20 July 2009

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中華人民共和國香港特別行政區政府總部教育局中華人民共和國香港特別行政區政府總部教育局中華人民共和國香港特別行政區政府總部教育局中華人民共和國香港特別行政區政府總部教育局

Education Bureau

Government Secretariat, The Government of the Hong Kong Special Administrative Region The People's Republic of China

本局檔號 Our Ref.: EDB(SD_CT)ADM/20/05/1(1) 電話 Telephone:

20 July 2009 To: Supervisors/Principals of all Schools

Dear Supervisor/Principal,

Arrangements for Commencement of 2009/10 School Year Under the Latest Development of Human Swine Influenza Background

Taking into account the development of human swine influenza (HSI) in Hong Kong and the advice from the Department of Health (DH), this Bureau announced on 11 June class suspension for all kindergartens, kindergarten-cum-child care centres, primary schools (including private independent schools, international and ESF schools) and special schools (except those Schools for Social Development with secondary section only). We further announced on 23 June that classes of the aforesaid schools would not be resumed in the 2008/09 school year. At the same time, secondary schools were recommended to reduce as far as possible the post-examination activities so as to advance the summer holiday for students with a view to minimizing disease transmission in schools.

Latest Situation

According to the DH’s latest assessment, though HSI is a new virus and transmitting easily through the population, it causes relatively mild disease. Having

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considered the present situation and DH’s advice, we decide that all kindergartens, kindergarten-cum-child care centres, special schools, primary and secondary schools (including private independent schools, international and ESF schools) could commence classes in the new school year 2009/10 as scheduled.

Support for Schools

To tie in with the preventive measures in the mitigation phase and provide support for schools in taking precautionary measures at the commencement of the new school year, we will provide again an additional one-off grant of $3,000 to each school for purchasing equipment or stuff (e.g. thermometer, masks and cleansing materials etc.) to reduce the spread of HSI in schools and safeguard students’ health. For details, please refer to Education Bureau Circular Memorandum No.107/2009.

In order to prevent the spread of HSI in schools after the commencement of the new school year and minimize the students’ chance of being infected, schools and parents should always stay vigilant against HSI. Schools should take appropriate measures in accordance with the advice set out in the “Handbook on Prevention of Human Swine Influenza in Schools” and “Guideline on Prevention of Human Swine Influenza for Commencement of the New School Year” (Appendix I) issued by EDB and Centre for Health Protection (CHP) of DH respectively. The aforesaid handbook/guideline could be browsed via the following paths of the respective webpages of EDB and DH:

EDB Homepage > School Administration > Administration > Prevention of Flu &

Other Communicable Diseases in Schools > 1. Prevention of Human Swine Influenza

> Guidelines >Handbook on Prevention of Human Swine Influenza in Schools

http://www.chp.gov.hk > Recommendations > Institutions and Businesses >

Guideline on Prevention of Human Swine Influenza for Commencement of the New School Year

For measures to be taken before and after the commencement of the new school year, schools are requested to pay special attention to the following:

Before Commencement of the New School Year

Schools should thoroughly clean and disinfect the school premises to secure a hygienic environment before the commencement of the 2009/10 school year.

Schools should also act in accordance with the recommendations set out in

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“Guideline on Prevention of Human Swine Influenza for Commencement of the New School Year”.

Schools should notify parents of the various arrangements on class commencement and request them to take proper precautionary measures at home, including paying attention to the health condition of their children. Parents should seek medical care for their children immediately and avoid sending them to schools if their children present fever or symptoms of influenza. Besides, they should notify the school at once if their children are confirmed of having contracted HSI. A sample parent letter is attached for reference (Appendix II).

Schools should contact school bus operators and lunch-box suppliers to ensure that normal services will be provided on the day of class commencement. Schools should also urge staff of the service providers not to go to work if they have fever or symptoms of influenza and ask them to make suitable alternative arrangements and notify schools and parents immediately.

