmental surface or items is anticipated.
Droplet precautions are designed to reduce the risk of droplet
transmission of infectious agents (e.g., influenza, rubella,
SARS etc) while airborne precautions are designed to reduce
the risk of infectious diseases, such as pulmonary tuberculosis
and chicken pox, transmitted by small droplet particulates (i.e.
droplet nuclei).

  1. Preventive Measures against Communicable Diseases

For sick guests who present respiratory symptoms such as
coughing, sneezing and fever, place a surgical mask on the sick
guest if he/she could tolerate in order to minimize the dispersal
of droplet or droplet nuclei. Advise the sick guests to seek
medical attention and avoid any mass assembling activities.
It is recommended to ask the guest with airborne infectious
diseases (e.g., pulmonary tuberculosis and chicken pox) to put
on a surgical mask, stay in a single room, stop participating any
mass assembling, and immediately seek medical help. If it is
practically possible, it is also recommended to minimize contacts
between the sick guest and hotel staff. Hotel staff should
wear a surgical mask for attending the sick guest, if necessary.
Thorough decontamination (see part III under section 3.3) of
the room housing the sick guest should be performed upon the
guest check out. For personal protection of staff members in
hotels, please refer to Part IV in the above.
3.4 Ventilation
This refers to the process of supplying and removing air to and from a
building, which could be achieved by natural and mechanical means.
Natural ventilation is usually characterized by uncontrolled inward and
outward air leakage through cracks, windows, doorways and vents.
Premises relying entirely on natural ventilation should have openings
of at least 5 to 10% of the floor area to obtain adequate ventilation
in the summer. [1] Mechanical ventilation is provided by air movers
or fans in the wall, roof or air-conditioning system, which promotes
supply and exhaust air flow in a controllable manner.

  1. Preventive Measures against Communicable Diseases

3.4.1 Purpose of ventilation
Provide fresh and clean air to maintain a thermally
comfortable work environment, and to remove or dilute
airborne contaminants.
Maintain the temperature and humidity within acceptable
range.
3.4.2 General ventilation design
Good air flow is very important.
Adequate ventilation can maintain the freshness of air,
prevent accumulation of heat and control the level of
airborne contaminants.
Carbon dioxide level of higher than 1,000 ppm may indicate
the insufficiency of indoor ventilation. [1, 2]
The location of fresh air intake points should be carefully
designed to prevent intake of contaminated air.
Optimum temperature of 20°C – 26°C. [3]
Optimum humidity of 40% – 70%. [3]
Avoid blocking of air flow from the supply registers.
Too much air movement causes draughts which are annoying,
if too little, people may complain of stuffiness.
Adjust diffusers and return air grilles properly.
Regular maintenance to keep the ventilation system clean
and functioning properly.

  1. Preventive Measures against Communicable Diseases

3.4.3 Infection control measures and ventilation issues
Microorganism such as mould or fungi, bacteria, viruses,
protozoa etc can be found indoors.
Mould or fungal growth on structural materials is a sign that
biological growth in the area is flourishing.
High air humidity, stagnant water, filters packed with dusts
and building structures that have been damaged by moisture
all provided favorable conditions for biological growth.
Use efficient filters in ventilation unit to remove airborne
particulates and spores of microorganisms from the
ventilation system.
Remove potential water sources that may encourage fungal
growth, especially stagnant water in ventilation systems.
Repair and maintain all water pipes and draining systems.
Repair areas that have been affected by flood or seepage.
Remove and replace contaminated porous materials, such as
heavily deposited ventilation unit filters, moldy ceiling tiles
and mildewed carpets.
Disinfect all smooth surfaces (such as wall tiles) that have
been contaminated by fungi.
Provide dehumidifier units for control of humidity within the
optimum range.

  1. Preventive Measures against Communicable Diseases

3.4.4 Maintenance of Mechanical Ventilation Systems
Proper inspection, cleaning, testing and maintenance
schedules should be drawn up and followed.
Replace air filters regularly.
Inspect all components of the ventilation system for
cleanliness and microbial growth regularly, and clean them
as required.
Test the performance of the system against the design
specification and make necessary adjustment or repair.
If water cooling towers are used, they should be so
maintained, e.g., use of biocides as appropriate, as to prevent
the growth of micro-organisms (please refer to the Table 1
and 2 below for the water quality of water cooling towers).
Ventilation system should function properly and be regularly
maintained.
Air-conditioning systems should be cleaned according to the
manufacturer’s instructions.
Filters should be changed or cleaned according to the
manufacturer’s instructions. Staff should put on appropriate
PPE (such as goggles and gloves etc) when changing the
filter. [4]
Grilles and air ducts should be cleaned regularly.
3.4.5 Cooling Water Quality Monitoring
Regular monitoring of specific water quality parameters
can provide an early signal before abnormal condition is
detected. This monitoring should be conducted on regular
basis. Indicative freshwater and sea water quality criteria are
provided in the Table 1 and 2 below. However, the owners
/ operators of the cooling tower system shall develop their
own quality monitoring schedules to suit their systems.

  1. Preventive Measures against Communicable Diseases

Parameters Cooling Water Quality Criteria
Heterotrophic colony countLess than 100,000 cfu/mL
Legionella bacteria countLess than 10 cfu/mL
Conductivity Less than 1500 μS/cm
Total dissolved solids Less than 1500 ppm
Suspended solids Less than 180 ppm
Calcium hardness Less than 500 ppm
pH 8 ~ 10
Total alkalinity 80 ~ 500 ppm
Oxidizing biocide Follow manufacturer’s specifications
Inhibitor level Follow manufacturer’s specifications
Temperature Optimal temperature for the system design and
current operating conditions
Chlorine as mg/L Cl Less than 200 mg/L
Sulphate as mg/L SO4Less than 200 mg/L
Total iron as mg/L Fe Less than 1.0 mg/L
Residual Cl Less than 0.3 ppm
BOD5
COD
Metal ions
Refer to EPD’s Technical Memorandum on
Standards for Effluent Discharged into Drainage
and Sewerage Systems, Inland and Costal Water
Table 1: Indicative cooling water quality table for fresh water type
cooling tower [4]

  1. Preventive Measures against Communicable Diseases

Parameters Cooling Water Quality Criteria
Heterotrophic colony countLess than 100,000 cfu/mL
Legionella bacteria countLess than 10 cfu/mL
Total dissolved solids Less than 100,000 ppm
Suspended solids Less than 180 ppm
pH 8 ~ 10
Total alkalinity 200 ~ 350 ppm
Oxidizing biocide Follow manufacturer’s specifications
Inhibitor level Follow manufacturer’s specifications
Temperature Optimal temperature for the system design and
current operating conditions
Chlorine as mg/L Cl Less than 70,000 mg/L
Total iron as mg/L Fe Less than 1.0 mg/L
BOD5
COD
Metal ions
Refer to EPD’s Technical Memorandum on
Standards for Effluent Discharged into Drainage
and Sewerage Systems, Inland and Costal Water
Table 2: Indicative cooling water quality table for sea water type
cooling tower [4]

  1. Preventive Measures against Communicable Diseases
    29
    Guidelines on Infection Control & Prevention in Hotel Industry 衞生署
    Department of Health
  2. Facts About Common Communicable Diseases
    4.1 Foodborne Disease & Specific Preventive Measures 4.1.1 Foodborne disease
    I. Norovirus
    Acute gastroenteritis in humans is usually caused by a group
    of viruses known as Norwalk-like viruses, also known as small
    round structured viruses (SRSVs).
    Food can also be contaminated at its source, and oysters
    from contaminated waters. Noroviruses are relatively
    resistant to environmental challenge: they are able to survive
    freezing, temperatures as high as 60°C, and have even been
    associated with illness after being steamed in shellfish.
    Moreover, noroviruses can survive in up to 10ppm chlorine,
    well in excess of levels routinely present in public water
    systems.
    Clinical features Usually self-limiting.
    With symptoms of acute-onset vomiting, watery non-
    bloody diarrhea with abdominal cramps, and nausea.
    Low-grade fever also occasionally occurs, and vomiting is
    more common in children.
    The incubation period is usually between 24 and 48 hours
    (median in outbreaks 33 to 36 hours), but cases can occur
    within 12 hours of exposure.
    Often cause outbreaks of gastroenteritis in common
    settings including restaurants and catered meals. Isolated
    cases of the disease also occur among people of all age
    groups.
  3. Facts About Common Communicable Diseases
    Mode of transmission
    Primarily through the fecal-oral route, either by
    consumption of fecally contaminated food or water or by
    direct person-to-person spread.
    Environmental and fomite contamination may also act as a
    source of infection.
    Transmission is also due to aerosolization of vomitus that
    presumably results in droplets contaminating surfaces or
    entering the oral mucosa and being swallowed.
    Waterborne outbreaks of norovirus disease in community
    settings have often been caused by sewage contamination
    of wells and recreational water.
    II. Salmonella
    Food Poisoning is usually caused by Salmonella. Approximately
    2000 serotypes cause human disease. Salmonella bacteria
    live in the intestines of human and many food animals, such
    as cows and chickens, and commonly contaminate foods of
    animal origin. People get Salmonella infection by ingesting
    these germs, usually in contaminated food or water, but also by
    putting objects or fingers contaminated with these germs into
    the mouth.
    Clinical features Common symptoms include vomiting, diarrhoea and
    abdominal pain, with or without fever.
    Serious complications, such as dehydration and septicaemia
    leading to death may occur when appropriate treatment is
    delayed, but these are rare.
    The incubation period is usually between 12 and 72 hours.
    The illness usually lasts 4 to 7 days.
    Occasionally can establish localized infection (e.g., septic
    arthritis) or progress to sepsis.

