22 patients
diagnosed with Hepatitis C virus, four died: SGH
SINGAPORE: Twenty-two patients at a renal ward in the Singapore
General Hospital (SGH) have been diagnosed with the Hepatitis C
virus. Among them, four have died, possibly from the virus.
In a media conference on Tuesday (Oct 6), SGH said that in early
June, the hospital discovered an increased frequency of Hepatitis C
virus infections in a renal ward. The hospital subsequently stepped
up checks for the virus in patients with abnormal liver function
tests in the same ward, and found 22 patients infected.
All 22 patients were admitted and stayed in the newly-renovated
Ward 67 between April to June 2015. Among them, eight have died,
including four who had “multiple co-morbidities and severe sepsis",
and the possibility that the Hepatitis C virus could have been a
contributing factor has not been ruled out.
Another three deaths were "thoroughly evaluated" and "no link to
the Hepatitis C virus infection has been established". One recent
death is pending review.
Of the 22 infected, the youngest is 24 years old, and the
remaining are between 50 and 60 years old.
SGH said that all cases were reviewed by a Medical Review
Committee, in consultation with the Ministry of Health and chaired
by an external senior hepatologist.
SGH said that their initial investigation indicated that the
source of infection might be due to "intravenous (IV) injectable
agents" or multi-dose vials which typically contain insulin or
vaccines.
Said Dr Tracy Carol Ayre, the chief nurse at SGH: "There are
policies in place that govern how intravenous drugs or drugs in
general are prepared, diluted and administered and that includes
your infection control practices, hand hygiene, new syringe, new
needle, swabbing of the bungs."
"In multi-dose insulin - and there are a number of multi-dose
vials currently - insulin vaccines are one of them. These are
generally shared. So you use it for that person, using a new
syringe and new needle, but it's then shared among multiple
patients. Because the idea is that you would have swabbed the bung,
you would have used a new syringe and new needle for that episode
and there's no reason for it to be contaminated again. So if in
theory, that this is the cause of it at the end of the day, then
that may have been some contamination along that process."
The hospital has since taken immediate precautionary measures,
stopping multi-dosing, even though it is, in SGH's words, a "long
established and accepted practices in healthcare institution".
Prof Fong Kok Yong, chairman of SGH’s Medical Board, said that
there is "no conclusive evidence" yet as investigations are still
ongoing.
He also said that there had been no new cases of Hepatitis C
virus infection since they implemented their precautionary
measures. Hospital staff who provided care to the renal patients
will also be screened.
SGH CEO Prof Ang Chong Lye said: "We would like to apologise
unreservedly for the grief, pain and anguish this has caused our
patients and families.
"What happens to our patients is always our responsibility. We
will spare no effort in reviewing our processes and examining all
possible sources of infection to prevent recurrence."
HEALTH MINISTRY CONVENES INDEPENDENT COMMITTEE TO
PROVIDE 'OBJECTIVE, CRITICAL REVIEW'
Minister for Health Mr Gan Kim Yong said: "I am gravely
concerned and disappointed with the occurrence of the cluster of
Hepatitis C cases in SGH."
Mr Gan added that he has appointed an independent review
committee to ensure an objective and thorough review of the
incident, to prevent future occurrences. "Going forward, the
committee will take about two months to complete this work," he
said.
"When the review is completed, we will share the outcome with
the public as well as with our healthcare clusters. We hope that
the SGH as well as all our healthcare institutions will learn from
this incident and work hard to continue to improve our patients’
safety. In this way, we will be able to ensure that we will
continue to take good care of our patients."
Mr Gan also urged members of the public to not jump to
conclusions before the outcome of the review. Meanwhile, he said
measures have been introduced to ensure that this issue will not
recur again.
He said: "Our first priority is to extend our help and support
to the patients to ensure that their conditions are managed and
taken care of, and also to provide support for the family members.
Our second priority is to look at how we can strengthen our
precautionary measures and safeguards to ensure this does not
happen again.
"Then, we will also put our efforts into reviewing the process
and see where are the gaps and the possible weaknesses, so that we
can introduce additional measures to strengthen them. This will be
the work of the review committee going forward."
Hepatitis C is a liver disease that is transmitted by
blood-bourne routes, and is not air-borne like SARS.
The average time period from exposure to symptom onset is two to
24 weeks. If left untreated, the long-term effect of the virus is
cirrhosis, liver failure, or liver cancer.
- CNA/es/xk/wl
