SARS 2003: ~1700 cases in Hong Kong; HCWs comprised ~60% of nosocomial outbreak cases across multiple hospitals worldwide. ^[1]

• Index case: Male/53, relative of Guangzhou professor, admitted 25/2/03 — seeded Hotel Metropole → chains of transmission to hospitals in HK (KWH, QMH, PYH, PWH), Vietnam, Singapore, Canada, and elsewhere. ^[1]
• Koch's Postulates applied to SARS-CoV: isolation of filterable virus in pure culture, consistent positive RT-PCR from SARS patients with seroconversion, first-generation diagnostics (RT-PCR for viral genes, immunofluorescent test for antibodies). ^[1]

The 1996 CDC/HICPAC framework combining Standard Precautions with Transmission-Based Precautions remains the organizing paradigm. The lecture's individual room, distance and PPE rules are historical teaching; use the current pathogen-specific table and local IPC policy in practice. ^[1][8][9]

Historical hand hygiene compliance in hospitals is typically < 40%. ^[1]

The lecture presents a table of compliance rates from 1981–1999 across ICUs, general wards, neonatal units, and emergency rooms. The range is 16–81%, with most studies clustered around 30–48%. This is a shocking indictment of HCW behavior and is why the WHO launched its "SAVE LIVES: Clean Your Hands" campaign.

QMH longitudinal compliance data (Baseline → 2018) ^[1]:

Key observations: compliance rose from 23.2% at baseline to ~77–80% after sustained audit-and-feedback programmes; the proportion using ABHR (handrub) increased dramatically while handwashing decreased, reflecting the shift to ABHR as the default method. ^[1]

Why compliance is low:

• Time pressure (perceived)
• Skin irritation from soap and water
• Inconvenient sink locations
• Low perceived risk ("my patient looks clean")

The lecture's 2003 time-course graph is best read qualitatively, not as a dosing table: under the study conditions, ABHR reduced recoverable organisms faster and to a greater extent than washing with plain soap. The plotted values are approximate and cannot predict efficacy for every product, organism or real-world technique. Current CDC guidance therefore prefers ABHR for most clinical indications when hands are not visibly soiled. ^[1][10]

Why ABHR is superior to soap-and-water for routine use:

1. Rapid broad antimicrobial activity for appropriately formulated products; efficacy remains organism- and product-dependent
2. More convenient — not limited by sink availability; can be carried in pocket, placed at point of care

• ABHR can be placed at the point of care (mounted on bed rails) or carried in the pocket of staff ^[1]

3. Better skin care — glycerol in WHO formulations acts as emollient

WHO ABHR Formulations ^[1][2]:

Role of each component:

• Ethanol (60–85%) / Isopropanol (60–80%) / n-Propanol (60–80%): The killing agents. All three alcohols possess both bactericidal and virucidal activity; they denature proteins and dissolve lipid membranes of microorganisms. ^[1]
• Glycerol: Prevents skin drying and cracking (cracked skin harbors more bacteria).
• Hydrogen peroxide (0.125%): Does NOT kill organisms on hands at this concentration. Its purpose is to inhibit growth of bacterial spores inside the bottle during storage. ^[2]

Alcohols are effective against vegetative bacteria, enveloped viruses, fungi, mycobacteria, and most non-enveloped viruses, but NOT against bacterial spores or prions. ^[1]

Descending order of resistance to germicidal chemicals (from most resistant to least):

Non-enveloped-virus susceptibility varies with virus and formulation. Do not infer that one ABHR product reliably inactivates every virus.

The slide's fixed 3 mL for 15–20 seconds is lecture-era wording. Current WHO technique is to apply a palmful/enough manufacturer-recommended product to cover all hand surfaces and rub until dry; the complete procedure takes about 20–30 seconds. A small volume that dries too early leaves areas untreated. ^[12]

The five WHO moments define WHEN to perform hand hygiene:

Local QMH/HKWC extension: clean hands before touching your own mucous membranes (e.g. rubbing your eyes or eating). This is a useful self-protection prompt, but it is not an official sixth WHO Moment. ^[1]

Why the 6th moment matters: The lecture emphasizes that bacterial counts on HCW hands range from 3.9 × 10⁴ to 4.6 × 10⁶ CFU. The minimum infective dose of influenza via intranasal inoculation is only 127–320 TCID₅₀ (~100 PFU). So touching your nose/eyes with contaminated hands can easily transmit influenza. ^[1]

The QMH poster says "Rub hands for at least 20 seconds." Current WHO technique describes the full handrub procedure as approximately 20–30 seconds, ending when hands are dry. ^[1][12]