Mode of transmission By consumption of contaminated food, water, or contact
with infected animals.
III. Hepatitis A
Hepatitis A virus (HAV) is classified as a picornavirus. Primates
are the only natural host. Hepatitis means inflammation of
the liver cells. It can be caused by infection, alcohol, drugs,
chemicals and hereditary diseases. Hepatitis A is one form of
viral hepatitis caused by Hepatitis A virus.
Clinical features Usually begins with symptoms such as fever, anorexia,
nausea, vomiting, diarrhea, upper abdominal discomfort,
muscle pain, and malaise.
Jaundice, dark-colored urine, or light-colored stools
might be present at onset or might follow constitutional
symptoms within a few days.
The incubation period is usually around 28 days (range:
15–50 days).
The illness lasts a few weeks but may rarely take months.
Most patients have a complete recovery but in a few cases,
the damage on the liver may be prolonged. Immunity is
usually life-long and there is no chronic carrier state.
Mode of transmission Occurs by fecal-oral route, either by direct contact with an
HAV-infected person or by ingestion of HAV-contaminated
food or water.

  1. Facts About Common Communicable Diseases

4.1.2 Preventive Measures of Foodborne Diseases
Keep the premises and kitchen utensils clean.
Dispose rubbish properly.
Keep hands clean and fingernails trimmed.
Wash hands properly with soap and water before eating or
handling food, and after toilet or changing diapers.
Drinking water should be from the mains and preferably
boiled.
Purchase fresh food from reliable sources. Do not patronize
illegal hawkers.
Avoid high risk food like shellfish, big coral reef fish, raw
food or semi-cooked food.
Wear clean washable aprons and caps during food
preparation.
Clean and wash food thoroughly.
Store perishable food in refrigerator, well covered.
Handle and store raw and cooked food separately (upper
compartment of the refrigerator for cooked food and lower
compartment for raw food) to avoid cross contamination.
Clean and defrost the refrigerator regularly and keep the
temperature at or below 4°C.
Cook food thoroughly.
Do not handle cooked and ready-to-serve food with bare
hands; wear gloves if necessary.
Consume food as soon as it is done.
If necessary, refrigerate cooked leftover food and consume
as soon as possible. Reheat thoroughly before consuming.
Discard any addled food items.
People at high risk of Hepatitis may consider receiving
Hepatitis A vaccination.

  1. Facts About Common Communicable Diseases

4.2 Respiratory Disease & Specific Preventive Measures 4.2.1 Respiratory disease
I. Legionnaires/Pontiac fever
Legionellosis is an infection caused by the bacterium Legionella
species. Legionellae survive and multiply in natural fresh
water, including lakes, rivers, streams, ponds, mud and soil, as
well as man-made water systems. The optimum temperature
for proliferation of the bacteria is around 20°C to 45°C, and
particularly in the range of 35°C to 43°C. The proliferation
ceases above 46°C and below 20°C, while the survival time
decreases to a few minutes at above 60°C. At 70°C the
organism is killed virtually instantaneously. The bacteria
can hardly survive in salt water and domestic water supplies
which is chlorinated. Over 42 species of Legionellae have been
identified and the Legionella pneumophilia serogroup 1 is most
commonly responsible for Legionnaires’ disease and outbreak.
The disease has two distinct forms:
Legionnaires’ disease, the more severe form of infection
which includes pneumonia
Pontiac fever, a milder illness which is self-limiting
Clinical features Typically manifested as severe pneumonia, with symptoms
of high fever over 39°C, malaise, unproductive cough,
chills, muscle ache, headache and breathless, and
confusion, some often culminating in respiratory failure.
Pontiac fever is a milder form of Legionellosis. Patients
usually present with fever, headache and muscle ache,
which last for about two to five days. Symptoms usually
resolve and patients get well without any medical
treatment.

  1. Facts About Common Communicable Diseases

The incubation period is 2 to 10 days.
Route of transmission By inhalation of airborne droplets (i.e. aerosols) or
particles in fine mist containing the bacteria into the lungs
where they are deposited.
According to the previous reported cases, the sources of
the aerosols causing an outbreak were mainly traced to
water systems in buildings including evaporative cooling
towers and humidifiers of air-conditioning systems, hot
and cold water services, fountains / sprinkler systems,
whirlpool and spas, industrial heating and cooling
processes, etc. normal range of operation temperature of
these systems is conducive to the growth of Legionellae.
There is no evidence of person to person spread.
Preventive Measures for Legionnaires/Pontiac fever In Air-conditioning System Remove all potential nourishing water source (e.g.,
stagnant water in drip pans, cooling coils and sumps).
Clean humidifiers or ventilation units regularly.
Use air cooled condensers instead of freshwater cooling
towers.
If freshwater cooling tower is used, effective dosage of
chemicals and biocides should be added to the water
tanks of the cooling tower to prevent growth of algae and
bacteria.

  1. Facts About Common Communicable Diseases

For Fountains The fountains should be built with materials that make
it easy to clean and maintain, such as stainless steel.
Since the smooth surface is simple for cleaning that also
minimizes the chance for bacterial growth.
Fountain is recommended to be placed with some distance
from the unprotected furniture, electrical appliances and
food serving area services.
Replace water regularly. Complete changing of water and
cleaning the fountain periodically, usually in 1 to 4 months
intervals or as follow the instructions provided by the
manufacturer, is desirable
If the fountain is placed in direct sunlight, the frequency
of cleaning should be increased to prevent the growth of
algae.
The reservoir and the pump should be cleaned thoroughly
after the draining out of water. All debris and sludge
should be rinsed and removed before re-operation.
1 in 99 diluted household bleach (5.25%) solution can be
used for general disinfecting purpose or other cleansing
agent as suggested by the manufacturer.
II. Influenza-like illness (ILI)
Influenza-Like illness (ILI) is a nonspecific respiratory illness.
Respiratory pathogens that may present with an ILI include
viruses such as influenza virus, respiratory syncytial virus
(RSV), adenovirus, rhinovirus and parainfluenza virus, as
well as bacterial pathogens such as Chlamydia pneumoniae,
Legionella sp., Mycoplasma pneumoniae and Streptococcus
pneumoniae. Influenza, RSV and certain bacterial infections are
particularly important causes of ILI because can lead to serious
complications.

  1. Facts About Common Communicable Diseases

Clinical features Characterized by clinically unexplained fever ≥ 38°C and,
respiratory symptoms of cough and / or sore throat, muscle
pain and headache.
The incubation period is 1 to 5 days.
Route of transmission Droplets of respiratory secretions are believed to be the
primary means of person-to-person influenza transmission.
Spread can also occur through direct person-to-person
contact or through fomites.
III. Avian Influenza
Avian influenza (H5N1) virus is one type of Influenza A virus. It
is known previously to infect birds only, cross species infections
have been documented in 1997 and 2003 in Hong Kong
affecting 18 and 2 human cases respectively. It then causes
millions of poultry deaths and
Clinical features Avian influenza has similar clinical presentation as human
influenza.
However, it runs a more rapid downhill course resulting in
high fever, chest infection, respiratory failure, multi-organs
failure, and even death.
Route of transmission Avian Flu is transmitted from infected live birds to man.
Transmission between humans is very inefficient.

  1. Facts About Common Communicable Diseases

Preparedness Plan for Influenza Pandemic Hong Kong Government Response Systems The Government’s plan includes a three-level response
system (Alert Response Level, Serious Response Level and
Emergency Response Level).
These levels are based on different risk-graded
epidemiological scenarios relevant to Hong Kong, and
each of them prescribes a given set of public health actions
required.
They are designed to match with the World Health
Organization (WHO)’s guideline1 for pandemic influenza
planning.
According to WHO, preparedness activities for influenza
pandemic should include surveillance, investigation and
control measures, laboratory support, infection control
measures, provision of essential medical services, antiviral
stockpiling, vaccination, port health measures, and
communication.