Schools should prepare enough preventive/personal cleaning materials, such as liquid soap, alcohol hand rub, disposable towels, household bleach, thermometers, facemasks and hand washing devices, etc. Where applicable to the situation of individual schools, schools could make use of the additional one-off grant, Expanded/Operating Expenses Block Grant or Expanded Subject and Curriculum Block Grant provided by this Bureau or other school income to purchase the above materials.

In case there is a need to organize any activities for students before the commencement of the new school year, schools should act in accordance with

“HSI Pandemic Mitigation Phase Guideline on School Functions and Extra-Curricular Activities” issued by CHP to step up the preventive measures.

For example, windows should be kept open as far as possible to ensure good ventilation for indoor activities. Parents should be well informed of the relevant arrangements.

After Commencement of the New School Year (1) Sustaining preventive measures

Schools should continue to take hygienic and preventive measures against HSI, like

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cleaning and disinfecting the school premises regularly to maintain environmental hygiene. For details, please refer to the aforesaid “Guideline on Prevention of Human Swine Influenza for Commencement of the New School Year”.

Schools should remind parents to urge their children to observe personal and environmental hygiene, check their children’s body temperature every day before sending them to school, record the reading and submit the signed “temperature record sheet” to the school for inspection.

Schools should remind staff/students to refrain from work/school and consult the doctor immediately if they have fever or feel unwell. If staff/students are confirmed of having contracted HSI, they should notify the school immediately.

(2) Monitoring the health condition of students and staff

Schools should pay attention to the health condition of students and staff and keep them away from school if they feel unwell. Schools should arrange those staff/students having fever and symptoms of influenza to leave school as soon as possible, seek medical attention and take rest at home.

If there is an increasing trend or unusual situation in the number of persons taking sick leave, schools should contact the staff or parents/guardians of the students concerned to ascertain the reasons for the sick leave.

(3) Reporting information

If there is an increasing trend or unusual situation in the number of persons taking sick leave due to the same infectious disease or similar symptoms (i.e. three or more students in the same class develop similar symptoms in a short period of time), schools should report to CHP and notify EDB as soon as possible.

(4) Planning school functions and activities

Schools may arrange functions and other school activities for their students on a need basis. Schools should act in accordance with “HSI Pandemic Mitigation Phase Guideline on School Functions and Extra-curricular Activities” issued by CHP. For example, windows should be kept open as far as possible to ensure good ventilation for indoor activities.

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(5) Adjusting the schedule of teaching and learning

On the first school day, schools may explore with students issues on the prevention of communicable diseases / HSI through tailor-made materials to heighten their awareness of personal and environmental hygiene through personal participation.

At the beginning of the school year, schools may consider adjusting their teaching timetable to finish the uncovered curriculum due to class suspension in the last school year. If necessary, schools may also conduct the unfinished examinations/tests scheduled to be held before the summer vacation.

Schools should provide appropriate learning support or make-up test/examination for students who could not take the test/examination owing to sick leave.

(6) Paying attention to environmental and personal hygiene

Schools should remind students on the importance of personal hygiene in preventing HSI and other communicable diseases and teach them the proper way in handling used materials for preventing HSI and other communicable diseases (e.g.

used facemasks and disposable towels should be put into lidded rubbish bin).

Schools should upkeep the environmental hygiene of the school campus, draw up the division of labour and work schedule for regular cleaning and disinfection of the school premises.

(7) Reviewing contingency arrangements

Schools should review existing contingency measures to ensure that school can handle the situation properly and maintain a normal operation when facing an outbreak of HSI or other communicable diseases.

Schools should build up an effective communication mechanism with parents for notifying them various school arrangements any time when necessary.

Criteria for Class Suspension

(1) Criteria for suspension of individual schools

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If there is an influenza (including HSI) outbreak in a school after the commencement of the new school year, CHP will make suggestions to the affected school on whether class suspension is necessary with due regard to individual circumstances in order to minimize the chance of transmission of the disease in school and to protect students’ health.

In line with the current strategy in the mitigation phase, CHP will base on a number of conditions, such as the numbers of students affected, severely ill and hospitalized, the progression of the outbreak, the effectiveness of control measures and so on in advising on class suspension. In general situation, reference will also be taken from (but not solely dictated by) the following indicators:

- the rate of sick leave reaching 10% or above;

- the rate of hospitalization being above 1%;

- admission of two or more students to Intensive Care Unit; or

- death of an otherwise healthy student in the school due to influenza.

