Shortly after Singapore General Hospital (SGH) revealed that 22 patients had been diagnosed with the potentially deadly hepatitis C virus, SingHealth chief Ivy Ng sent a cluster-wide message to staff to "keep strong".
She told them last Wednesday: "Despite our very best efforts, we can still fail our patients; hurt them when we mean to heal them; and trigger understandable distrust in the public whom we only seek to serve."
SGH was alerted to an infection in its renal ward in mid-May, as an unusual number of its kidney patients were diagnosed with hepatitis C, which can lead to liver failure. Typically, it has two to four such cases a year among renal patients. It started to react when seven cases turned up within four weeks. Since then, eight patients have died, with up to five deaths linked to theirbeing infected with the hepatitis C virus.
Professor Ng quoted from a note sent by a chief executive officer of another health cluster, who said SGH had "good surveillance and reporting" and "open disclosure and strong accountability".
The unnamed CEO also said: "It shows that you have a strong patient safety and learning culture."
A separate memorandum to staff last Thursday from SGH's CEO, medical board chairman and chief nurse said they wanted to address the question of why it took the hospital four months to inform the Ministry of Health of the infections.
The delay was because it was not an airborne virus (which is spread easily); SGH did not want to "cause unnecessary alarm" as "that would not be responsible". They told staff: "We took action immediately in early June, when we noticed the clustering of seven cases within four weeks, which is unusual."
SGH had told the media it started internal investigations in mid-May, although its infectious control team was not activated till early June.
Eight patients were diagnosed with the virus by the end of May, 10 more were diagnosed in June, two in July, and one each in August and last month.
SGH told the media that all the infections occurred between April and the time it stopped the use of multi-dose vials some time in June. A multi-dose vial contains more than one dose of medicine.
It is confident that it has arrested the spread of the virus.
Prof Ng told staff that the hospital had stopped using multi-dose vials "except where unavoidable".
"We need to commit ourselves to an obsessive adherence to our strict protocols for infection control. Thousands of patients entrust their care to us. We cannot fail them."