Monday, 14 December 2015

Three recent healthcare outbreaks in Singapore

Another Hospital Makes A Boo-Boo
14 babies from KK Hospital’s Intensive Care Unit diagnosed with ‘red eye’

14 babies at the KK Women’s and Children’s Hospital (KKH) Neonatal Intensive Care Unit (NICU) were diagnosed with conjunctivitis — or more commonly known as red eye or sore eye —  between mid Oct and 1 Dec.

According to the Health Promotion Board, Conjunctivitis (Red eye) is an inflammation or infection of the transparent membrane (conjunctiva) that lines the eyeball that causes the eye to be swollen and makes small blood vessels in the eye become more prominent resulting in red eye. Can the ICU still be called Intensive Care Unit if the care provided is not adequate?

This is the third recent healthcare saga in Singapore. In October, Singapore General Hospital revealed cases of hepatitis C. Just last week (4 Dec), National University Hospital (NUH) also came clean with their tuberculosis (TB) cases.

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Outbreak infected 14 babies at KKH’s Intensive Care Unit
Photo of baby with conjunctivitis from improveeyesighthq

14 newborn babies with serious medical conditions were infected with “red eye” syndrome, medically known as conjunctivitis at the KK Hospital’s neonatal intensive care unit (NICU). All 14 babies were admitted into the ICU ward between mid-Oct and Dec 1.

The babies whose lives are already endangered in the ICU are now facing greater dangers upon infection. 12 KK Hospital employees working in the NICU were also infected. Victims with the “red eye” syndrome will have swollen eyelids and discharge from their eyes. According to the chairman of the KK Hospital Division of Medicine, the condition is caused by the virus, Adenovirus Type 8.

This is the third case of infection outbreak in Singapore this year. In the first case of the virus outbreak which killed 7, the Health Ministry found the hospital staffs guilty for not following infection control procedures. Health Minister Gan Kim Yong has not commented on the virus outbreak and has not offered to resign despite having the multiple outbreaks killing and endangering many lives.

Ministry of Health’s Review Committee on virus outbreak: SGH staffs at fault
Tuberculous disease outbreak in NUH, 178 children recalled for test

Virus outbreak at SGH: 22 infected and 8 dead

14 babies in KKH got 'sore eyes' between Oct to Dec

A total of 14 babies were diagnosed with conjunctivitis at the KK Women's and Children's Hospital (KKH) Neonatal Intensive Care Unit (NICU), the hospital confirmed on Friday (Dec 12). It added that the last of these cases was diagnosed on Dec 1.

It also denied reports that the NICU was closed due to the cases of conjunctivitis.

Said Associate Professor Ng Kee Chong, Chairman, Division of Medicine, KKH: "We accept referrals from other hospitals for complex cases requiring tertiary neonatal care. As such, the NICU occasionally operates at maximum capacity and has to stop taking external referrals as a result. The NICU was never closed. It had stopped accepting non-urgent new external referrals because it was full."

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14 babies in KKH's intensive care unit contract 'red eye'
KK Women's and Children's Hospital. PHOTO: ST FILE

Fourteen newborn babies at KK Women's and Children's Hospital's (KKH) neonatal intensive care unit (Nicu) contracted conjunctivitis between mid-October and Dec 1.

Associate Professor Ng Kee Chong, chairman of the hospital's Division of Medicine, said that all the babies were in the Nicu for serious medical conditions.

He told The Straits Times that 12 hospital employees working in the Nicu were also diagnosed with the condition. "Upon diagnosis, these staff were treated and put on medical leave," he said.

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14 newborn babies in KK Women's and Children's Hospital contracted conjunctivitis (red eyes) between October to Dec 2015. Professor Ng Kee Chong, Chairman of the Hospital's Medicine Division said all babies were in the NICU for serious medical conditions. 12 NICU employees were also diagnosed with conjunctivitis and put on medical leave.

Prof Ng said the first baby probably contracted the viral infection from its mother and a few weeks later another 2 babies were found with the same eye disease. It is a common eye problem that is painful with swelling of the eyelids and may cause eye discharge.

He also added: "Isolation measures were immediately instituted for these babies upon diagnosis. Additional precautionary measures were undertaken by KKH, which included enhanced barrier protection for better efficacy against this type of virus, implementing donning of additional

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5 children found to have latent TB

Five of the children screened at the National University Hospital (NUH) after one of its paediatric nurses was found to have pulmonary tuberculosis (TB) have tested positive for a latent infection of the disease.