The general period for class suspension is seven days. However, CHP would make reference to other conditions, such as the numbers of students affected, severely ill and hospitalized, the progression of the outbreak and so on in advising whether an individual school should suspend its classes for an extended period.

(2) Criteria for territory-wide class suspension

CHP of DH would continue to monitor the development of HSI and infection situation closely. At the present stage, there is no need to issue guidelines on territory-wide class suspension. CHP would advise on whether a territory-wide class suspension is needed based on the actual epidemic situation, including the spread of the disease and patients’ condition, occurrence of serious/fatal infections beyond expectation and the extent of outbreaks in the community. If necessary, we would make an early announcement on the arrangements of territory-wide class suspension after consultation with DH and other relevant departments.

Conclusion and Enquiry

We would like to call on schools again to keep the school environment clean, remind staff members and students to pay attention to personal hygiene and carry through all precautionary measures against HSI. We will keep in close contact with DH, review

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the situation and release latest information on HSI to schools from time to time.

Schools should continue to pay attention to the webpage of Education Bureau.

For enquiries, please contact your respective Senior School Development Officer/Pre-primary Services Officer.

Yours sincerely,

(S K LEUNG) for Secretary for Education

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Appendix I

Guideline on Prevention of Human Swine Influenza for Commencement of the New School Year (July 2009)

Preamble

Human swine influenza (HSI) is causing local transmission in Hong Kong. Although HSI causes a relatively mild illness in most persons, it is efficiently spread, given the lack of antibodies in the population, especially among children and adolescents.

This guideline provides guidance for commencement of the new school year. It aims to reduce HSI transmission and prevent large-scale outbreaks from occurring.

General principles

Early identification and segregation of persons with influenza like illness (ILI) from others.

Heightened awareness to personal and environmental hygiene.

Administrative control to avoid overcrowding.

Vigilance and prompt notification on clustering of ILI.

Actions to be taken before commencement of the new school year

School management should adopt the following measures to maximize protection of its students and staff.

1. Ensure a clean and hygienic school environment

Disinfect the school premises including classrooms, kitchen, canteen, toilets and bathrooms with 1 in 99 diluted household bleach (one part of 5.25% hypochlorite solution in 99 parts of water), wait until dry and then rinse with water. Use 70%

alcohol for metallic surfaces.

Require school bus operators to apply the above principles for cleaning and disinfection of school buses.

Ensure an adequate supply of surgical masks, gloves, alcohol-based handrub, thermometers, household bleach, and toilet utilities such as liquid soap, disposable towels or hand-dryers.

Maintain good indoor ventilation, open windows wide and turn on exhaust fans.

Make sure air conditioning systems allow an adequate amount of air exchange, have air filters cleaned and are well-maintained.

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2. Maintain close communication with staff/students

Provide information on human swine influenza symptoms so that staff and students could recognize them early and report sickness in a timely manner.

Remind staff and students about personal hygiene to prevent influenza transmission in the school. Remind students to stay home, put on a mask and seek medical care from designated flu clinics immediately if they develop flu symptoms such as fever, sore throat or cough (Please note Annex I for the location of designated flu clinics and Annex II for fact sheet on human swine influenza).

Explain to staff and students the importance of personal hygiene including hand washing, and cough manners such as covering mouth and nose with tissue paper when coughing and sneezing, putting soiled tissue paper in a lidded bin and washing hands afterwards.

Advise staff and students to avoid visiting overcrowded and poorly ventilated venues.

Require staff and students to notify the school if they should develop influenza symptoms such as fever, sore throat, cough, or be admitted to hospital, and require them to stay at home for rest until symptoms have improved and fever has subsided for at least 2 days, or follow the medical advice on sick leave, whichever is longer.

3. Maintain close communication with parents

Encourage parents to familiarize themselves with symptoms of influenza in order to recognize them early and report children’s sickness in a timely manner. Advise parents to teach and reinforce personal hygiene measures among children to prevent transmission of influenza in the school. Remind parents to keep children at home, let them put on a mask and seek medical care from designated flu clinics immediately if they develop flu symptoms such as fever, sore throat or cough.