  1. Facts About Common Communicable Diseases

The three-tiered response levels for Influenza Pandemic Response Level Public health objectives Command & control structure AlertObtain timely and accurate
information from other places with a view to preventing introduction of the disease into Hong Kong and to detect local cases as early as possible.
The Food and Health Bureau (FHB), Department of Health (DH), Hospital Authority (HA),
Agriculture, Fisheries and Conservation Department (AFCD) and the Food and
Environmental Hygiene Department (FEHD) are the main parties assessing the nature and level of risks.
Serious Contain the disease as soon as possible, identify foci of infection, prevent
local transmission and exportation of disease to other places.
Steering Committee chaired by Secretary for Food and Health (SFH) will be set up to steer
Government response.
The Steering Committee will be chaired by the Chief Executive.
The Steering Committee will have as its core members the Permanent Secretary
for Food and Health (Health) (PS(Health)), Permanent Secretary for Food and Health
(Food) (PS(Food)), Permanent Secretary for Education, Permanent Secretary for Commerce and Economic Development (Commerce, Industry and Tourism), Director of Agriculture, Fisheries and Conservation, Director of Food and Environmental Hygiene, Director of Health (DoH), Controller, Centre for Health Protection (Controller, CHP), Director of Information Services (DIS), Director of Social Welfare, Commissioner for Tourism and Chief Executive of the Hospital Authority. The committee will co-opt other senior officials and non-Government experts as circumstances warrant.
• Emergency Early phase: contain the disease as soon as possible, identify foci of infection, prevent large outbreak from occurring, interrupt and stop chain of local transmission and prevent exportation of disease to other places.
Late phase: slow down progression of the epidemic and minimise loss of human lives in
order to buy time for the production of an effective vaccine against the novel
pandemic influenza strain.
• The Steering Committee will be chaired by the Chief Executive.
The Steering Committee will have the Chief Secretary for Administration, the Financial
Secretary, the Secretary for Justice, SFH, the Secretary for Commerce and Economic
Development, the Secretary for Education, the Secretary for Development, the Secretary
for Home Affairs, the Secretary for Transport and Housing, the Secretary for Environment, the Secretary for Labour and Welfare, the Secretary for Security, Director of Chief Executive’s Office, DoH and DIS as its members; and will co-opt other senior officials and non-Government experts as circumstances warrant. •

  1. Facts About Common Communicable Diseases

IV. Severe Acute Respiratory Syndrome (SARS)
Severe acute respiratory syndrome (SARS) is a viral respiratory
infection caused by a coronavirus (SARS-CoV).
Clinical features The initial symptoms are influenza-like.
Usually begin with fever, which is often high (38°C or
above), and sometimes associated with chills, rigors,
headache, malaise, muscle pain or even diarrhoea.
At the onset of illness, some patients may only have mild
respiratory symptoms. After a few days, symptoms of
lower respiratory tract infection may follow, including
cough without sputum and difficulty in breathing.
In around 10% of patients, the illness may rapidly progress
to respiratory failure requiring intensive medical care.
Symptoms can be more variable among elderly patients.
Symptoms usually appear within 2 to 7 days after
contracting the disease, but the incubation period can be
up to approximately 10 days.
Mode of transmission Predominantly transmitted through close person-to-person
contact, especially via respiratory droplets produced when
an infected person coughs or sneezes.
Droplet spread can take place when droplets from the
cough or sneeze of an infected person are propelled a
short distance and deposited on the mucous membranes
of the mouth, nose, or eyes of persons who are nearby.
The virus can also spread when a person touches a surface
or object contaminated with infectious droplets and then
touches his or her mouth, nose, or eyes.

  1. Facts About Common Communicable Diseases

Preventive measures of respiratory disease
I. General Practices:
Maintain good personal and environmental hygiene.
Ensure good ventilation.
Maintain proper function of toilets, drains and pipes.
Cover nose and mouth with tissue paper while sneezing or
coughing, and dispose nasal and mouth discharge properly.
Keep hands clean and wash hands properly: before touching
eyes, nose and mouth, if there is a need to do so; after
handling objects soiled by faeces, respiratory or other body
secretions; after touching public installations or equipment,
such as escalator handrails, elevator control panels or door
knobs.
People with symptoms of respiratory tract infection or fever
should wear a mask and consult a doctor promptly. Let the
doctors know the travel history
People returning from endemic areas should consult doctors
promptly if they have symptoms of respiratory diseases after
the trip.
II. Specific Practices -Avian Influenza
During the «flu» season, it is better to avoid crowded public
places where the ventilation is not good.
Influenza vaccine is prepared according to the prevalence of
strains in the community each year, as recommended by the
World Health Organisation.
Droppings of infected live birds and poultry may carry the
Avian Flu virus, therefore, one should avoid touching live
birds and poultry and their droppings.
If you have been in contact with live birds and poultry, wash
hands thoroughly with liquid soap and water immediately.

  1. Facts About Common Communicable Diseases

If you keep live bird at home, avoid close contact with the
pet and wash hands thoroughly with liquid soap each time
after touching it or after cleaning its droppings.
Schools and nurseries should take measures to prevent
children from coming into contact with live birds.
Poultry and eggs should be thoroughly cooked before
eating.
When traveling outside Hong Kong, avoid touching live birds
and poultry.
4.3 CA-MRSA and Specific Preventive Measures 4.3.1 CA-MRSA
Staphylococcus aureus is a bacterium commonly found on
human skin and mucosa. About a third of normal healthy
people may carry this bacterium in the nose or on skin without
infection. Occasionally, this bacterium gets into the body and
causes disease, such as skin infection, wound infection, food
poisoning, urinary tract infection, pneumonia and infection of
blood stream.
Most strains of Staphylococcus aureus are sensitive to many
antibiotics and infections can be effectively treated. However,
those strains that are resistant to the antibiotic methicillin
(methicillin-resistant Staphylococcus aureus, MRSA) are usually
resistant to other commonly used antibiotics such as penicillins
and cephalosporins. It is widely recognised that indiscriminate
use of antibiotics may contribute to antibiotic resistance.

  1. Facts About Common Communicable Diseases

In the past, MRSA infections commonly occurred in
institutionalised persons and hospitalised patients. In recent
years, many countries observe MRSA infections in healthy
individuals who have not been hospitalised or stayed in other
healthcare facilities or institutions, nor received medical
procedures in the past 1 year prior to symptom onset. They are
known as community associated- MRSA (CA-MRSA) infections
and usually have different patterns of antibiotic resistance. The
medical profession concerns about the emergence of CA-MRSA.
Clinical features Commonly causes skin or soft tissue infections (pimples,
boils or abscesses).
Symptoms may include redness, warmth, swelling, skin
tenderness or pus drainage.
Sometimes more serious effects such as purulent wound
infections and severe pneumonia may occur, requiring
hospitalisation and special antibiotics for treatment.
Mode of transmission Direct contact with wounds, discharge and soiled areas,
usually via hands which may then contaminate other body
sites, items or surfaces.
Risk factors include close body contact, presence of
openings in the skin such as cuts or abrasions, crowded
conditions, and poor personal hygiene.
The bacteria can be carried by healthy individuals, usually
in nasal cavity, hair and armpit regions, and these carriers
may pass the bacteria to other people.

  1. Facts About Common Communicable Diseases

4.3.2 Preventive measures of CA-MRSA
Keep hands clean by washing thoroughly and frequently
with liquid soap and water, or by rubbing them properly
with alcohol handrub.
Wear gloves whenever it is necessary to touch grossly soiled
objects, (e.g. saliva, pus discharge of other household
members or pets), and wash hands thoroughly afterwards.
This is especially important for immunocompromised
persons.
Avoid sharing personal items such as unlaundered towels,
clothing or uniforms and razors.
Avoid direct contact with wounds or anything contaminated
by wound secretions.
Clean any broken skin such as abrasions or cuts immediately
and cover properly with waterproof adhesive bandages.
Wash hands before and after touching wounds. Consult a
doctor promptly if symptoms of infections develop.
Avoid contact sports and visiting public bath houses if you
have an open wound.
Maintain environmental cleanliness and sterilize reused
equipments in public places such as sports centre and public
bathroom.
Do not take antibiotics indiscriminately. Antibiotics should
be prescribed by registered medical practitioners and the
patient should complete the whole course of treatment
according to the prescribed dosage and frequency.
Observe strict hand hygiene and wear mask (for those with
respiratory symptoms) if individuals are taking antibiotics.

  1. Facts About Common Communicable Diseases

4.4 Statutory Notifiable Communicable Diseases
Some communicable diseases are highly infectious and cause severe
consequences to such an extent that they threaten human lives and
affect the economy. If there are proper precautionary or control
measures in place, the disaster posed by these communicable diseases
can be averted. To safeguard public health and safety, every country
or region has legislation stipulating certain communicable diseases
as statutory notifiable diseases which warrant special precautions,
and policies are developed to prevent outbreaks and to contain their
spread.
At present, there are 45 statutory notifiable communicable diseases
under the Prevention and Control of Disease Ordinance (Cap. 599)
in Hong Kong. The list is attached in Appendix B. (The list may be
amended subject to prevailing public health need and policy).
All registered medical practitioners are required to notify the Central
Notification Office (CENO), Centre for Health Protection (CHP) of
the Department of Health all suspected or confirmed cases of these
diseases. Medical practitioners are also advised to report other diseases
and conditions that are of public health concern. The Centre for Health
Protection will conduct surveillance and control of these diseases.