NO RINGS. NO ARTIFICIAL NAILS. KEEP NAILS SHORT. ^[1]

Why:

• Rings create reservoirs underneath where organisms survive hand hygiene
• Artificial nails harbor more gram-negative organisms and fungi
• Long nails can puncture gloves and scratch patients

The lecture shows QMH compliance data (2017 2Q – 2019 1Q) trending over time, broken down by staff group and by the 5 moments ^[1]:

Compliance by staff group (2018 1Q – 2019 1Q) ^[1]:

Doctors consistently have the lowest hand hygiene compliance among all staff groups. ^[1]

Compliance by 5 Moments (2019 1Q, selected staff) ^[1]:

The weakest moments are Moment 1 (before patient contact) and Moment 2 (before aseptic procedure), especially among doctors — doctor compliance for Moment 2 was only 30.8%. This illustrates that ongoing audit and feedback is necessary to maintain compliance. ^[1]

Slides 24–25 compile historical laboratory studies into wide survival ranges. The visual message is more reliable than memorising an endpoint: many viruses, bacteria and yeasts persist long enough for a hand, curtain or device to become an intermediate vehicle. The numbers vary markedly with inoculum, material, temperature, humidity, cleaning, assay and study design; they are not promises that an organism will remain infectious for the stated maximum in a ward. ^[1]

Examples visible in the slide tables include minutes-to-hours on hands and hours-to-months on inanimate surfaces. HBV is noteworthy because it can remain infectious on environmental surfaces for at least seven days. The practical response is scheduled and spill-responsive cleaning, special attention to high-touch surfaces, correct disinfectant/contact time, and hand hygiene before the next patient or clean task. ^[1][8][13]

A QMH observation slide quantifies how often mutually touched surfaces reconnect the care zone: bed rail 14 contacts/hour, bedside table 12, clinical notes 9, bedding 6, curtain 4, and cabinet 1. The ranking is the point—cleaning and hand hygiene must account for items that staff and patients repeatedly share, including notes and curtains, not just visibly dirty surfaces. ^[1]

92% of curtains showed contamination within 1 week: MRSA (21%), VRE (42%). ^[1]

This is a lecture-era QMH local programme targeting VRE and other faecal MDROs, not a universal hand-hygiene protocol:

A VRE-colonized patient produces up to 1 million VRE per gram of stool. Within 48–72 hours of admission, the patient's fingers and environment become heavily contaminated. ^[1]

Entry Control ("入口管制"): Directly Observed Hand Hygiene (DOHH) before taking meals and drugs

• Rationale represented by the diagram: contaminated fingers provide a route into the mouth and gastrointestinal tract. The cartoon is a transmission model, not proof that handling one tablet inevitably causes VRE infection.
• The patient cleans hands with ABHR before eating or taking medications. ^[1]

Exit Control ("出口管制"): Personal hygiene in the toilet

• Before toilet: Wipe toilet seat lid with tissue sprayed with disinfectant
• After toilet: the local poster instructed soap-and-water followed by ABHR. In ordinary current practice, thorough soap-and-water handwashing is sufficient; add ABHR only if required by the facility's protocol. ^[1][10]
• QMH installed 283 toilet seat disinfectors across 46 wards' toilets. ^[1]

Patient Education: "Seven Important Things to Protect Yourself While in Hospital"

QMH provides patients with a structured checklist of seven self-protection measures ^[1]:

1. Ask staff to perform hand hygiene before they touch you
2. Hand hygiene before taking medication (ABHR)
3. Hand hygiene before meals (ABHR)
4. Wipe faucet handles with disinfectant-wetted tissue before obtaining water for mouth rinsing/tooth brushing
5. Wipe the toilet seat with disinfectant-wetted tissue before use
6. After defaecation: the historical local poster used soap and water, then ABHR; after urination: soap and water
7. After using a bedpan: wipe hands with wet tissue, then ask staff for ABHR

Items 2–4 represent entry control (reducing hand-to-mouth transfer); items 5–7 represent exit control (reducing environmental contamination from faecal flora). Preserve the concept, but follow current local product and hand-hygiene instructions rather than treating the seven-item 2013 poster as universal guidance. ^[1]

Timeline of emerging MDROs: MRSA (1980s) → VRE (1990s) → ESBL (1990s) → Carbapenemases (2000s: KPC [Class A], OXA [Class D], IMP/VIM/NDM [Class B metallo-β-lactamase]) → Plasmid-mediated colistin resistance mcr-1 (2015). ^[1]

This progression is why infection control is escalating in importance — we are running out of antibiotics.

