Changes to boost disease-outbreak control

People walking past Block 6 at Singapore General Hospital, on Dec 8, 2015.
People walking past Block 6 at Singapore General Hospital, on Dec 8, 2015.PHOTO: ST FILE

They include letting healthcare staff report outbreaks anonymously, beefing up IT systems that track incidents

Healthcare professionals will soon be able to anonymously report infectious disease outbreaks, and IT systems used to track these incidents will be beefed up.

These are some of the changes made at the recommendation of a task force set up last December to strengthen outbreak detection and response in Singapore.

The eight-member team's 15 recommendations also included measures to improve how the Ministry of Health (MOH) monitors infectious diseases, as well as establish a clear decision-making structure.

The team also proposed changes to boost communication between healthcare institutions and ensure such outbreaks can be properly handled even outside acute hospitals.

The task force, headed by Minister of State for Health Chee Hong Tat, was established in the wake of the hepatitis C outbreak at the Singapore General Hospital last year.

  • Ways to speed up detection and response

  • •Update list of notifiable diseases.

    •Develop supplementary automated surveillance system.

    •Clarify criteria to notify Ministry of Health (MOH) of incidents.

    •Standardise surveillance of sick staff in healthcare institutions.

    •Allow doctors and laboratories to report incidents just once, and provide them with multiple channels and more efficient systems for reporting.

    •Publish guides for doctors, laboratories and institutions.

    •Improve communication between MOH and healthcare institutions.

    •Improve IT systems to better monitor and detect outbreaks, and trigger alerts.

    •Strengthen interactions across healthcare sector.

    •Designate Communicable Disease Division to oversee infectious disease surveillance and outbreak reporting.

    •Improve internal framework for classifying and managing incidents, and decision-making authority.

    •Better internal framework will be supported by the improved MOH operations centre for infectious diseases.

    •Engage hospitals to better determine their capabilities, develop standards, and conduct peer reviews across institutions regularly.

    •Build up the ability of the six regional health systems to manage infection control issues outside acute hospitals.

    •Set up the National Outbreak Response Team; this was done in March.

Then, 25 kidney patients admitted between January and September were diagnosed with the viral infection. Eight of them died.

Following this, an independent review committee was set up to probe the causes behind the outbreak. It concluded that poor infection control practices and a slow response time were to blame.

The task force was then created to strengthen Singapore's ability to detect and respond to such outbreaks. It submitted 15 recommendations to Health Minister Gan Kim Yong on June 30, all of which were accepted.

The team comprised experts in infectious diseases, systems engineering and data science.

For example, MOH said in a statement yesterday, healthcare professionals will be able to anonymously report outbreaks "to encourage a culture of open reporting".

"People on the ground sometimes have a better sense of what is going on," said Adjunct Associate Professor Lim Poh Lian, who heads the infectious diseases department at Tan Tock Seng Hospital.

"Doing so takes away some of the barriers to why people might not want to come forward, because they might not want to cause trouble."

The ministry has designated its Communicable Diseases Division as the unit in charge of overseeing surveillance of all infectious diseases and outbreak reporting.

MOH has also expanded the list of notifiable infectious diseases, which doctors are required by law to report to the authorities, from 43 to 49.

The list, which originally included diseases such as dengue and Ebola, will now also include botulism, tetanus, leptospirosis, murine typhus, rabies and Japanese encephalitis.

On the technology front, the task force recommended that MOH improve its data analytic capabilities to monitor the situation and trigger alerts if abnormalities are detected.

MOH said it will consolidate data from different sources and design the system to trigger alerts if needed. It will also share the data collected with healthcare institutions, after putting in safeguards to protect individuals' privacy.

"This two-way information flow will help to improve surveillance and early detection, enhance situational awareness across institutions, and encourage sharing within the healthcare system for better infection prevention and control," it said.

MOH had previously announced the initial recommendations of the task force in March. These included setting up a new National Outbreak Response Team, as well as simplifying the process of notifying the authorities of infectious diseases.

Professor Leo Yee Sin, who is director of the Institute of Infectious Diseases and Epidemiology and chaired the independent review committee, said the changes show a conscious effort to continue improving our healthcare system.

"This is quite a major change," she said. "Although the entire system in Singapore is well known to be good internationally, we have to look into continuing to improve all our processes."

A version of this article appeared in the print edition of The Straits Times on July 09, 2016, with the headline 'Changes to boost disease-outbreak control'. Print Edition | Subscribe