(Please note Annex I for the location of designated flu clinics and Annex II for fact sheet on human swine influenza) vise staff and students to avoid visiting overcrowded and poorly ventilated venues.

Remind parents to check the child’s body temperature every day before school, complete and sign the temperature record sheet to be presented for inspection by the school.

Require parents to notify the school immediately if children should develop symptoms of influenza such as fever, sore throat, cough, or be admitted to hospital.

Remind parents to keep sick children at home, and not to bring them to school until symptoms have improved and fever has subsided for at least 2 days, or follow medical advice on sick leave, whichever is longer.

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Issue a letter to parents before or on the day of commencement of the new school year to appeal for their understanding and cooperation on the following matters.

(Please note Annex III for sample letter to parents):

Provide children with handkerchiefs or tissue paper, which should not be shared with peers.

Check body temperature, record the reading and sign the temperature chart before sending children to school.

Do not send children to school if they have fever. (Body temperature varies with age, time of day and level of physical activity. Different reference values for normal body temperature may be adopted for different measuring methods and instruments. Always refer to inserts and instructions that come with the thermometer. In general, if an oral thermometer is used, a reading above 37.5^oC would be considered high. Please refer to “Guidelines on Prevention of Communicable Diseases in Schools / Kindergartens / Kindergartens-cum-Child Care Centres /Child Care Centres” for details.)

Report to the school immediately if children are sick and provide details of the sickness including symptoms, diagnosis and whether hospitalization is required.

Keep sick children away from school until symptoms have improved and fever has subsided for at least 2 days, or follow medical advice, whichever is longer.

Cooperate with the school by picking up the sick child from the school to seek medical care immediately.

For students with chronic medical illnesses, parents should inform staff about the students’ medical needs, and seek medical advice on need of additional measures as appropriate.

Actions to be taken after commencement of the new school year

Pay attention to announcements from the Department of Health for any update management on human swine influenza. School management should adopt the following measures to maximize protection of its students and staff.

1. Check Body Temperature

Remind parents to check the child’s body temperature every day before school, complete and sign the temperature record sheet to be presented for inspection by the school.

Remind parents not to send children to school if they have fever. (Body temperature varies with age, time of day and level of physical activity. Different reference values for normal body temperature may be adopted for different

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measuring methods and instruments. Always refer to inserts and instructions that come with the thermometer. In general, if an oral thermometer is used, a reading above 37.5oC would be considered as fever. Please refer to “Guidelines on Prevention of Communicable Diseases in Schools / Kindergartens / Kindergartens-cum-Child Care Centres /Child Care Centres” for details.)

Inspect students’ temperature records and conduct spot temperature checks. If parents fail to take their children’s temperature, schools should take up the job.

Staff who are responsible for taking the temperature should take all necessary safety measures. For the use of personal protective equipment, please refer to section 4.3 of the “Guidelines on Prevention of Communicable Diseases in Schools/ Kindergartens/ Kindergartens- cum-Child Care Centres/ Child Care Centres”, e.g. change disposable gloves before nursing another child.

2. Keep sick leave records of staff and students and notify suspected outbreaks early

On any school day, there could be occasional students suffering from ILI (for instance, no more than 2 students in the same class having similar symptoms.).

Ascertain the cause of absence by contacting parents/guardians of absentees if an increase or unusual sick leave pattern is noticed.

Report to Central Notification Office (CENO) (Tel: 2477-2772; Fax: 2477-2770) for epidemiological investigation and outbreak control when an increase or unusual absenteeism pattern among students with the same infectious disease or similar symptoms is noticed (For example, where 3 or more students in the same class develop similar symptoms within a short period of time, this may indicate a cross-infection in the school).