  1. Facts About Common Communicable Diseases
  2. Outbreak of Communicable Diseases 5.1 Outbreak of Communicable Diseases The hotel management should keep a clear staff sick leave record,
    and document usual number of sick staff. If the guests or staff in a
    hotel develop similar symptoms one after another and the incidence
    rate is higher than that at ordinary times, this is an outbreak from the
    epidemiological point of view. An example is cited below for reference.
    Two or more people develop similar symptoms after eating common
    food items. This means that a cluster of food poisoning may have
    occurred. The infective agent may be bacteria, viruses or toxins
    contained in the food.
    5.2 Management of Outbreak of Communicable Disease 5.2.1 Infection control measures during outbreak
    If hotel guests/staff are suspected to have contracted a
    communicable disease, they should be temporarily isolated
    and prompt medical treatment should be arranged.
    Appropriate infection control measures should be
    implemented as soon as possible (e.g. hotel guests/staff
    with respiratory symptoms should put on surgical mask
    during respiratory outbreak) to prevent further spread of the
    infection in hotel.
    Group activities among sick hotel guests should be avoided.




    46
    Guidelines on Infection Control & Prevention in Hotel Industry 衞生署
    Department of Health
  3. Outbreak of Communicable Diseases 5.2.2 Disinfection of environment
    During outbreak situation, disinfect the environment with
    1 in 49 diluted household bleach (5.25%) solution, leave for
    15-30 minutes before rinsing with water and mopping dry.
    Special attention should be paid to the disinfection of toilets,
    kitchens and objects which are frequently touched such as
    light switches, door knobs and handrails.
    Use highly absorptive materials to preliminarily clean up
    surfaces contaminated with vomitus/excreta/secretions
    before performing the above disinfection procedure.
    5.3 Recommendations on Management of Specific Communicable Diseases 5.3.1 Food poisoning
    List names of people suspected to be infected and
    information on food consumed within several days before
    the outbreak for use by the Department of Health during
    investigation.
    Save food remnants for investigation.
    Disinfect articles or places soiled by excreta or vomitus.
    Clean and disinfect toilets with 1 in 49 diluted household
    bleach (5.25%) solution.
    Ensure good personal, food and environmental hygiene in
    the hotel.
    Maintain a hygienic environment in the kitchen and make
    sure that the refrigerator works properly.
    Infected staff, especially food handlers, should be granted
    sick leave to prevent spread of the disease.

5.3.2 Outbreak of respiratory tract infection
List names of people suspected to be infected.
Adjust the Mechanical Ventilation and Air Conditioning
System (MVAC) and open windows if possible, to improve
indoor ventilation and allow more fresh air intakes.
Be stringent with personal and hand hygiene and observe
for respiratory hygiene/cough etiquette.
Group / assembling activities should be suspended during the
outbreak period.
Sick staff should refrain from work until fully recovered.

  1. Outbreak of Communicable Diseases
  2. Infection Control Measures in Special Facilities
    Hotel guests who have a fever, cough, respiratory symptoms or any signs
    of infection should not use common showers, saunas, Jacuzzis or spas (such
    as those provided in hotel health clubs or gyms) as moist atmosphere will
    aggravate the spread of respiratory viruses.
    6.1 Swimming Pools and Whirlpool Spas Acute conjunctivitis, Legionella’s diseases, Pseudomonas dermatitis and
    Cryptosporidiosis are common communicable diseases that could be
    transmitted in swimming pools or in whirlpool spas settings. Persons
    with signs and symptoms of communicable diseases, such as fever,
    cough, red eye syndrome or non-intact skin conditions should be
    prohibited from using the swimming pool.
    Pictorial signage should be displayed conspicuously at the entrance of
    the swimming pool area to alert hotel guests of this restriction and to
    advise users not to spit or urinate in the pool. Staff member should
    advise any persons with signs and symptoms of communicable diseases
    to leave the pool and seek medical advice as soon as possible.
    Measures such as strengthening of the surveillance of the water quality
    and the disinfection system of the swimming pool are of paramount
    importance to prevent infectious disease transmission.
    6.1.1 Environmental cleansing
    I. Daily cleansing routine
    The water of the pool should be completely changed by
    circulation through a filtration system or by removal from
    source in the frequency of not less than once in every 4 hours
    for a covered swimming pool and not less than once in every
    6 hours for an open air pool during which the swimming
    pool is in use by bathers. [29]
    Remove grease on water surface, hair and visible dirt (with
    the help of vacuum where necessary).

The whole area and all the facilities of the swimming pool
and spa (including walls, floors, equipment, tables and chairs,
stepways, handrails, diving boards, chutes, changing rooms,
showers, foot baths, lockers and latrine fitment) should be
kept clean.
Regular cleansing and disinfection should be carried out at
least once a day by using diluted household bleach (e.g. 1
in 99 diluted household bleach (5.25%) solution) and hence
rinse with water and mop dry. [30]
Dry any collection of water poodles around the pool,
especially at corners and sewage exhaust, to prevent the
formation of breeding ground for mosquitoes and germs.
Scales damaged grouting and stained tiles (results of poor
pH control and impaired water balance) should be dealt
with.
The standard of water clarity should be maintained [31]
in such a way that the turbidity of water as expressed in
Nephelometric Turbidity Units should not exceed 5; and the
colour of water as expressed in Hazen Units or Pt-Co Colour
Units should not exceed 5.
Costume or towels supplied to all bathers should be
disinfected, by immersion for not less than 30 seconds in
boiling water [36] or laundering using hot water (70-80°C)
and detergent. [32]
II. Weekly cleansing routine
Backwash of the filter on weekly basis or when it is triggered
by a pressure drop.
Clean pool wall, pool floor, handrails and stairs to remove
bad marks.
Clean the shower room with cleansing powder to remove
accumulated dirt and soap.

  1. Infection Control Measures in Special Facilities
  2. Infection Control Measures in Special Facilities
    Check tiles for any defect.
    III. “When Necessary” cleansing routine
    Super chlorination (addition of an extra dose of chlorine
    to pool and staying overnight to achieve the Free Available
    Chlorine level to 6.0ppm) is recommended [33] every 2 to
    4 weeks during regular usage if the pool would not be
    emptied for thorough cleansing routinely or when the
    amount of combined chlorine is deviated from standard
    value during routine daily test.
    After super chlorination, the pool can only be used until the
    chlorine residual drops below 3.0ppm. [33]
    6.1.2 Pool Decontamination
    I. Fecal materials found in pool
    The procedure depends on whether the stool is formed and
    can be removed intact. When it happens, close the pool,
    remove the stools, and raise the residue chlorine level to not
    less than 2 ppm for at least 1 hour with pH between 7.2 and
    7.8 and wait for the chlorine level to resume normal before
    the pool is reopened for use. [43]
    If a loose stool is dispersed in the pool, raise the residue
    chlorine level up to 3 ppm for 53 hours and take water
    sample for testing the total bacterial count. Reopen the pool
    after passing the test. For small pools, drain way the pool
    water, completely disinfect the pool with diluted bleach (1
    part of household bleach in 49 parts of water), refill water
    for circulation, take water sample for test and reopen the
    pool after receiving a satisfactory result. [43]
    As it is always difficult to differentiate between formed or
    loose stool in water, a more stringent measure should be
    taken, i.e., to treat it as loose stool, whenever in doubt. [33]

II. Blood or Vomit
There is no well-documented evidence that the bloodborne
pathogens, e.g. Human Immunodeficiency Virus (HIV), Hepatitis
B Virus (HBV) or Hepatitis C Virus (HCV), are likely to be
transmitted to swimmers from a blood spill in a pool. However,
pathogens such as noroviruses (Norwalk-like viruses) are
likely to be spread by vomitus. The following procedures are
recommended for disinfecting the pool after blood, body fluid
or vomitus contamination [28]:
The pool should be temporarily cleared and the
contamination dispersed until there is no further trace.
Wear appropriate PPE before cleaning up the spillage.
For blood, it should not be washed into poolside drains.
Cleanse the visible matters with disposable absorbent
material.
For blood spillage, mop the area with cloth or paper towels
soaked with 1 in 4 diluted household bleach (5.25%) solution
and leave for 10 minutes before rinsing with water; for
body fluids or vomitus, mop the are with cloth or paper
towels soaked with 1 in 49 diluted household bleach (5.25%)
solution and leave for 15-30 minutes before rinsing with
water.
Test the disinfectant levels (i.e., Chlorine level) and water
quality to ensure it is satisfactory before allowing people to
swim.