"Treatment has been offered to these patients as a precautionary measure," an NUH spokesman said late last night.

The hospital said it had contacted more than 160 patients, and more than 130 of them had been brought in by their parents for screening.

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5 child patients found with latent TB after screening: NUH

The National University Hospital has screened more than 130 child patients after it was discovered that one of its paediatric nurses had pulmonary tuberculosis (TB).

The hospital said in an update on Tuesday (Dec 22) that it has contacted more than 160 patients in total for screening. Out of these, none has active TB, but five have positive Mantoux reading, which is indicative of latent TB infection, said NUH, adding that they have been offered treatment as a precautionary measure.

An NUH spokesperson said in a statement that latent TB infection can be effectively treated to prevent progression to active TB, with current treatment options reducing the risk of developing active TB by more than 90 per cent.

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Tuberculous disease outbreak in National University Hospital, 178 children recalled for test
Photo of NUH from reuelwrites

There has been a tuberculous disease outbreak in Singapore’s National University Hospital (NUH) and 178 children have been recalled for testing.

The hospital found out the outbreak when a nurse was tested positive for tuberculous (TB), with a TB patch the size of a 50-cent coin last Friday (Nov 27). The nurse first experienced persistent coughing in July. One of the wards affected was ward 47. 131 of the children are under two years old and 34 are especially vulnerable as they had just received a transplanted organ and were under immune system suppressant drugs.

Professor Paul Tambyah, an infectious disease expert at NUH, said there is a 10% chances of people getting the bacteria if a person coughs at them for two hours, and that the risk of infection depends on the exposure, the bacterial load of the infected and the immune system of the exposed.

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NUH recalling 178 children cared for by nurse with TB
Photo: The Straits Times

The first of the 178 patients were at NUH (above) for screening on Tuesday. The children will have a chest X-ray to check for TB, and blood tests if aged five or older, and/or skin tests to see if they have the bug latent in them.

The National University Hospital (NUH) is recalling 178 paediatric patients - including 131 under the age of two years - who had been cared for by a nurse now confirmed to have tuberculosis (TB).

They include 34 children who have received a transplanted organ, so are on immunosuppression drugs and therefore at higher risk than normal children.

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1 baby found to have latent tuberculosis after NUH recalled patients for screening
The boy was found to have latent TB, which means he has the bacteria in his system, but does not have the disease.PHOTO: ST FILE

One of the children exposed to the nurse at the National University Hospital (NUH) who has tuberculosis (TB) has been found to have the bug.

The boy, who is four months old now, was in Ward 47 where the nurse worked, from Aug 23 to Sept 5.

The hospital is recalling 178 paediatric patients who had been cared for by the nurse before she discovered she had the disease.

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NUH recalls 178 children suspected of TB

The National University Hospital (NUH) has recalled 178 paediatric patients for TB tests which include chest X-rays, blood tests, and skin tests. All of them have been cared for by a nurse who has been confirmed to have contracted TB.

After the SGH hepatitis C saga which affected 23 patients and saw 4 deaths, we would have thought that other public hospitals such as NUH would have taken a leaf out of SGH’s book and learnt how to practise preventive measures. Well, apparently not….

Out of the 178 patients recalled, 34 have taken immunosuppression drugs after receiving an organ transplant, which puts them at a higher risk of contracting the disease. Further, children have a weaker immune system compared to adults.

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Review Committee finds fault with SGH’s practices on Hepatitis C outbreak
Photo – The Straits Times, Tan Weizhen

The report by the Independent Review Committee (IRC) has found that sloppy practices, including poor infection control, led to the Hepatitis C outbreak in Singapore General Hospital’s (SGH) renal wards 64A and 67 where 25 patients were infected between the period of April and June 2015.

The report by the review committee was submitted to the Ministry of Health (MOH) on 5 December and has been accepted by the ministry.

The independent review committee headed by Professor Leo Yee Sin, the director of the Institute of Infectious Diseases and Epidemiology, was announced by MOH on 6 October to review the report by SGH submitted to the ministry on 24 September. The review committee was convened on 28 September by the Minister of Health, Gan Kim Yong.