3. Maintain Environmental Hygiene

Clean and disinfect frequently touched surfaces, furniture, toys, commonly shared items and floor at least daily by using appropriate disinfectant (e.g. 1 part of 5.25%

household bleach in 99 parts of water for non-metallic surface or 70% alcohol for metallic surface), wait until dry and then rinse with water. Cleaning utensils should be soaked in 1 in 49 diluted household bleach for 30 minutes and then rinsed thoroughly before reuse. (Please note Annex IV for procedures of preparing/ using diluted bleach)

Use absorbent disposable towels to wipe away obvious contaminants such as respiratory secretions, vomitus or excreta, and then disinfect the surface and neighbouring areas with disinfectant (e.g. 1 part of 5.25% household bleach in 49 parts of water for non-metallic surface or 70% alcohol for metallic surface), leave for 15-30 minutes, and rinse with water. (Please note Annex IV for procedures of preparing/ using diluted bleach)

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Apply the same principles for cleaning and disinfection of school buses.

Ensure adequate ventilation and avoid overcrowded situations when planning mass activities in or outside school. Keep windows wide open and turn on exhaust fans. Clean air filters of air-conditioning systems on a regular basis.

In the event of school outbreaks, raise the concentration of bleach (e.g. 1 part of 5.25% household bleach in 49 parts of water for non-metallic surface) for cleansing and disinfection, and follow steps as instructed above.

4. Maintain Personal Hygiene and Healthy Lifestyle

Remind staff and students about cough manners such as covering mouth and nose with tissue paper when coughing and sneezing, putting soiled tissue paper in a lidded bin and washing hands afterwards.

Encourage staff and students to wash hands with liquid soap or cleanse with alcohol handrub frequently, such as before school begins, prior to and after serving food. Advise against touching eyes, nose or mouth with hands, and sharing of towels and feeding utensils. (Please note Annex V for Guidelines for Hand Hygiene)

Remind children to bring their own handkerchiefs or tissue paper to school, which should not be shared with peers.

Remind students not to share personal items, lunch boxes or drinks.

Educate students on using drinking fountains.

Avoid contact with the mouthpiece and protective guard of the drinking fountain when drinking directly from it.

Advice young children use a container to collect water from the fountain for drinking, and not drink directly from the fountain.

Students who are suffering from an acute respiratory illness should avoid drinking directly from drinking fountains.

Do not contaminate the drinking fountain, for example, by spitting or using it to wash hands.

Encourage students to practise healthy lifestyle such as eating a balanced diet, having regular exercise and taking adequate rest to enhance body resistance.

students on using drinking fountains.

5. Observe health condition of students and staff recovering from influenza

Require staff and students who develop influenza-like symptoms and fever to stay at home, and refrain from school until symptoms have improved and fever has subsided for at least 2 days, or follow medical advice on sick leave, whichever is longer.

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Watch for persistent symptoms in students recovering from a recent influenza infection. Invite parents to bring the sick child home and seek medical care.

6. Care for Sick Students in School

Provide surgical masks to students who develop flu-like symptoms and keep them in a separated room.

Advise students to cover nose and mouth with tissue paper when coughing or sneezing, dispose soiled tissue paper in a lidded bin or flush into the toilet, and perform hand hygiene afterwards.

Inform the parents to take the sick students to seek medical consultation from designated flu clinics or to the nearby Accident & Emergency Department if necessary (Please note Annex I for the location of designated flu clinics) .

Keep windows in the room wide open and turn on fans / exhaust fans for better ventilation.. Keep air-conditioners well-maintained and dust-filters frequently cleaned.

With consent, designate staff to care for ill persons to limit the risk of cross infection.

Staff with chronic medical illnesses or who are pregnant that predispose them to influenza related complications should not take care the sick students.

Ensure staff taking care of the sick students should adopt protective measures, which include performing hand hygiene before and after contact with the student, wearing a surgical mask (Please refer to Annex VI: Use Mask Properly) and putting on appropriate Personal Protective Equipment (PPE) if needed.

Remind staff who come into contact with respiratory secretions or objects contaminated with respiratory secretions to observe hand hygiene immediately.

Perform environmental cleansing and disinfection the room with 1 in 99 diluted household bleach (1 part of 5.25% household bleach in 99 parts water), wait until dry and rinse with water. If the room is dirtied with respiratory secretions, disinfect with 1 in 49 diluted household bleach (1 part of 5.25% household bleach in 49 parts water), leave for 15-30 minutes, and then rinse with water.