  1. Infection Control Measures in Special Facilities

6.1.3 Water Standards and Testing Frequency
To ensure a good and safe water quality in swimming pools and
spa, the following water standard and test frequency should be
observed:
Pool standards Parameter Range Testing frequency
Pool Water Temperature ( ° C) 26-28 Twice daily
Spa Water Temperature ( ° C) [34]28-35 Twice daily
Room Temperature ( ° C) [34] 22-28 Once daily
Room Humidity (%) [34]] 50-75 Once daily
Free Chlorine (ppm) [35][44] 1.0-3.0 Hourly
Combined Chlorine (ppm) [35] < 1 Hourly
pH [31][44] 7.2-7.8 Hourly
Clarity [31] Floor markings on the pool bottom at its greatest depth can be clearly visible when looking from the side of the pool.
Once daily
Total colony-forming units /ml
[31][44]
<200 Regularly and if necessary E. coli, /100 ml [31] [44] 0 Regularly and if necessary Remarks:
Owing to various methods of pool disinfection, filtration and construction, individual
departments can follow their pool manufacturer’s label directions or maintenance
authority advice for the pool parameters, provided that the pool water is safe and
hygienic.

  1. Infection Control Measures in Special Facilities

6.1.4 Pool Maintenance
To ensure the proper function and acceptable water quality of
swimming pools and whirlpools, qualified contractors should be
commissioned to carry out maintenance work on pool backing,
water treatment, filters, pumping and circulation systems
regularly. Besides, the pool should be emptied at least annually,
allowing a complete change of water and thorough inspection
of the tiles, grouting and fittings. [33]
Frequency of every maintenance action is suggestive. The in-
charge has to decide according to its local situation (e.g., pool
users’ load)
6.2 Fitness Centre or Gymnasium Room The gymnasium environment and its equipments are commonly shared amongst people using the facilities, therefore, they are considered as frequently touched surfaces and common shared items. Inadequately
cleaned equipment and reusable towels are the common breeding
ground of bacteria, such as community associated methicillin resistant
Staphylococcus aureus (CA-MRSA), gymnasium users may acquire CA-
MRSA skin and soft tissues infection during contact sports or sharing
of common equipment.
Respiratory hygiene and cough etiquette should be observed from
time to time (please refer to section 3.3.1 II for details). Daily cleaning
of the gymnasium environment and its equipment, together with
keeping good personal hygiene, are very important to provide a clean
environment for both the gymnasium users, as well as the staff.

  1. Infection Control Measures in Special Facilities

6.2.1 Environmental cleansing:
General facilities and areas of the fitness centre should be
washed with a 1in 99 diluted household bleach (5.25%)
solution and wiped at least once daily.
The frequency of cleaning should be stepped up if the
facilities become dirty.
To facilitate frequent cleaning, adequate disinfectant (such
as 70% alcohol) and paper towels should be made readily
accessible for gymnasium users and staff.
All towels and clothing provided by the gymnasium or fitness
centre should be laundered using hot water (70-80°C) cycle
between use. [32]
Receptables with a lid should be readily available for the
disposal of used paper towels.
Handwashing facilities and 70% alcohol handrub should be
provided for the gymnasium user and staff to wash their
hands after cleaning or wiping down equipment.
6.2.2 Personal hygiene for users
Disinfect any broken skin such as cuts or abrasions immediately and cover properly with waterproof adhesive dressing. Avoid participation in any activities in the gymnasium or
fitness centre if the draining wounds cannot be securely
covered by dressing materials.
Do not share personal items such as towels, clothing, or
water bottles.
Keeping feet dry, frequent changes of absorbent socks, and
adequate drying of shoes between uses.
Keep fingernails short.
Keep hands clean at all time.

  1. Infection Control Measures in Special Facilities

Perform hand hygiene as necessary: before eating and
touching nose, mouth or eyes; after going to toilet, touching
public installations or equipment; and after the work-out
session.
Rub hands with a disinfectant containing 70-80% alcohol if
hands are not visibly soiled and liquid soap and water are
not available.
Consider to stop working out at the fitness centre and seek
medical advice if you have respiratory symptoms such as
fever, cough, sore throat, runny nose, shortness of breath or
breathing difficulties.
6.3 Child Care Facilities Infants and toddlers are highly susceptible to contagious diseases and therefore keeping the child care environment clean and orderly is very
important for health and safety of both children and service providers.
Routine cleaning with detergent and water is sufficient for removing
pathogens from surfaces in child care facilities. However, some items
and surfaces such as diaper changing area, toileting area or toys should
be disinfected regularly. [17, 21, 26]
6.3.1 Diapering
The diaper changing area or furniture that may come
to contact with faeces or urine should be cleaned and
disinfected after each diaper change or decontaminated
promptly when they are visibly soiled. [17, 20-21, 23, 25-26]
Tables or counter surfaces used for diapering should be
made of smooth, non-absorbent, non-porous materials or a
washable pad cover. It should be easily cleaned and free of
any cracks. [17, 21, 25-26]

  1. Infection Control Measures in Special Facilities

Hand hygiene facilities should be located in close proximity
of the diapering area. [17, 21, 25]
Soiled diapers should be disposed properly in a lidded waste
container.
Hand hygiene should be performed immediately after each
diaper change. [17, 21, 25-26]
For soiled cloth diapers or clothing [17, 25], empty faecal
contents into the toilet and place in a leak resistant bag.
Do not wash or rinse diapers or clothes soiled with faecal
materials in child care facility as it increases the risk of
splashing, contamination of hands and environmental
surfaces.
Disposable towels should be used on top of the mat, and
they should be changed between each diaper change. [17,
20]
Diaper changing area should not be used for food service or
storage, and play area. [21, 25]
Any episodes of diarrhea discovered when changing a diaper,
the child should be separated from other children and kept
out from the child care facilities, as possible. [20, 25]
6.3.2 Furnishings
All furnishings in the child care centre should be washed or
cleaned at least daily and steam-cleaned periodically. [17, 21]
Furnishings and high-touched surfaces should be cleaned
and disinfected regularly or the frequency of cleaning and
disinfection should be increased as the circumstances require.
[27-28]
Surfaces contaminated with body fluid should be disinfected
immediately with 1 in 49 diluted household bleach (5.25%)
solution, leave for 15-30 minutes, and then rinsed with water
and dried. [28]

  1. Infection Control Measures in Special Facilities

The schedule of cleaning, operation manual and training
should be established and followed. [27]
6.3.3 Toileting Area
Hand washing facilities should be made convenient in toilet
area. Toilet adapters or step stools that help children to flush
toilets are preferred. [21, 25]
Potty should be emptied immediately after use. They should
be cleaned and disinfected at least daily or when it should
visibly soiled with urine or faeces. [17, 21, 25]
Potty chairs should not be rinsed in a sink used for hand
washing. [17]
No toy is allowed to be taken to the toilet area. [21]
6.3.4 Toys and Ball Pool
Toys with suitable materials that can be easily cleaned and
disinfected should be selected. [18, 21, 24, 26]
Toys made of strong absorbents materials, such as wool or
stuffed furry toys, should not be used if they will be shared.
[17-18, 27]
Large stationary toys such as climbing equipment should be
cleaned and disinfected at least weekly and whenever visibly
soiled. [18, 26]
If toys are likely to be mouthed, it should be rinsed with
water after disinfection between uses by individual children,
or it should be alternatively washed in a dishwasher. [17-18]
Toys and equipments such as blocks or trucks that are not
put into mouths should be cleaned at least daily or when
obviously soiled. [17, 26]

  1. Infection Control Measures in Special Facilities

Hard or plastic toys should be cleaned regularly e.g. daily by
washing with water and detergent, followed by thorough
rinsing and drying. [17, 21, 26]
Soft or cloth toys should be washed daily in the hot
water cycle of washing machine, taking care to follow the
manufacturers washing instructions. [17, 21, 26]
If toys are required for cleaning and disinfection, do so
immediately or they should be stored in a designated labeled
container separated from the toys that are clean and ready
for use. [18]
Toys should be decontaminated immediately when it is visibly
soiled or contaminated. [21, 26]
Hard and plastic toys should be disinfected with 1 in 49
diluted household bleach solution, then rinsed with water
and let it dry. [21, 26]
70% alcohol solution could be used on the metal surface of
any toys
Soft or stuffed toys could be cleaned by laundering process
in a hot water wash (at least 60°C) of washing machine.
Heavily contaminated toys may have to be discarded. [17, 21,
26]
Hand hygiene of the children is recommended after handling
contaminated toys or after playing in the ball pool. [21, 26]
6.3.5 Management guidance for gastroenteritis outbreak
Sick children or those who present gastroenteritis symptoms
should be excluded from child care facility. Prompt medical
treatment should be arranged. [17, 20, 23, 25, 27]
Group activities should be suspended during the period of
outbreak. [17, 21, 25]

  1. Infection Control Measures in Special Facilities

Environmental surface such as toilet seats, flush handles or
door handles should be cleaned and disinfected with 1 in
49 diluted household bleach (5.25%) solution regularly or if
situation allows and requires, the frequency of cleaning and
disinfection could be increased. [17, 21, 23, 25, 27]
70% alcohol should be used for disinfecting metal surfaces,
if required. [25, 27]
If spillage occurs (please refer to section 5.2.2 for details of
spillage handling), it should be decontaminated promptly.
Procedures for cleaning and disinfecting toys should be
strictly followed. [17, 21]
Soft or stuffed toys should not be used during the period of
outbreak. [21]
Other toys should be washed and disinfected at least daily.
Stock rotation should occur to limit the number of toys
accessible at once. [21]
Ensure practice of good hand hygiene and diapering
changing in all children and care providers. [17, 21, 27]
6.4 Sauna, Massage and Beauty Centre As general good practices, sufficient dressing rooms, shower rooms,
toilet facilities and separate locker for the guests are recommended
to promote the personal hygiene. Adequate handwashing facilities
including handwashing basin, liquid soap and paper towels/hand dryer
should be provided to facilitate handwashing for the users. Adequate
showering facilities and toiletries including bathing liquid soap and
shampoo should be provided for the convenience of the guests using
the facilities. [37, 41, 42] Hand hygiene (please refer to section 3.3.1
I for details) as well as respiratory hygiene (please refer to section
section 3.3.1 II for details) should be observed from time to time.