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What is missing in SGH report
Associated Press/Joseph Nair - The windows of wards are seen with the sign of Singapore General Hospital on Tuesday, Oct. 6, 2015 in Singapore. The top public hospital in Singapore said Tuesday that four of its patients died after a new renal ward was hit by an outbreak of hepatitis C, likely from intravenous treatment. (AP Photo/Joseph Nair)

It must be the briefest statement to end a brewing crisis. And it was said with a firm air of finality.

“There is no evidence to suggest that the escalation from the director of medical services to the minister was deliberately delayed,” Leo Yee Sin, chairman of the committee that investigated the Hepatitis C scare at SGH, said last week.

Their report was damning, exposing lapses in protocols at Singapore’s oldest hospital. This pride of Singapore’s health care industry was tardy in recognising the outbreak, its own investigations were messy and there were delays in reporting the matter to the Ministry of Health.

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Review committee places fault of Hep C outbreak on poor practices at SGH

It also found no evidence of deliberate delays by SGH or MOH staff in escalating the outbreak or in informing the Minister for Health.

It’s in — the independent review committee that looked into the Hepatitis C virus (HCV) outbreak at Singapore General Hospital (SGH) has released its report on its findings today (December 8).

Three days prior, their report was submitted — and later accepted, by the Ministry of Health (MOH), and if you’d like to read the entire thing, it’s available here. It’s 80 pages long, though, so we thought we’d take you through some key points from a shorter version of it:

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Ministry of Health’s Review Committee on virus outbreak: SGH staffs at fault

The Independent Review Committee set up by the Ministry of Health (MOH) blamed staffs at the Singapore General Hospital (SGH) for the Hepatitis C virus outbreak occurred between April and June.

According to the 79-page report, SGH staffs committed multiple breaches of infection control:
  • Not following standard procedures in administering blood-taking and giving medication
  • Inefficient workflow designs
  • Contaminated medical equipment and environment due to inadequate cleaning and disinfection practices
7 patients living in affected wards died due to the infection. Police investigations have also revealed no foul play. However it is not mentioned if the SGH staffs guilty of the infection control breaches will be taken to task for criminal negligence leading to deaths.

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Hepatitis C Outbreak: SGH’s Sloppiness Killed Patients, Says Independent Committee
25 people were infected with Hepatitis C and 8 of those in the affected ward died – with 7 deaths linked to the infection. All this, due to sloppy handling of equipment by staff at Singapore General Hospital

That was the finding of the Independent Review Committee, tasked with investigating the outbreak which was covered up for months before word spread to the Ministry of Health, and Singapore’s Health Minister.

18 spot checks found that staff were lax with the hygiene, and the handling of contaminated equipment.

The committee also found that there were gaps in infection prevention and control practices, failure by SGH to recognise the outbreak, and delays in notifying the higher-ups in the hospital as well as the MOH.

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SDP calls for Minister of Health to take responsibility for Hep C incident

Singapore Democratic Party (SDP) calls for Minister for Health Mr Gan Kim Yong to take responsibility for the Hepatitis C episode which took place during April to June this year that had 25 patients infected and claimed seven lives.

The press release which was signed off by Dr Chee Soon Juan, SDP’s Secretary-General, pointed out that the incident is the largest recorded hospital outbreak of hepatitis C in Asia and one of the largest in the world with tragic consequences for many families, yet the outbreak was allowed to “smoulder for months before the public and, in particular, those at risk were alerted”.

SDP goes on to state that the report released by the Internal Review Committee (IRC) appointed by the Ministry of Health (MOH) over the Hepatitis C infections saga “puts the blame squarely on the Singapore General Hospital (SGH) staff and seemed eager to absolve the MOH of its responsibilities over the matter”.

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WP calls for stronger response and escalation framework after Hep C outbreak

A stronger response and escalation framework for Healthcare-Associated Infections (HAIs) is required after the outbreak of Hepatitis C at the Singapore General Hospital (SGH), said the Workers’ Party in a press release on Wednesday.

The Independent Review Committee convened to look into the outbreak – which contributed to the deaths of seven patients – released its report yesterday, citing a combination of overlapping factors, such as poor infection control and sloppy practices at SGH, as leading to the incident. The Ministry of Health (MOH) has announced that it will put together a taskforce to look at the recommendations of the committee and determine an action plan.

