Call for regular audits and clear rules at hospitals

A nurse giving a demonstration on patient safety and infection control measures at SGH in October during a media tour. An independent committee found that poor infection control caused the hepatitis C outbreak there earlier this year. Some 25 kidney
A nurse giving a demonstration on patient safety and infection control measures at SGH in October during a media tour. An independent committee found that poor infection control caused the hepatitis C outbreak there earlier this year. Some 25 kidney patients who were admitted from January to September were diagnosed with the blood-borne virus, and eight have since died.ST PHOTO: KUA CHEE SIONG

Hospitals should have regular audits and make rules as easy to follow as possible, say those in the industry, and not just have good infection control protocols.

These measures, which could range from conducting surprise spot checks to making sure that sinks are conveniently located, would help to reduce the risk of transmitting infections.

The topic has come under the spotlight after an independent review committee found that poor infection control caused the hepatitis C outbreak at the Singapore General Hospital (SGH) earlier this year.

Some 25 kidney patients who were admitted to the hospital between January and September this year were diagnosed with the blood-borne virus. Eight of them have since died.

Regular audits, suggested Dr Desmond Wai, of Mount Elizabeth Novena Specialist Centre, are a way of helping staff be more aware of what they are doing.

"It's like driving - if you know there's a speed camera up ahead, you will slow down," the gastroenterologist said.

Hospitals, he added, should try to make following the standard protocol as easy as possible for all healthcare staff. "For example, you need to think about the workflow so that the clean and dirty areas never overlap," he said. "The flow between them should be one-way only."

In response to queries yesterday, a Ministry of Health (MOH) spokesman said that it carries out biennial inspections of all hospitals to ensure they comply with regulations.

"Since we were informed of the outbreak, MOH has reminded all healthcare institutions and providers of the need to strictly comply with clinical protocols and guidelines, including infection prevention and control safeguards," the spokesman said.

Comparing the hepatitis C outbreak with the severe acute respiratory syndrome (Sars) crisis in 2003, healthcare consultant Jeremy Lim said that it shows that people tend to be more alert when they are at personal risk.

"During Sars, healthcare professionals here were more vigilant because they were personally much more at risk," said Dr Lim, who also teaches at the National University of Singapore's Saw Swee Hock School of Public Health.

"For a lot of hospital-acquired infections, the patients are more at risk because they are immuno-compromised."

Experts also said that, as far as possible, hospitals should try to make sure the staff on duty are able to adequately handle patient loads to reduce the risk of accidents.

"When we are in a rush, we are tempted to take shortcuts," Dr Wai pointed out.

His sentiments are shared by former nurse Elizabeth Chan, who remembers how, as a young nurse in the 1970s, she once dashed to deliver a baby with her bare hands - only to get a literal slap on the wrist from her mentor. "She told me: 'The baby won't fall; put on your gloves!'" recalled Ms Chan, 69, who used to be a hospital nurse and is now a senior nurse educator.

"I think it's easier to make mistakes or miss out some steps when you're in a hurry."

Linette Lai and Tan Weizhen

A version of this article appeared in the print edition of The Straits Times on December 10, 2015, with the headline 'Call for regular audits and clear rules at hospitals'. Print Edition | Subscribe