  1. Infection Control Measures in Special Facilities

Having a shower before entering and using of the facilities is
recommended. [38] Towels provided for the guests should be
laundered using hot water (70-80°C) cycle between use. [32] A covered
receptacle should be provided exclusively for soiled linens and towels
which can be readily emptied and cleaned. [37, 41, 42]
Guests with signs and symptoms of communicable diseases, such as
skin lesions, respiratory illness or diarrhea should be prohibited from
the use of the facilities. [37, 41]
6.4.1 Environmental cleansing
I. Sauna
Sweeping or vacuuming the sauna room should be
performed after each session to keep it free from dust and
hair. [37]
The environmental surface, especially the bench top, should
be disinfected with 1 in 99 diluted household bleach (5.25%)
solution after each session, then rinsed with water and
wiped dry.
If floor is covered with ceramic tile, all the duckboards should
be removed and disinfected with 1 in 99 diluted household
bleach (5.25%) solution after each session, then rinsed with
water and wiped dry. Before replacing back the duckboards
to the original position, the floor underneath should also be
cleaned with detergent, rinsed well and wiped dry at least
daily.
If bleach is used, cleaning and disinfection should be done at
room temperature and under good ventilation. The surfaces
should be thoroughly rinsed with water before subsequent
session.[38]
II. Massage & beauty centre
Separate massage room for each patron if possible. [42]

  1. Infection Control Measures in Special Facilities

All walls, ceilings, floors should be in good repair and
maintained in a clean and sanitary condition. It should be
cleaned at least twice each day. [42]
The surface of massage couch should be made of durable
washable plastic or other waterproof material which is easy
for cleaning, disinfecting and maintenance.
It should be disinfected with 1 in 99 diluted household bleach
(5.25%) solution then rinsed with water and wiped dry after
each use. It should be checked for any defect regularly.
Written record of cleaning and disinfecting schedule should
be established and maintained. [42]
6.4.2 Specific requirement and practice
I. Sauna
Wooden benches should be painted with a waterproof paint
to seal and smooth the surface, facilitate drying, and reduce
areas where bacteria may grow.[38]
Stainless steel surface of the electric sauna heater should be
wiped with mild detergent and soft cloth at least daily. It
should then be rinsed with water afterwards.
Sauna stones can be washed with soapy water and rinsed
with plain water. It should be inspected from time to time
to make sure their integrity and cleanliness. It should be
changed if cracked or they are giving off a bad odor.
Clients should be encouraged to use a clean towel or clothing
to act as a barrier between the benches and bare skin.[32,
38, 39]
Maintenance check should be done yearly or as suggested by
the manufacturer for the sauna facilities.

  1. Infection Control Measures in Special Facilities

II. Massage and beauty centre
All towels or linen should undergo proper laundering process
after each use. [32, 37, 41, 42]
Single-use paper coverings should be discarded into a
sanitary receptacle after use. [42]
All instruments should be kept clean, in good repair, and
capable of being disinfected and/or sanitized. For example,
hot stones used for massage should be disinfected after each
use. Disposable instruments should be used when available.
[37, 41, 42]
If clothing is provided for the guests, it should undergo
proper laundering process after each use. [32, 37, 42]If
underwear is provided, it should be disposable and for single
use only. [42]
To avoid contamination, staff should ensure any make-up,
cream, ointment, massage oil or similar substance is removed
from its original container / tube using a clean disposable
applicator. Applicators used for dispensing must not be re-
dipped into the original container and must be discarded
after each client. Single use applicators are recommended.
[39]
Leftover portion for dispensing should not be returned to
the original container and must not be used on other clients.
[39]
Pump outlets, bottles and nozzles for dispensing are a
potential source of contamination, particularly due to the
contents accumulated around the outlet. Nozzles should be
cleaned frequently and dried before replaced. Wash bottles
and nozzles in warm water and detergent, rinse them under
hot running water, and dry them using a lint-free cloth,
before refilling the bottle or replacing the pump / spray
nozzle. Pump / spray bottles should never be topped up. [39]

  1. Infection Control Measures in Special Facilities

6.4.3 Personal hygiene of health of masseur / masseuse
Masseur / masseuse should maintain good personal hygiene,
such as executing proper hand hygiene, [37, 39] keeping
nail short and clean. No artificial nails, such as acrylic nails,
accessories, such as watch or ring, is allowed on providing
massage service.
Masseur / masseuse should wear clean outer garments /
uniform when serving a patron. [41, 42]
Masseur / masseuse should be refrained from work if they
have active skin lesion, nail infection or any signs and
symptoms of infectious disease, such as fever, sore throat or
cough. [37]
6.4.4 Public showering facilities
Materials such as the large tiles are recommended for ease of
maintenance. It should be checked for any defect regularly.
The shower room surface should be cleaned frequently with
detergent and water, or it should be disinfected regularly
with 1 in 99 diluted household bleach (5.25%) solution, then
rinsed with water and wiped dry, if necessary.
Grab bars and showerheads should be cleaned frequently as
these are the commonly touched area.
Floor should be kept dry after cleaning.
Handwashing facilities, including handwashing basin, liquid
soap and paper towels or hand dryer, should be provided. [37]
Eusure adequate toiletries, such as bathing liquid soap &
shampoo are provided. [37]
Towels provided for the guests should be laundered using
hot water (70-80°C) cycle between use. [32]

  1. Infection Control Measures in Special Facilities

A covered receptacle which can be readily emptied and
cleaned should be provided exclusively for the soiled linens
and towels. [37]
The guests should be recommended to avoid walking with
bare foot in the shower room. [38]
About half a litre of water should be poured into each drain
outlet regularly (e.g. once a week) so as to maintain the
water column in the pipe to serve as water lock. [40]
Ensure the drain pipes are built with U-shaped water traps;
the pipelines should never be altered without authorization.
[40]
Ensure the soil pipes are unobstructed and the sewage drains
are functioning properly without leakage so as to avoid
breeding of infective agents. [40]
The ventilation system should be maintained to provide a
well-ventilated environment. The exhaust fan should be
cleaned regularly.
6.5 Catering Services To safeguard the health of guests and to ensure the satisfactory
standards are reached, guidelines and instructions on food safety
and food premises hygiene issued by the Food and Environmental
Hygiene Department (FEHD) should be complied from time to time.
Hotel management should also promote food safety and hygiene by
providing relevant trainings to food handlers and supervisors regularly.
The following advices should not be taken in any way as a substitute
for the regulations issued by the FEHD. Please refer to the most
updated guidelines and information posted on the FEHD’s website at
http://www.fehd.gov.hk for details.

  1. Infection Control Measures in Special Facilities

6.5.1 Personal hygiene of food handlers
Keep all parts of bodies, clothing, hands and nails clean
at all times. Nails should be kept short and unpolished.
Cover wounds on hands completely by suitable waterproof
dressings.
Perform proper hand hygiene frequently and as required.
Wear mask when handling food and disposable gloves
especially when handling ready-to-eat food.
Refrain from smoking, spitting, chewing, eating, sneezing
or coughing over unprotected food or food contact surface,
touching ready-to-eat food with bare hands, sitting, lying
or standing on any surface liable to come into contact with
food, tasting food with fingers, touching hair or other parts
of bodies when inside food preparation areas as that may
result in contamination of food.
Food handlers suffering or suspected to be suffering from
a communicable disease should immediately report their
illness to the management and seek medical treatment. They
should be immediately suspended from engaging in any
work that may allow them to come into contact with food,
food contact surfaces, food utensils and equipment.
6.5.2 Food Hygiene
Food should be supplied from approved and reputable
sources and promptly identified and moved to proper
storage areas upon receipt to facilitate tracing products in
the event of a recall or food incident,
Food and raw materials should be stored off the floor and
first-in-first-out principle for food storage should be applied
to minimize the growth of microorganisms and to prevent
food from becoming unsafe or unsuitable during their
expected shelf-lives.

