SGH Hep C
cluster: Measures to improve infection control, response
mooted
SINGAPORE: The Independent Review Committee (IRC) convened to
investigate the Hepatitis C virus (HCV) cluster at Singapore
General Hospital (SGH) on Tuesday (Dec 8) outlined recommendations
to improve infection control and the national response system to
such events.
The IRC’s recommendations followed its 79-page report, which was
accepted by the Ministry of Health (MOH). The report identified
breaches in infection control as a likely cause of the HCV cluster,
where seven people died, and also highlighted flaws in the system
response to unusual and unfamiliar outbreaks.
The committee, which was set up in late September and which
included international experts, said there was a need for SGH to
review existing standard operating procedures (SOPs) and practices
on infection control, to further reduce the risk of contamination
of medical equipment and contact surfaces, as well as to ensure
adequate environmental cleaning and disinfection.
Specific measures included designating a clean area for the
preparation of intravenous medication, using washable keyboard
covers, not touching surfaces on computerised medical carts with
contaminated or gloved hands, and considering the option of using
fluorescent dye to assess the adequacy of cleaning.
The committee also recommended that SGH ensure staff adhere to
standard precautions for infection control, and adopt best
practices such as those laid out in guidelines from the US Centres
for Disease Control and Prevention (CDC) - but adapted to the
Singaporean context.
For instance, the hospital should consider the use of needleless
intravenous devices, to allow safe injection of medication without
the use of needles. CDC guidelines also include the appropriate use
of single-dose and multi-dose vials.
SGH should strengthen its monitoring and supervision framework
for staff to ensure compliance to SOPs, said the review committee.
It added that SGH should prepare a plan for corrective measures
specific to the findings identified by the IRC.
"This plan should be formulated within one month and submitted
to MOH for review, to ensure patient and healthcare worker safety,
and maintain a high standard of patient care with particular
attention to infection control," the committee said in its
report.
The IRC comprised of the following members:
Prof Leo Yee Sin (Chairman) - Director and Clinical Director,
Tan Tock Seng Hospital
Prof Lim Seng Gee - Senior Consultant, Division of
Gastroenterology and Hepatology, Department of Medicine at the
National University Hospital (NUH)
Assoc Prof Helen Oh - Head of Infectious Diseases at Changi
General Hospital (CGH)
Dr Titus Lau - Senior Consultant, Division of Nephrology at
NUH
Ms Paulin Koh - Chief Nurse at CGH
Assoc Prof Quek Swee Chye - Deputy Chairman of the Medical Board
at NUH
Dr Jeffrey Cutter - Director (Communicable Disease Division) at
MOH
Also present at the press conference on Tuesday were Assistant
Professor Angela Chow, Head of the Department of Clinical
Epidemiology at TTSH's Institute of Infectious Disease and
Epidemiology, and Professor Tan Chorh Chuan, President of the
National University of Singapore. They were appointed as resources
for the IRC to tap on during the review.
RESPONSE FRAMEWORKS SHOULD BE ENHANCED
The committee also recommended
that MOH to enhance its current surveillance and outbreak response
frameworks to cater for unusual and unfamiliar events, for outbreak
detection investigation and management, communication and
escalation protocols, and the appropriate roles of MOH and the
hospital in question.
The IRC suggested improving the national notification and
surveillance system for acute HCV, taking reference from
international best practices and adapting them to the Singaporean
context.
One possibility, said the committee, is to build an electronic
system where laboratories can automatically send notifications to
MOH. It also said there should be a designated team within MOH to
carry out surveillance, identify and investigate potential
outbreaks and ensure adequate expertise nationally for
investigations.
But hospitals should also continue to take responsibility and
develop frameworks and capabilities for healthcare-associated
infection outbreaks, it added.
Where required, the hospital’s capabilities can be supplemented
with additional resources from the national healthcare system,
including but not limited to infectious diseases specialists and
epidemiologists.
The committee also asked MOH to strengthen its escalation and
communication processes for healthcare-associated infections,
especially unusual and unfamiliar ones, within and between
hospitals, public healthcare clusters and MOH. This should be
achieved through clearer guidelines on the assessment of the
significance and severity of a healthcare-associated infection,
said the IRC.
It noted that it may not be easy to set guidelines for all
situations, so regardless of systems in place, healthcare
professionals should be alert to escalate any event that is
unfamilar and unusual. Doctors, especially, are reminded of their
obligation to report instances of infectious disease, as stipulated
by MOH.
When asked if MOH would convene a Committee of Inquiry (COI) as
called for by the opposition Workers’ Party, the ministry said it
was satisfied with the IRC’s findings and recommendations.
“We do not see a need to convene a COI to repeat what the IRC
has done. What else is there to establish that the IRC has not
established?” said MOH in a statement. “Our priority now is to
focus efforts and resources on implementing remedial measures to
improve patient safety and patient care.”
The infection has affected 25 patients at SGH’s renal ward.
- CNA/xq