The slide deck teaches the classic > 5 μm droplet / < 5 μm airborne and 1 metre split. Slide 55 itself shows a continuum of particle sizes within one exhaled cloud. Modern practice should not treat 5 μm or 1 metre as a biological cliff: route assignment and PPE are pathogen-, procedure-, ventilation- and exposure-specific. The Contact/Droplet/Airborne categories remain useful administrative controls, but current pathogen-specific guidance and local IPC policy decide the bundle. ^[1][8][9]

The lecture lists MDR bacteria, infectious gastroenteritis, selected paediatric respiratory viruses and contagious skin disease as examples. Do not assign precautions from a memorised organism list alone: use the current disease-specific table. Viral haemorrhagic fever, for example, requires pathogen- and exposure-specific enhanced IPC and PPE rather than generic Contact Precautions alone. ^[1][9]

Contact Transmission can be:

• Direct: Body surface to body surface (e.g. bathing, turning the patient)
• Indirect: Via contaminated intermediate object (equipment, environmental surface, HCW hands) ^[1]

PPE for Contact Precautions:

• Gown AND gloves — don before entering the room, remove before leaving the room ^[1]

Patient Placement:

• Single room preferred; alternatively cohorting (placing patients with the same organism together) ^[1]

Dedicated equipment: Stethoscope, BP cuff, thermometer should NOT be shared between contact-precaution patients and non-isolated patients. ^[1]

What the Glove-Misuse Photographs Show

Slide 53 shows gloves being washed, rubbed with alcohol, used on telephones and lift controls, and carried from dirty to clean spaces. These photographs teach that a glove can become a mobile contaminated surface:

• Do not wash or apply ABHR to disposable gloves for reuse.
• Change gloves between patients and between dirty and clean tasks on the same patient.
• Remove gloves before touching shared clean equipment or leaving the care zone.
• Perform hand hygiene immediately after glove removal; gloves are not a substitute for hand hygiene. ^[1][8]

Contact Precautions — Conditions Table ^[1]:

Note: Chickenpox and disseminated herpes zoster require airborne precautions in addition to contact precautions; respiratory viral infections in young children require droplet precautions in addition to contact precautions. ^[1]

Droplet precautions are used for: Influenza, Invasive H. influenzae type b, Invasive N. meningitidis, Diphtheria (pharyngeal), Adenovirus, Parvovirus B19, Mumps, Rubella, Mycoplasma pneumoniae, Streptococcal pharyngitis, Pertussis, Pneumonic plague. ^[1]

Key facts about droplets:

• Sneezing produces up to 40,000 droplets of 0.5–12 μm, expelled at 100 m/s. ^[1]
• The historical deck labels droplets as > 5 μm and within 1–2 metres. Treat this as an exam taxonomy, not a guarantee: exhaled particles form a size continuum and exposure depends on proximity, duration, ventilation and the procedure.

PPE for Droplet Precautions:

• Surgical mask (and/or eye protection) when within 1 metre of the patient ^[1][2]

Patient Placement:

• Single room or cohorting; maintain ≥ 1 metre spatial separation ^[1]

Source Control: Place a surgical mask on the patient to reduce shedding of respiratory droplets during transport. ^[1]

The mask photographs add a simple technique check: the mask should cover nose, mouth and chin, with the nosepiece moulded and gaps minimized. A mask below the nose, under the chin or dangling from one ear is neither reliable source control nor appropriate staff protection; avoid touching or repeatedly lowering the contaminated front. ^[1]

Droplet Precautions — Conditions Table ^[1]:

Note: Respiratory viral infections in infants/young children (Adenovirus, Parainfluenza, RSV) require contact precautions in addition to droplet precautions. ^[1]

Classic airborne triad: pulmonary/laryngeal tuberculosis, measles and varicella/disseminated zoster. Additional or combined precautions depend on the pathogen and exposure. Current guidance for emerging respiratory viruses should supersede the deck's lecture-era lists. ^[1][9]

Airborne Infection Isolation Room (AIIR):

• Negative pressure relative to corridor (air flows IN, not out)
• ≥ 12 air changes per hour (ACH) for new construction/renovation; ≥ 6 ACH for existing facilities ^[1]
• Air exhausted directly to the outside or recirculated through HEPA filtration ^[1]
• Doors kept closed ^[1]

An anteroom is not a universal defining requirement for every AIIR. The lecture diagram includes one, but the essential ventilation controls are monitored negative pressure, appropriate air changes, suitable exhaust/HEPA handling and a closed door. Follow facility engineering standards. ^[1][8]