Any staff who develop respiratory symptoms after taking care of a sick student should seek medical advice from designated flu clinics promptly, wear a surgical mask and take rest at home (Please note Annex I for the location of designated flu clinics).

Keep a record of students’ sick leave.

Centre for Health Protection Department of Health

July 2009

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Annex I Designated flu clinics under Hospital Authority

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Annex II Human Swine Influenza

Background

The World Health Organization has declared the human swine influenza A/H1N1 (swine flu) outbreak a global pandemic. Confirmed cases of swine flu have been reported in many parts of the world, including Hong Kong.

Originally known to circulate among pig populations, the swine flu viruses do occasionally infect human beings. In this present international swine flu outbreak, human-to-human transmission has occurred.

Symptoms

The symptoms of human swine influenza are usually similar to those of human seasonal influenza and include fever, cough, sore throat, runny nose, muscle pain and headache.

Some people infected with swine flu may also have vomiting and diarrhoea.

Mode of transmission

Human-to-human transmission of swine flu is thought to occur in the same way as seasonal flu is spread among people, mainly through coughing or sneezing. People may also become infected by touching objects soiled with flu viruses and then touching their mouth, nose or eyes.

Swine flu has not been known to be transmissible to people through eating properly handled and cooked pork or pork products. Cooking pork to an internal temperature of 70°C (160°F ) kills the swine flu virus.

Management

People who develop flu symptoms should put on a mask and consult a doctor as soon as possible.

Those who have been to affected places or been exposed to sick persons should tell the doctor the travel and contact history. Antiviral agents can reduce the severity and duration of illness but must be used under doctor's prescription. It is important for people not to self-medicate.

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Prevention

Since H1N1 swine flu viruses are very different from human H1N1 viruses, vaccines for human seasonal flu will not provide protection against H1N1 swine flu viruses.

Members of the public should observe the following precautionary measures:

Keep hands clean and wash hands properly. Alcohol-based handrub is also effective when hands are not visibly soiled.

Avoid touching mouth, nose or eyes.

Wash hands with liquid soap promptly if they are dirtied by respiratory secretions, e.g.

after sneezing or coughing.

Cover mouth and nose when sneezing or coughing.

Avoid going to crowded or poorly-ventilated places. If you must do so, step up personal

hygiene and put on a mask.

Do not spit. Always wrap nasal and mouth discharges with tissue paper, and dispose of the

tissue paper properly in a rubbish bin with a lid.

Wear a mask when respiratory symptoms or fever develop. See a doctor right away.

Do not go to work or school if you develop influenza-like symptoms.

Strict adherence to personal and environmental hygiene is essential for prevention of swine flu.

Department of Health reminds travellers to watch out for the latest developments in the swine flu outbreak when planning travel. Travellers should prepare adequate face masks and alcohol-based handrub and take the following precautionary measures:

During the trip: maintain good personal hygiene, wash hands or use handrub frequently and

avoid contact with sick people.

Before returning: do not get on board an airplane when influenza-like symptoms develop.

Put on a mask and seek medical attention where you are.

After returning: avoid going to crowded places and pay close attention to your health.

Seek medical consultation from public clinics or hospitals right away if fever or influenza-like symptoms appear.

For enquiries, please call 2125 1111.

Version 19 June 2009 Centre for Health Protection

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Annex III

Sample letter to parents

According to the announcement of the Centre for Health Protection of the Department of Health, human swine influenza (HSI) is causing local transmission in Hong Kong. It is expected that the situation will persist for a period of time. To provide maximum protection for students and prevent spread of HSI in the school, parents are advised to co-operate with the school by reminding students to observe personal hygiene and keep schools clean and hygienic.

We appeal to your understanding and cooperation on the following matters to prevent spread of infection during the human swine influenza pandemic:

Provide children with handkerchiefs or tissue paper, which should not be shared with peers.

Check body temperature, record the reading and sign the temperature chart before sending children to school.

