The deadly hepatitis C outbreak in the Singapore General Hospital came as a jolt to many who have grown to take for granted the high standards established by the public healthcare system - its levels of integrity, efficiency and reliability. It is sobering and sad that the viral outbreak affected 22 kidney patients, eight of whom have died, with four deaths linked possibly to hepatitis C.
Some of the attention has focused on the use of multi-dose vials as a possible source of contamination. However, this method of dispensing medication is not uncommon. What is critical is strict adherence to guidelines on the use of such vials. Even single-use vials are governed by important safety rules. Thus, it's par for the course for hospitals to manage cost-efficient practices in tandem with stringent protocols (like the routine use of new sterile syringes and needles). Ultimately, of course, a system is only as good as its practitioners and operating culture. The tragic outbreak should serve as a reminder of this axiom.
Under the circumstances, it was prudent to appoint an independent review committee to ascertain "if all possible measures had been taken to identify the possible points of infection control breach". It must carry out its task rigorously to help the Ministry of Health to determine any weaknesses in the infection-control workflow and to remedy these expeditiously. Nailing down what went wrong and setting acceptable safety standards will be critical to the public memory of the case.
Another important aspect of the outbreak is the way in which the reporting and alert systems of hospitals function. This is critical when risks of spreading infections are high, especially through acute healthcare processes designed to help patients but which might be inadvertently causing harm to them, hospital staff and visitors. At a moment such as this, any organisational reluctance to draw unwanted attention to itself should be nipped in the bud. Instead, transparency should be a hallmark of public hospital administration. This is the best antidote for unfounded fears and theories that can spread virally when officials are less than forthcoming or are perceived to drag their feet before alerting higher authority, briefing the media and answering public queries. Trust is more likely to abound when the Singapore system is unfailingly open about lapses and meticulous in putting things right.
While standards of care are generally high here, there is a danger that the relative absence of crises could breed complacency from assumptions that a certain protocol is fail-safe or that particular individuals down the line will catch errors. Certainly, one should guard against clinically non-significant alerts from myriad sources leading to alarm fatigue. But a sensible culture of safety must be an intrinsic part of the healthcare system.