PPE for Airborne Precautions:

• A fit-tested N95 or higher particulate respirator is the key respiratory control. Add eye/face protection, gown and gloves when Standard Precautions, another transmission route, the pathogen or the task requires them. ^[8][9]

Fit Testing:

• Before initial use, whenever a different make/model/style/size is used, and at least annually, an appropriate fit test is required under OSHA's respiratory-protection standard. ^[14]
• Repeat fit testing is required if ^[1]:
  • Significant weight change (~10% increase or decrease)
  • Change in facial structure (dental work, cosmetic surgery, accident)
  • Appropriate model/size no longer available
  • Any condition interfering with face-piece sealing

Facial hair or stubble crossing the sealing surface prevents reliable use of a tight-fitting respirator. Perform a user seal check every time the respirator is donned; this does not replace formal fit testing. ^[14]

Donning (6 steps) ^[1]:

1. Place respirator in palm
2. Position over nose, mouth, and chin
3. Put headbands in place — avoid crisscrossing
4. Seal nosepiece by pressing along nasal bridge
5. Positive pressure test: Cover mask, exhale sharply — no air should leak from edges
6. Negative pressure test: Cover mask, inhale sharply — mask should depress slightly inward; no air leak

Doffing (4 steps) ^[1]:

1. Avoid touching the front of the respirator (contaminated surface)
2. Tilt head forward, pull bottom headband over head with both hands
3. Grab upper strap with both hands, keep tension as you remove it (lets mask fall forward without flipping inside out)
4. Discard in waste container; perform hand hygiene

The deck's Standard + Contact + Droplet + Airborne bundle for H7N9/MERS captures a sound early-outbreak principle: when routes and severity are uncertain, escalate protection while evidence is gathered. It is not a timeless organism table. For any emerging pathogen—including SARS-CoV-2—use current public-health and institutional guidance, then de-escalate or modify the bundle when the route and clinical task are clarified. ^[1][9]

Slide 71 gives the historical teaching shorthand HBV up to 30%, HCV up to 7%, HIV 0.3%. Do not quote all three as current equivalent estimates:

Risk rises with a deep injury, visible blood, a hollow-bore needle placed in a vein/artery and a source with transmissible viraemia. HBV is especially important because it is vaccine-preventable and remains infectious on surfaces for at least seven days. ^[13][15]

1. Percutaneous (needlestick, sharps injury) — most common. 2. Mucous membrane exposure (splash to eyes/mouth). 3. Non-intact skin (dermatitis, abrasions, open wounds). ^[1]

Procedures following sharps injury ^[1]:

The named QMH destinations and AIRS workflow are lecture-era local instructions. Students and staff should know the current hospital hotline, after-hours route and reporting system before an exposure occurs. ^[1]

HIV PEP is an emergency: report and start promptly when indicated. Do not wait for source results or the next working day. ^[18]

The newspaper slide references a UK nurse who died with community-associated PVL-positive MRSA (Panton-Valentine leukocidin). PVL is a pore-forming toxin associated with recurrent skin/soft-tissue infection and severe necrotising pneumonia; the image is a reminder that MRSA is not confined to hospitals, not proof that PVL alone determines outcome. ^[1]

The sharps-injury management and HIV PEP discussed here directly overlaps with GC 061. The durable lesson from GC 107 is immediate first aid, reporting and assessment; use the current occupational PEP guideline rather than a fixed historical “two-hour window” or local action list. ^[1][5][18]

For immunocompromised patients (e.g. post-chemotherapy neutropenia, bone marrow transplant):

• A selected allogeneic haematopoietic stem-cell transplant recipient may require a Protective Environment with positive pressure and HEPA-filtered incoming air to reduce exposure to airborne mould spores; this is distinct from a negative-pressure AIIR. ^[8]
• Emphasize meticulous hand hygiene, safe food handling and pathogen/exposure-specific precautions. A restrictive “low-microbial diet” should not be presented as a universal infection-control requirement.
• Prevention of infections includes: screening for latent infections (HSV, CMV, HIV, HBV, Toxoplasma) before transplant ^[6]

Surgical antibiotic prophylaxis (e.g. cefazolin when indicated) is another form of patient protection. The exact agent, timing, redosing and discontinuation depend on the operation, pharmacokinetics and current local protocol; do not carry the slide-era blanket “within 30 minutes and never post-operatively” rule into every case. ^[7]

GC 104 provides the theoretical framework; GC 107 is the practical application. Key overlaps include the transmission-based precautions taxonomy and PPE guidance. ^[2]