Biomedical Engineering Reference
In-Depth Information
chairperson should report to both HAHO ICET
and HCE. Members consisted of senior medical,
nursing, administrative staff as well as the ICT.
Each wore conspicuous arm-bands for identifica-
tion and was given the authority to immediately
warn or counsel staff on issues related to infec-
tion control. The ICET were effective in enhancing
compliance to infection control practices among
hospital staff, and played an important role towards
reduction in the nosocomial transmission of SARS.
in HA hospitals were upgraded to include 530
isolation wards with 1280 isolation beds, and
five such wards with 120 isolation beds had been
converted in PYNEH. Resources were allocated
for training and research in infection control
and epidemiology; development of contingency
plans; and establishment of a Center for Health
Protection (CHP). Conduction of drills based on
different clinical scenario further augmented our
preparedness against future outbreaks.
23.8 Outbreak Resolution
With two additional HCW who developed break-
through infection due to non-compliance to infec-
tion control measures, a total of 13 HCW
among 1300 exposed employees in PYNEH
had contracted and recovered from SARS. Four
infected HCW transferred from other hospitals also
had full recovery. Of the 90 patients confirmed
to be suffering from SARS by laboratory criteria
[35], 21 (24%) required ICU care and four died.
These included the index case and two deaths from
concomitant cardiovascular diseases (myocardial
infarction and stroke), resulting in the lowest case
fatality rate of 3.4% [23] for SARS patients in
Hong Kong [8,13,36]. This figure also compared
favorably to mortality figures worldwide [37,38].
Apart from the index case, all deaths occurred in
patients above the age of 65 years with significant
comorbidities [23]. A twice-weekly SARS follow-
up clinic was set up in a SARS convalescent ward
from April 15 onward, followed by a Post-SARS
Clinic under the direction of HAHO. Hong Kong
was finally removed from the list of areas with
local SARS transmission on June 23, 2003.
23.10 Conclusion
After overcoming the onslaught of SARS, the
Hong Kong community has become aware that
emerging infections may and can occur at any
time. This is further reinforced by the recent
avian influenza outbreaks which keep reminding
us of this looming threat. In addition, hospi-
tals have to evaluate their levels of preparedness
against bioterrorism, which can simulate infectious
disease outbreaks. Priority areas for improvement
suggested have included community involvement;
staff education; improved information technology;
disease surveillance; and additional equipment and
staff [40]. The experience of our hospital in the
SARS outbreak may serve as a prototype for such
response in a hospital setting. Under these circum-
stances, the healthcare system and the community
as a whole must join force to combat the common
enemy. Multi-dimensional and flexible response
plans require strong leadership and clear directions
to be effective, but must also take into account
human frailties in times of great stress, when every
resource is stretched to its utmost limit.
References
1. World Health Organisation (WHO). Communi-
cable disease surveillance and response, Pandemic
Influenza Preparedness Planning. Update on 14
March 2005. http://www.euro.who.int/eprise/main/
who/progs/csr/cooperation/20050218_1. Accessed
on April 19, 2005.
2. World Health Organisation (WHO). Summary
table of SARS cases by country, 1 November
2002-7 August 2003. Update on 15 August 2003.
23.9 Aftermath
In the aftermath of SARS, the Government of
Hong Kong has strengthened our healthcare
system to withstand further disease outbreak
[39] and potential bioterrorism. Point-to-point
communication with Mainland China on outbreak
notification was established, together with an
electronic web-based platform to report clusters
of febrile HCW or patients in hospitals. Facilities
