SGH – the tip of the iceberg?

If you are Singaporean, I am sure you would know about the Hep-C outbreak in SGH.  You would probably have read that the Independent Review Committee (IRC) had released a report recently. In the report, it indicated that several lapses by SGH had led to the outbreak. The IRC identified “gaps in infection prevention and control practices, failure to recognise the outbreak, inadequate investigations and delays in notifying the higher-ups within the hospital and the Health Ministry.”

Such gaps included errors in the procedure of injecting medication into patients’ intravenous tube. A staff member opened the cap of a patient’s intravenous tube instead of a side port when injecting medication into it. The committee highlighted that “Such a practice poses a risk of the patient’s blood flowing out through the Intravenous (IV) cannula, leading to environmental contamination and transmission of infection, as well as exposure of the patient to contaminants entering his or her bloodstream,’’ said the committee.

The gaps also included blood stains left uncleaned on the wall and on medical carts and trolleys. The medical carts and trolleys should have been cleaned and disinfected before they were pushed into preparation rooms, but they weren’t. And even if they had been cleaned, the committee found that the cleaning process as demonstrated by the staff of SGH to be inadequate. The IRC also reported that there was “inadequate hand hygiene observed among some staff when they were performing procedures”.

But it’s not just the actions of the staff that led to the incident. The layout of one of the wards, Ward 67, was also part of the cause. This was the ward where most of the patients were believed to have been infected. The IRC had found that the layout of the ward resulted in the that staff members having to modify “their practices in order to complete their tasks’’.

The IRC also found that nurses performed some duties that were normally performed by junior doctors, like giving the first dose of IV medications. Though this was one of the few “good” things that the IRC said about the whole incident, I think it is worrying. Why did nurses have to perform duties that should have been performed by junior doctors? Was it due to a shortage of junior doctors? Or were the junior doctors slacking off?

If all these lapses could have happened in SGH, what’s to say that there aren’t similar lapses in other hospitals? Were the errors in procedure isolated cases of incompetence by a few nurses, or are they indicative of systemic issues (e.g. lack of, or worse, wrong training, shortage of manpower thus leading to nurses having to rush therefore increasing chances of mistakes) in hospitals? Are the lack of hand hygiene and inadequate cleaning only restricted to SGH? Or is that the case for other hospitals too?

It is not enough to say that this must certainly be an issue isolated to SGH because there weren’t any problems in the other hospitals. Just because it hasn’t happened doesn’t mean that it won’t. Goodness knows how long these problems in SGH had been going on for. Perhaps the Hep-C outbreak had been a problem that was just waiting to happen. I mean… before this incident, would any of us have known that there was blood on walls and hospital carts and trolleys in SGH that weren’t adequately cleaned? No right? So maybe there are similar problems in other hospitals too, just that we don’t know about them. Yet. So. Are there other problems just waiting to happen in any of our other hospitals?

Well… there is already a conjunctivitis outbreak in the  KK Women’s and Children’s Hospital’s (KKH) neonatal intensive care unit (NICU). 14 babies at the NICU and 12 staff who worked in the NICU were found to have contracted conjunctivitis (also known as sore-eyes) between mid-October and 1 December. While the first baby who contracted conjunctivitis probably caught it from its mother, it is still cause for concern that so many babies and staff were infected. The silver lining of this incident is that it didn’t take KKH the eons that SGH took to inform the public. Which again makes one wonder why did it take SGH so long to inform members of the public?

It is important that we learn from the Hep-C outbreak in SGH. But it is important to not just stop with SGH. In all of our public hospitals, are there gaps in training and manpower allocation that need to be address, are there any work processes that need to be improved, and are there any additional checks that need to be put in to prevent such an incident from ever happening again in any of our hospitals? MOH owes this to Singaporeans. They need to do more to make Singaporeans regain confidence in our public hospitals. MOH ought to do a systemic review of all our hospitals. After all, prevention is better than cure.

[Featured image: Minister Gan Kim Yong from screenshot of interview with CNA]


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