  1. Infection Control Measures in Special Facilities

Ensure food be kept at proper temperature during cooling,
storage, display and transportation to suppress bacteria from
multiplying to an unsafe level in the food. The temperature
inside the refrigerator should be kept at or below 4°C and
the freezer at or below -18°C. The temperature inside the
refrigerator should be monitored regularly.
Frozen food should be thawed properly and completely to
minimize the growth of food poisoning bacteria and toxin
production.
Prevent cross-contamination between raw and cooked or
read-to-eat food by separate handling (e.g. using separate
knives and chopping boards) and storage. Food should also
be properly protected during storage, preparation, display,
service and transportation to prevent contamination by
equipment, utensils and personnel as the transfer of bacteria
from one food (usually raw) to another is one of the major
causes of foodborne illnesses.
Cook food thoroughly before consumption in order to
ensure food safety. The centre or the thickest part of the
food needs to reach 75°C for 15 seconds to kill any bacteria
causing foodborne diseases, although heating food to a
lower temperature for longer periods of time may be equally
effective.
Food that previously cooked and cooled be reheated
thoroughly be-fore consumption to minimize the time that
cooked food is exposed to the temperature danger zone
(between 4°C and 60°C) which allows pathogenic bacteria to
grow during the reheating process.

  1. Infection Control Measures in Special Facilities

6.5.3 Premises Hygiene
Ensure walls, floors and ceilings are properly maintained
and kept clean, sewerage / grease trap, plumbing system
and extraction / exhaust systems in food room are in good
working condition and grease filters installed and kept clean
so as to protect food from contamination.
Ensure ventilating system in premises is functioning properly
to safeguard the health of customers and workers.
Toilets should be kept clean and free from obstruction. Water
closets should be in good working condition and wash hand
basins should be adequate, kept clean and provided with
liquid soap and hand-drying facilities to facilitate frequent
handwashing of food handlers.
Ensure adequate waste containers, properly covered and
emptied daily.
Prevent pest infestation – proper storage of food, proper
disposal of rubbish, be aware of signs of pest infestation and
arrange for pest disinfestations where necessary.
Prohibit dogs, cats, birds or pets in food rooms.
Ensure no deviation from approved layout.
6.5.4 Utensils and equipment
Food contact surfaces of equipment and utensils should be
properly maintained, kept clean and sanitized between uses.
Non-food contact surfaces of equipment should be properly
maintained and kept clean.
Cleaned equipment and utensils should be properly stored.

  1. Infection Control Measures in Special Facilities
  2. Appendix Appendix A: Hand Hygiene Technique 69
    Guidelines on Infection Control & Prevention in Hotel Industry 衞生署
    Department of Health
  3. Appendix Appendix B: Notification of Infectious Diseases
    In accordance with the Prevention and Control of Disease Ordinance (Cap.599),
    there are 45 notifiable infectious diseases. All registered medical practitioners are
    required to notify the Centre for Health Protection all suspected or confirmed cases
    of these diseases. Medical practitioners are also advised to report other diseases and conditions that are of public health concern. The Centre for Health Protection will
    conduct surveillance and control of these diseases.
    Statutory notifiable diseases
    These are the infectious diseases specified in the First Schedule to the
    Prevention and Control of Disease Ordinance (Cap. 599). Notification of suspected or
    confirmed cases of these diseases is required by law.
    Acute poliomyelitis •
    Amoebic dysentery •
    Anthrax •
    Bacillary dysentery •
    Botulism •
    Chickenpox •
    Cholera •
    Community-associated methicillin-
    resistant Staphylococcus aureus
    infection

    Creutzfeldt-Jakob disease •
    Dengue fever •
    Diphtheria •
    Escherichia coli O157:H7 infection •
    Food poisoning •
    Haemophilus influenzae type b
    infection (invasive)

    Hantavirus infection •
    Influenza A (H2), Influenza A (H5),
    Influenza A (H7) or Influenza A (H9)

    Japanese encephalitis •
    Legionnaires’ disease •
    Leprosy •
    Leptospirosis •
    Listeriosis •
    Malaria •
    Measles •
    Meningococcal infection (invasive) •
    Mumps •
    Paratyphoid fever •
    Plague •
    Psittacosis •
    Q fever •
    Rabies •
    Relapsing fever •
    Rubella and congenital rubella •
    Scarlet fever •
    Severe Acute Respiratory Syndrome •
    Smallpox •
    Streptococcus suis infection •
  4. Appendix Other communicable diseases of topical public health concern
    Though not specified in the First Schedule to the Prevention and Control of
    Disease Ordinance, medical practitioners are urged to report suspected or confirmed
    cases of the following diseases to CENO for arrangement of investigation and control
    as appropriate:
    Acute flaccid paralysis • Cryptosporidiosis •
    Brucellosis • Enterovirus 71 infection •
    Chikungunya fever • Vibrio vulnificus infection •
    Suspected institutional outbreaks
    Any suspected institutional outbreaks of communicable diseases can be
    reported to CENO for arrangement of investigation and control as appropriate.
    Some common examples are as follows:
    Acute Conjunctivitis • Head Lice •
    Gastroenteritis • Respiratory Tract Infections •
    Hand-foot-mouth Disease • Scabies •
    (Please refer to CENO on-line website @ www.chp.gov.hk/ceno for the
    update list of statutory notifiable diseases)
    Tetanus •
    Tuberculosis •
    Typhoid fever •
    Typhus and other rickettsial diseases •
    Viral haemorrhagic fever •
    Viral hepatitis •
    West Nile virus infection •
    Whooping cough •
    Yellow fever •
  5. Appendix Appendix C: Commonly Used of Disinfectants NameConcentrationUsage Properties
    Sodium
    Hypochlorites
    1% (10,000 ppm)
    Dilution ratio 1 :5*
  6. 1% (1, 000 ppm)
    Dilution ratio 1 :50*
  • Preparation of
    Diluted should be according to the information sheet of “Preparation of Bleach”
    Environmental or equipment disinfection
    Mixes with water Corrosive to metals Avoid contact with skin or mucous membrane Contact with acids liberates toxic gas
    Diluted solution decompose rapidly Freshly prepared diluted bleach should be used within 24 hours
    Alcohols:
    e.g.
    – Ethyl Alcohol
    – Isopropyl Alcohol
    70% Skin or metal
    surface
    disinfection
    instrumental
    disinfection
    Inflammable liquid Rapid
    action but volatile Poor
    penetration into organic
    matter
    Diguan ides :
    e.g.
    – Chlorhe x id ine :
    Hib itane
    aqueous 1:1000 Skin and mucous
    membrane
    disinfection
    Wound dressing
    Solution Low toxicity
    – Chlorhe x id ine
  • cetrim ide/
    cetavlon e. g.
    Savlon
    aqueous 1:100 Solution Low toxicity
    Detergent properties
  1. Appendix Appendix D: The Use of Bleach The Use of Bleach
    Bleach is a strong and effective disinfectant. Its active ingredient, sodium
    hypochlorite, denatures protein in micro-organisms and is therefore effective in
    killing bacteria, fungus and viruses. Household bleach works quickly and is widely
    available at a low cost. Diluted household bleach is thus recommended for the
    disinfection of facilities.
    As bleach irritates mucous membranes, the skin and the airway, decomposes
    under heat or light and reacts readily with other chemicals, caution should be
    exercised in the use of it. Improper use of bleach may reduce its effectiveness in
    disinfection and also lead to accidents which can be harmful to health. Overuse of
    bleach or using a bleach solution that is too concentrated results in the production
    of toxic substances that pollute the environment and disturb ecological balance.
    Tools and Equipment
    Before cleaning, get all necessary tools and equipment ready. Cleaning tools,
    cleansers/disinfectants, measuring tools and protective gear will be needed.
    Cleaning tools:
    Brush, mop, towel, spray can and bucket.
    Cleansers/disinfectants:
    Bleach and water.
    Measuring tools:
    Tablespoon and measuring cup.
    Protective gear:
    Mask, rubber gloves, plastic apron and goggles (recommended).
  2. Appendix Procedures of Preparing / Using Diluted Bleach
  3. Keep windows open when diluting or using bleach to ensure good
    ventilation.
  4. Put on protective gear when diluting or using bleach as it irritates mucous
    membranes, the skin and the airway.
  5. Cold water should be used for dilution as hot water decomposes the active
    ingredient of bleach and renders it ineffective.
  6. Bleach containing 5.25% sodium hypochlorite should be diluted as follows:
    • 1 in 99 diluted household bleach (mixing 10ml of bleach with 990ml of
    water) can be used for general household cleaning.
    • 1 in 49 diluted household bleach (mixing 10ml of bleach with 490ml of
    water) is used to
    • disinfect surfaces or articles contaminated with vomitus, excreta and
    secretions.
  7. Make adjustments to the amount of bleach added if its concentration of
    sodium hypochlorite is above or below 5.25%.
  8. For accurate measurement of the amount of bleach added, a tablespoon or
    measuring cup can be used.
  9. Rinse disinfected articles with water and wipe dry.
  10. Cleaning tools should be soaked in diluted bleach for 30 minutes and then
    rinsed thoroughly before reuse.
  11. Finally, wash hands with liquid soap, then dry hands with a clean towel or
    disposable towel.
    • Calculation: Multiplier of the amount of bleach added = 5.25
    concentration of sodium hypochlorite in bleach
    • For example, when diluting a bleach containing only 5% sodium
    hypochlorite, the multiplier is 5.25 / 5=1.05. That means 10 x 1.05 =10.5ml
    of bleach should be used when preparing a bleach solution.
  12. Appendix Precautions
    • Avoid using bleach on metals, wool, nylon, silk, dyed fabric and painted
    surfaces.
    • Avoid touching the eyes. If bleach gets into the eyes, immediately rinse
    with water for at least 15 minutes and consult a doctor.
    • Bleach should not be used together or mixed with other household
    detergents as this reduces its effectiveness in disinfection and causes
    chemical reactions. For instance, a toxic gas is produced when bleach is
    mixed with acidic detergents such as those used for toilet cleaning. This
    could result in accidents and injuries. If necessary, use detergents first and
    rinse thoroughly with water before using bleach for disinfection.
    • As undiluted bleach liberates a toxic gas when exposed to sunlight, it
    should be stored in a cool and shaded place out of reach of children.
    • Sodium hypochlorite decomposes with time. To ensure its effectiveness, it
    is advised to purchase recently produced bleach and avoid over-stocking.
    • For effective disinfection, diluted bleach should be used within 24 hours
    after preparation as decomposition increases with time if left unused.
    November 2007 (revised)
  13. Appendix Appendix E: Maintain Cough Manners
  14. Appendix Appendix F: Sequence of Donning & Removing Personal Protective Equipment (PPE) 77
    Guidelines on Infection Control & Prevention in Hotel Industry 衞生署
    Department of Health
  15. Appendix Appendix G: Useful links Department of Health http:// www.dh.gov.hk
    – Centre for Health Protection http://www.chp.gov.hk
    – Central Notification Office (CENO) http://www.chp.gov.hk/ceno
    – Travel Health Service http://www.travelhealth.gov.hk/
    – Central Health Education Unit http://www.cheu.gov.hk
    Food and Environmental Hygiene Departmenthttp://www.fehd.gov.hk
    Center for Disease Control and Preventionhttp://www.cdc.gov
    World Health Organization http://www.who.int