“We urge this taskforce to solicit feedback widely from the medical profession and the broader public,” read the WP’s statement, which was signed off by Non-Constituency Member of Parliament Leon Perera, who is part of the WP Executive Council’s media team. “We also recommend that this taskforce be co-led by a respected, retired healthcare professional to ensure that recommendations are formed from a perspective of sufficient independence from the existing organization structure. This taskforce bears a heavy responsibility as MOH is the last line of defence against failures in any healthcare institution.”

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What Singapore’s lead opposition parties said in response to the Hep C review report
WP decided to call off its crusade for a COI, while SDP somehow managed to link it to ministerial salaries

On Tuesday, we saw the independent review committee tasked with investigating the closely-watched Hepatitis C outbreak at the Singapore General Hospital’s renal unit release their report for public scrutiny (and in case you missed it, you can read our summary of it here).

The Workers’ Party:
  • Decided to abandon its pursuit of launching a Committee of Inquiry into the matter (whew).
  • Suggested things it hopes the newly-formed taskforce (to be headed by this MP-elect, by the way:) will look into
Singapore Democratic Party:
  • Noted that the report seemed to absolve the Ministry of Health of blame over what had happened.
  • Asked when the serious information circulating various divisions was communicated to the highest levels of authority in the ministry, calling for the release of emails and communication among those involved.
  • Declared that the Health Minister should take responsibility for the communication taking place within his ministry, and also should take responsibility for the seven Hep C-linked deaths that occurred as a result of the outbreak.
  • Said that if exceptionalism is a justification for high salaries, ministers should not be excused for lapses like this.
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IRC report shows escalation and notification process was flawed and needs overhaul

The report identifies gaps in the infection control procedures for Healthcare-Associated Infections (HAIs) at SGH, as well as in the national system for notification, escalation and response. For example:
  • blood specks infected with Hepatitis C Virus (HCV) found on the wall of Ward 67
  • the delays in the SGH renal unit notifying SGH infection control
  • the MOH-CDD’s failure to classify the initial notifications as acute HCV
  • the failure to perform certain elements of investigation before 3 September, which were only undertaken at the request of the Director of Medical Services (DMS) on 3-17 September
  • SGH senior management and some clinicians assuming that SGH was liaising with MOH-CQPT (Clinical Quality, Performance & Technology Division) and that MOH-CQPT would inform the DMS if necessary
This incident contributed to the loss of seven lives. We should take an extremely serious view of such failings and gaps. We welcome the Minister’s assurance that changes will be made to reduce the risk of this incident recurring, and that the issue of accountability of personnel will be addressed by Human Resource (HR) panels at SGH, SingHealth and MOH. We look forward to reviewing the decisions from these panels when these are made public.

The Independent Review Committee (IRC) has made several recommendations for addressing the gaps it identified, such as creating a team within MOH to deal with outbreaks, improving the national notification and surveillance system for acute HCV and strengthening the escalation process for unusual HAIs. MOH has also announced the formation of a Taskforce to review these recommendations and determine an action plan.

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The report released today by the Review Committee appointed by the Ministry of Health (MOH) over the Hepatitis C infections saga puts the blame squarely on the Singapore General Hospital (SGH) staff and seemed eager to absolve the MOH of its responsibilities over the matter.

For example, it says that while “within SGH, communication with senior management took place early...there was a delay in escalation from...SGH to MOH”.

But this is contradicted by the report itself as the Committee also states that “from late April onwards” – which was when the infections were first discovered – the MOH was informed through three of its divisions serially: beginning with the Hospital Services Division (HSD)'s National Organ Transplant Unit (NOTU), and also the Communicable Diseases Division (CDD) and the Clinical Quality, Performance and Technology Division (CQPT).

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Off with (whose) head?
Just whose head should roll? It’s not a surprise that an opposition party would ask for a governing member to fall on his sword – or demand that he be guillotined. It also will be no surprise if the G ignored it

SGH’s parent company, SingHealth, is convening a disciplinary panel and the Health ministry is doing the same. These are normal HR practices and likely to be guarded as internal affairs not meant for public consumption. So a range of penalties will probably kick in if staff members are found wanting during the Hepatitis C outbreak. Warning letter? Suspension? Demotion? Sacking?