Do not send children to school if they have fever. ((Body temperature varies with age, time of day and level of physical activity. Different reference values for normal body temperature may be adopted for different measuring methods and instruments.

Always refer to inserts and instructions that come with the thermometer. In general, if an oral thermometer is used, a reading above 37.5^oC would be considered as fever.)

Report to the school immediately if children are sick and provide details of the sickness including symptoms, diagnosis and whether hospitalization is required.

Keep sick children away from school until symptoms have improved and fever has subsided for at least 2 days, or follow medical advice, whichever is longer.

Cooperate with schools by picking up a sick child from the school to seek medical care immediately.

For students with chronic medical illnesses, parents should inform staff about the students’ medical needs, and seek medical advice on need of additional measures as appropriate.

For more information, please visit the Centre for Health Protection website www.chp.gov.hk

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Annex IV

Procedures of Preparing / Using Diluted Bleach

1. Keep windows open when diluting or using bleach to ensure good ventilation.

2. Put on protective gear when diluting or using bleach as it irritates mucous membranes, the skin and the airway.

3. Cold water should be used for dilution as hot water decomposes the active ingredient of bleach and renders it ineffective.

4. 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.

5. Make adjustments to the amount of bleach added if its concentration of sodium hypochlorite is above or below 5.25%.

Calculation: Multiplier of the amount of bleach added = 5.25 concentration of sodium hypochlorite in bleach

For example, the bleach used contains 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.

6. For accurate measurement of the amount of bleach added, a measuring cup can be used.

7. Rinse disinfected articles with water and wipe dry.

8. Cleaning tools should be soaked in diluted bleach for 30 minutes and then rinsed thoroughly before reuse.

9. Finally, wash hands with liquid soap, then dry hands with a clean towel or disposable towel.

Precautions

1. Avoid using bleach on metals, wool, nylon, silk, dyed fabric and painted surfaces.

2. Avoid touching the eyes. If bleach gets into the eyes, immediately rinse with water for at least 15 minutes and consult a doctor.

3. 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.

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4. 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.

5. Sodium hypochlorite decomposes with time. To ensure its effectiveness, it is advised to purchase recently produced bleach and avoid over-stocking.

6. For effective disinfection, diluted bleach should be used within 24 hours after preparation as decomposition increases with time if left unused.

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Annex V Guidelines for Hand Hygiene

Many infectious diseases can be transmitted through direct contact. If hands are contaminated with pathogens, especially when they are soiled with respiratory discharge or faecal matters, diseases include dysentery, cholera, hepatitis, influenza, and hand, foot and mouth disease can be spread easily. Observance of hand hygiene is the prerequisite of the prevention of the spread of communicable diseases. There are two ways to achieve hand hygiene including good handwashing and proper use of alcohol-based handrub.

When do we perform Hand Hygiene?

1. Before touching the eyes, nose and mouth 2. Before eating or handling food

3. After using the toilet

4. When hands are contaminated by respiratory secretions, e.g. after coughing or sneezing

5. After touching public installations or equipment, such as escalator handrail, elevator control panels or door knobs

6. After changing diapers or handling soiled articles when looking after young children or the sick

7. Before and after visiting hospitals or residential care homes.

8. After making contact with animals or poultry

As a matter of good practice, students are reminded to clean their hands. In general, we should wash hands with soap and water when hands are visibly soiled or likely

contaminated with body fluid, for example, after using the toilet or changing the diapers, after coughing or sneezing. When hands are not visibly soiled, 70-80% alcohol-based handrub is also effective for disinfection.

Steps for Hand Hygiene

a) Handwashing with soap and water:

1. Wet hands under running water.

2. Apply liquid soap and rub hands together to make a soapy lather.

3. Away from the running water, rub the palms, back of hands, between fingers, back of fingers, thumbs, finger tips and wrists. Do this for at least 20 seconds.

4. Rinse hands thoroughly under running water.

5. Dry hands thoroughly with either a clean cotton towel, a paper towel, or a hand dryer.

6. The cleaned hands should not touch the water tap directly again.

The tap may be turned off by using the towel wrapping the faucet; or

after splashing water to clean the faucet.