References: 1.Occupational Safety and Health Branch. Labour Department. Guidance Notes on
Ventilation and Maintenance of Ventilation Systems. 2005.
2.American Society of Heating, Refrigerating and Air-conditioning Engineers, Inc.
ANSI/ASHARE Standard 62-2001. Ventilation for Acceptable Indoor Air Quality.
2004.
3.Occupational Safety and Health Branch. Labour Department. A Simple Guide to
Health Risk Assessment. Office Environment Series OE 4/2004. Ventilation. 2004.
4.Electrical & Mechanical Services Department. Code of Practice for Water-cooled Air
Conditioning Systems. Part 2: Operation and Maintenance of Cooling Towers. 2006.
5.Barrie. Laundry hygiene and handling of contaminated linen. In: G. A. J. Ayliffe.,
A. P. Fraise., A. M. Geddes., & K. Mitchell (Eds), Control of Hospital Infection. A
Practical Handbook (4th ed.). London: Arnold. 2000. (pp239-343)
6.Maurer, I. M. Hospital Hygiene. London: Edward Arnold.1985.
7.Centers for Disease Control and Prevention. (2000). Laundry in Health Care Setting.
Retieved November 15, 2005 from http://www.cdc.gov/ncidod/dhqp/bp_laundry.html
8.Bradley, B. Physical and Chemical Disinfection In: G. A. J. Ayliffe., A. P. Fraise., A. M.
Geddes., & K. Mitchell (Eds), Control of Hospital Infection. A Practical Handbook
(4th ed.). London: Arnold. 2000. (pp75)
9.World Health Organization-Western Pacific Region. Practical Guidelines for
Infection Control in Health Care Facilities.(2003) Retrieved February 21, 2005, from
http://www.wpro.who.int/sars/docs/practicalguidelines/default.asp
10.NHS Executive. Hospital Laundry Arrangements for Used and Infected Linen. (1995)
Retrieved March 1, 2005, from http://www.dh.gov.uk/PublicationsAndStatistics/
LettersAndCirculars/HealthServiceGuidelines/HealthServiceGuidelinesArticle/fs/en?
CONTENT_ID=4017865&chk=5M eXDx
References: 11.Blaser, M. J., Smith, P. F., Cody, H. J., Wang, W. L., & LaForce, F. M. Killing of
Fabric-associated Bacteria in Hospital Laundry by Low-temperature Washing. The
Journal of Infectious Diseases, (1984)149(1). 48-57.
12.New South Wales Hospitals Planning Advisory Centre. Report on Research into
Proposed Low Temperature Water Washing in Hospital Laundries in New South
Wales. Sydney: Author. (1988).
13.Rice, R. G.. Century 21 – Pregnant with ozone. Ozone Science & Engineering, (2001)
24, 1-15.
14.Weavers, L. K., & Wickramanayake, G. B. Disinfection and sterilization using ozone.
In: S. S. Block (Ed), Disinfection , Sterilization, and Preservation. (5th Ed) USA:
Lippincott Williams & Wilkins. (2001) pp205-214
15.Barrie. Control of Hospital Infection. Laundry, Kitchen, Hygiene and Clinical Waste
Disposal. (1994) pp239-243
16.Barros AJD, Ross DA et al. Preventing acute respiratory infections and diarrhea in
child care centres. Acta Paediatr 1999; 88: 1113-8.
17.Centers for Disease Control and Prevention. A Handbook for Child Care Providers:
Safe and Healthy Child Care, 1996.
18.Centers for Disease Control and Prevention. Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in Healthcare Settings, 2007.
19.Centers for Disease Control and Prevention. Preventing the Spread of Influenza (the
Flu) in Child Care Settings: Guidance for Administrators, Care Providers, and Other
Staff, 2006.
20.Centers for Disease Control and Prevention. Division of Bacterial and Mycotic
Diseases:Shigellosis,2005.availablefrom: http://www.cdc.gov/ncidod/dbmd/
diseaseinfo/shigellosis_g.htm
21.Health Protection Agency. Guidelines for the Control of Infection and Communicable
Disease in Nurseries and Other Institutional Early Years Settings in South West
London Sector, 2005.
22.Dartford and Gravesham National Health Service Trust. Policy on the Cleaning and
Disinfection of Toys, 2004.
23.Environ Health Associates, INC. Norovirus Outbreak Control Guidelines, 2004.
24.Randle J, Fleming K. The risk of infection from toys in the intensive care setting.
Nursing Standard 2006; 20: no. 40.
25.Community Care Facilities Branch, Ministry of Planning, Victoria, BC. Preventing
Illness in Child Care Settings, 2003.
26.Public Health Protection Division, United Kingdom. Infection Control Guidance for
Nurseries, Playgroups and other Childcare Setting, 2006.
27.Centre for Health Protection, Department of Health. Guidelines on Prevention of
Communicable Diseases in Child Care Centres, Kindergartens and Schools, 2004.
28.Infection Control Branch, Centre for Health Protection, Department of Health.
Guideline for Environmental Decontamination(Advanced Draft), 2007
29.Public Health and Manicipal Services Ordinance 132 CA: Swimming Pools
Regulation, Section 9, Changing of Water, 2000
30.Food and Environmental Hygiene Department. Guidelines on Prevention of Breeding
of Blood Worms in Swimming Pool, 2006. Available at http://www.fehd.gov.hk/
safefood/risk-pest-arthropod_mos.html on 19 December 2007.
31.Public Health and Manicipal Services Ordinance 132 CA: Swimming Pools
Regulation, Section 10, Quality of Water, 2000
32.Victorian Government Department of Human Services. Health Guidelines for
Personal Care and Body Art Industries, 2004
33.Hospital Authority. Guidelines on Management of Hydrotherapy & its Facilities.,
2007.
34.Standard Australia AS 3979 Hydrotherapy pools, the Victorian Rehabilitation, 1993
References:
35.The Chartered Society of Physiotherapy Service standards, Management of the
Hydrotherapy pool, 2000
36.Public Health and Manicipal Services Ordinance 132 CA: Swimming Pools
Regulation, Section 15, Sterilization of bathing costumes and towels, 2000
37.Greenwich Department of Health. Body Care Facilities Technical Standards and
Requirements. February 2004 Revision.
38.Los Angeles County Department of public health, Guidelines for Reducing the Spread
of Staph/CAMRSA in Non-Healthcare Settings. v. 2. February 2007
39.State Government of Victoria, Australia, Department of Human Service. Massage,
Manicure, Pedicure and Facials. Client Health Information. July 2006
40.http://www.bd.gov.hk/english/documents/code/dsg/DrainagePipeMaintenance.pdf
41.Greenwich Department of Health. Division of Environmental Services.
Massage Establishments: Technical Standards. (2002) available at:
http://greenwichct.virtualtownhall.net/Public_Documents/GreenwichCT_Environment/
GreenwichCT_HDAppsFrms/I00F4E371.0/Technical%20Standards.pdf
42.Leisure and Culture Services Department. Operations Permit: Massage Business
Chapter 6.60, November 1996

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