The IRC report named no names beyond the people with big titles who had to face the media with public pronouncements. It blamed things that went wrong, rather than the people who allowed things to go wrong or the people who did things wrong. It blamed the unwieldy system of reporting outbreaks, the lack of structures and clear responsibilities with the hospital and the ministry and even the lay-out of the affected ward. But it also said that the outbreak was “unusual” because Hep C patients don’t show symptoms and can only come about when someone takes a good look at lab reports on their blood.

Now, if the sword fell on the medical staff in the ward, you can expect the usual complaint that it is always the “little people’’ who get the chop for not sticking to standard operating procedures when ministering to patients. Maybe some of them deserve this, say, a particularly sloppy medical staff member who doesn’t deserve his or her position as a healthcare professional. Who wants to stay in a dirty hospital ward?

related: WP wants an explicit timeline…and here’s the outbreak timeline

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Unhygienic Practices in SGH Persisted Despite Lapses that Caused Hepatitis C Infections

Singapore General Hospital has said it will learn from incident whereby 25 patients were infected with Hepatitis C after staying at one of the hospital’s wards.

But in the wake of the infections, and even as investigators were trying to find the cause of the infections, unhygienic practices continued.

The independent review committee tasked with investigating the outbreak of infections conducted 18 spot checks and found that staff failed to observe appropriate hygiene in handling medical equipment.

Related Posts:
4 Dead After Hepatitis C Outbreak at SGH, Drug Injections Blamed for Infections
SGH Accused of Hiding the Truth about Hepatitis C Infection Cases Last Year
“They Never Told Me I was Staying in the “Infected” Ward Until 2 Days Ago”
MOH: Delay in Disclosing Hepatitis C Outbreak Was Not Politically-Driven
Review Committee Finds One More SGH Patient Died due to Hepatitis C Infection
One More SGH Patient Found to Have Contracted Hepatitis C
SGH Finds Two More Hepatitis C Infections in Latest Screenings
Hepatitis C Timeline Reveals SGH’s Shocking Lack of Regard for Patients Lives

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Hepatitis C deaths/infection – innocent taxpayers pay the price but SGH, MOH not accountable for screw up?

Singaporeans should not expect any accountability from a own self hold own self accountable PAP government. If PAP had wanted to hold any PAP-appointed CEO/senior civil servants accountable, a COI would have been convened, not another PAP ‘independent’ review committee.

The current situation is similar to another ‘independent’ committee set up to review AIM by MND: it found no misuse of funds by town councils which sold public property at a steep discount to AIM, a PAP-owned company. The outcome of every wayang committee is a foregone conclusion – wait long long for accountability to be addressed.

MOH said that “within MOH, there was no single division with clear responsibility and capability to deal with the issue, resulting in a gap in ownership”. Will even an idiot believe this?

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22 Patients Infected With Hepatitis C In SGH, 4 Dead

An outbreak of the hepatitis C virus in one of Singapore General Hospital’s (SGH) renal wards has led to 22 patients being infected with the virus, according to media reports. Of the 22, the youngest is 24-years-old and the remaining are between 50 to 60-years-old.

Four have died. SGH has apologised for the lapse.

The hospital said in a media briefing on Tuesday that there was an increase in hepatitis C virus infections in early June 2015 in the renal ward. This prompted urgent checks for the virus by SGH on patients who were staying in the same ward and had abnormal liver function test results. Investigations into the cause of the infections are ongoing but initial investigations have pointed the source to “intravenous (IV) injectable agents”.

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Virus outbreak at SGH: 22 infected and 8 dead

A Hepatitis C virus outbreak happened at a renal ward in Singapore General Hospital with 22 patients infected and among them, 8 dead, possibly from the infection. All 22 patients were staying at the newly-renovated Ward 67 between April and June this year. The news have been covered up until an official press release made by SGH today (Oct 6).

Among the 8 dead, 4 had “multiple co-morbidities and severe sepsis” with Hepatitis C infection possibly being the cause. The other 3 deaths, according to SGH, has been “thoroughly evaluated and no link to Hepatitis C virus infection has been established”. The last death is still “pending review”.

The youngest infected is a 24 year old, while the rest are between 50 and 60 years old. All names and profiles have been censored by the Singapore government.

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6 drug resistant TB cases in AMK
Hepatitis C: Chronic & Acute infections
Hepatitis C cluster @SGH: 22 infected, 4 have died
Three recent healthcare outbreaks in Singapore
Staff Disciplined after Hepatitis C Outbreak