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Please note:

Towels should never be shared.

Used paper towel should be properly disposed of.

Personal towels to be reused must be stored properly and washed at least once daily.

It is even better to have more than one towel for frequent replacement.

b) Use of alcohol-based handrub

Apply a palmful of alcohol-based handrub and cover all surfaces of the hands. Rub the palms, back of hands, between fingers, back of fingers, thumbs, finger tips and wrists for at least 20 seconds until the hands are dry. The picture below demonstrates the 7 steps in the use of alcohol-based handrub.

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Annex VI Wearing a mask properly

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Appendix II Sample Letter to All Parents on

Commencement of New School Year

(Schools may revise the content according to their specific situation)

<Date>

Dear Parents,

According to the Department of Health (DH)’s latest assessment, though the human swine influenza (HSI) is a new virus and transmitting easily through the population, it causes relatively mild disease. Having considered the recent situation and DH’s advice, the Education Bureau (EDB) announced on 20 July that all kindergartens, kindergarten-cum-child care centres, special schools, primary and secondary schools (including private independent schools, international and ESF schools) could commence classes in the new school year 2009/10 as scheduled. In view of this, classes of our school will commence on (Month) (day) as scheduled.

During the summer vacation, we have thoroughly cleaned and disinfected the school premises. We would urge all staff members and students, including lunch-box suppliers and school bus drivers, to step up precautionary measures to ensure personal hygiene and environmental hygiene of the school. We would also request our staff (including drivers and attendants of school buses and nanny vans) to take their body temperature daily before going to school. If they have fever or other symptoms of influenza, they must not return to school and appropriate arrangements would be made.

On the first school day, we would arrange special programmes/activities to enhance students’ knowledge and awareness of HSI. Besides, we would avoid as far as possible overcrowding and keep windows open and exhaust fans on for good ventilation. Facemasks would be provided to staff members and students who have such a need.

It is the responsibility of every citizen to prevent the spread of HSI. We would like to call on you to maintain a hygienic household and to cooperate with us in providing your child a safe learning environment. Please pay attention to and carry out the following measures thoroughly:

Pay attention to the health condition of your child. If he/she has fever or symptoms of influenza, he/she should refrain from school and seek medical care immediately.

Check your child’s body temperature daily before sending him/her to school, record the readings and sign on the temperature record sheet (Form A) as attached. Your child should return the completed sheet to us every day.

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To prevent infection, please urge your child to bring tissue paper to school every day and remind them not to share towels or tissue paper with others.

If your child is confirmed of having contracted HSI, he/she should not go to school unless he/she has fully recovered and is recommended to do so by the Centre for Health Protection.

If your child is confirmed of having contracted HSI, you are requested to notify our teacher, Mr/Ms <Name of Teacher> at <Telephone number> immediately to facilitate our prompt action in taking contingency measures and notifying the CHP and the EDB.

To provide your child with a safe learning environment, we need your full support in co-operation with our efforts. For the sake of your child and others, we hope that you can follow the measures mentioned above strictly. For enquiries, please contact our teacher, Mr/ Ms <Name of teacher> at <Telephone number>.

Yours sincerely,

School Principal/Supervisor,

[This letter can be downloaded from the following path: http://www.edb.gov.hk > School Administration

>Administration>Prevention of Influenza (including Human Swine Influenza / Avian Flu) and Other Communication Diseases (including SARS) in Schools > Prevention of Human Swine Influenza – Useful materials]

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Form A

Name of School Temperature Record Sheet

(Monthly record, can be attached to the student handbook)

1. Parents/Guardians should take their children’s body temperature before going to school. If the children have fever (the normal body temperature range could be referred to the guideline on “Checking Body Temperature”) he/she should consult a doctor promptly, take sick leave and stay at home for a rest.

2. Parents/Guardians should record their children’s temperature and sign on the record sheet daily. The record sheet should be returned to class teacher for checking.

3. Please also complete on holiday.

Name of student : Class : Class no. : Month :

Date Time for taking temperature Temperature Signature of Parent/Guardian

A.M. / P.M. ℉/℃