Rising to the Challenge of Infection Control: Hong Kong Benchmarks Its Performance

The former British colony, now granted autonomy within China, is home to more than seven million people and, together with the effects of a sub-tropical climate, this crowded enclave represents a particularly challenging environment for the control of infectious diseases. However, in the health care sector Hong Kong is one of the region’s leaders in establishing procedures and practices aimed at minimizing the risks of healthcare associated infections (HCAI).
  A major contributor in the field has been the Hong Kong Infection Control Nurses’ Association (HKICNA), which this year celebrates the 20th anniversary of its foundation. Its growth in membership, as well as its importance as a driver of best practice, has been stimulated by the MRSA and SARS events experienced in Hong Kong. From a nucleus of just 40 members, the HKICNA has grown to include more than 800 nurses, with members throughout Hong Kong’s 44 public and 10 privately-run hospitals.

Following the first detected case of MRSA in 1985, infection control units were rapidly set up in all public hospitals. It was an initial step, further encouraged the formation of the HKICNA, whose first members were all nurses trained as full-time infection control professionals in each hospital and supported by an infection control doctor. However, recognition and development was slow – until the enclave was hit by the SARS outbreak in 2003.
  “At its peak, from March to August, there were 1,755 confirmed cases,” says Pat Ching, founding Chair of the HKICNA. “And 30% of those were health care workers. Whilst SARS was a very unpleasant experience, it also concentrated everyone’s minds on the importance of infection control. There’s no doubt it has had a very beneficial impact in that respect.”


Pat Ching

Today, for every 250 hospital bed in Hong Kong there is one full-time infection control practitioner, many of whom are HKICNA members and former front-line nurses. That compares to an average of one per 500 beds before the SARS outbreak.
  “We are trained in epidemiology, surveillance of HCAI, best patient-careprocedures,
and the investigation and control of hospital outbreaks, ” says Ms Ching, who is also the Senior Nursing Officer for the Chief Infection Control Officer (CICO) at Hong Kong’s Queen Mary hospital. “The job involves education among all staff, ensuring what should be done is done.”

Surveillance includes monitoring working practices and also the analysis of trends in HCAI, detecting clusters and outbreaks at an early stage. The work also includes surgical site infection (SSI), with post-discharge wound infection surveillance where all surgical patients are contacted 30 days after discharge from hospital.
  “We benchmark our performance in infection control against CDC (Center for Disease Control and Prevention) standards in the United States,” adds Ms Ching. “Hong Kong is a relatively prosperous community and I would say we are leaders in our region of the world and above average on a global scale.”

The impact of SARS has led to the provision of more and better isolation units in most Hong Kong hospitals, although overcrowding in the general wards is still a problem, with extra beds sometimes required. There are also long waiting times for most operations, but Ms Ching points out that these are all problems shared with many European countries where there is a well-funded public health service.
  In the operating room, the use of single-use drapes and gowns for staff and patients is becoming more popular, especially in the private hospitals. Whilst the improved barrier protection and long-term cost benefits of singleuse products are commonly accepted, Ms Ching points out that health care in Hong Kong is administered through seven regions, each of which has a centralized laundering, sterilization and packing unit serving a number of hospitals.
  “There is quite a large capital investment in these facilities, which needs to be paid off and there are also staffing implications if they are closed,” she says. “But, of course, there are big savings in logistics costs and emissions from using disposable products.
  “In Hong Kong, I think they will become adopted through a phased introduction. It is a question of bringing them in as these laundering units become due for replacement or are run down. Although single-use gowns are more fluid resistant, some doctors still say they are not as pliant or comfortable to wear, which is not the case with the latest products.”

As regards hand hygiene, patients themselves are encouraged to ask staff before surgical procedures if they have cleaned their hands thoroughly.
  “This is not an easy thing to do, as Hong Kong people, mostly Chinese, tend to be quite submissive and accepting of authority,” adds Ms Ching. “But they have every right to expect high professional standards and we are doing research to find out more ways and means to encourage patient participation.”
  To highlight the importance of infection control, the HKICNA holds regular training courses in co-operation with the health authority and also organizes a bi-annual international conference, with eminent guest speakers drawn from all over the world. In addition, members are sponsored to attend other international conferences and a grant structure is in place to encourage more research work.
  “We are making progress in improving standards in Hong Kong,” adds Ms Ching. “But there is still much to be done and it is important that all hospital staff is committed to playing their part.”