A mixture of public consternation and some relief is likely to greet the findings of the Independent Review Committee tasked with probing the hepatitis C outbreak in the wards of the Singapore General Hospital (SGH) earlier this year.
Concern is warranted by the findings of the committee, which identified poor infection control practices at the hospital, where the outbreak affected 25 patients, eight of whom died.
The virus was responsible directly for, or contributed to, seven deaths. Compounding the infection control issue were the hospital's tardiness in recognising the outbreak; its incomplete investigations; and its delay in escalating the incident. These are serious lapses, hardly of a kind to be associated with a premier medical institution in a country where procedures and protocols are taken seriously, not least when lives are at stake.
A measure of relief is occasioned by the fact that stealing of drugs, foul play or contaminated medical products were not the cause of the outbreak, and that there were no deliberate reporting delays. The committee's readiness to get to the heart of the problem speaks of the importance of transparency and accountability in upholding the credibility of public institutions. However, relief will not last long if the lessons of the crisis are not learnt, remembered and internalised. That expectation applies not only to SGH but also to other hospitals, whether public or private.
Indeed, the Ministry of Health itself has to be intensely alert to its responsibilities of oversight. The administrative structure for this has been strengthened with the establishment of a unit to deal with unusual outbreaks in hospitals. A repetition of the crisis would be deadly for public confidence in the Singapore health system. Disciplinary action, if any, taken against any of the key people involved in the episode would send a clear message to healthcare staff that lapses could cost lives in their area of work. Going forward, however, prevention is more important than punishment although, of course, no one guilty of serious dereliction of duty should get away scot-free.
In that context, it falls on the new task force, set up to strengthen infection control in all hospitals, to help ensure that high standards of surveillance and detection prevail throughout the system. In the light of checks which found that hospital staff did not always adhere to established practices, a question which arises is whether factors such as the workload might cause them to make mistakes that are out of sync with the care and professionalism for which they are known. That the healthcare system functions well most of the time is reassuring. What will boost confidence in it is the knowledge that mechanisms are in place and protocols are observed meticulously to control damage when things go wrong. Every Singaporean has a stake in the outcome of that process.
