Kidney dialysis centres have been warned to segregate patients with hepatitis B and properly clean equipment used by them. This is after the Ministry of Health (MOH) found that several centres had flouted these guidelines.
In an Oct 14 circular, two weeks after news of a hepatitis C outbreak at the Singapore General Hospital was made public, the ministry reminded centres to use dedicated dialysis machines and stations for those with the blood-borne virus.
"Dialysers and bloodlines (tubes used during dialysis) must not be shared among patients. Bloodlines shall be used once and discarded," the circular said.
849 patients screened by SGH for hep C virus
The Singapore General Hospital (SGH) said yesterday it had screened a total of 849 patients for the hepatitis C virus.
They had been patients in wards 64A and 67, the location of an outbreak of the liver virus, from January to September.
Of these, 777 patients tested negative for the virus and three tested positive, as announced by the hospital earlier. The results of 69 others are pending.
SGH also said 315 staff members had been screened, and all tested negative.
To date, 25 patients admitted to SGH between April and June have been diagnosed with the same family of hepatitis C virus. Eight patients have died, with five deaths possibly linked to the virus.
An independent review committee investigating the outbreak recommended that SGH expand its screening to verify if precautionary measures put in place in the wake of the outbreak had been effective. The hospital had originally screened only those who had stayed in the wards between January and June.
"We would also like to encourage, where possible, that all renal dialysis centres use dedicated dialysis machines for patients with hepatitis C and HIV infections."
There are 95 kidney dialysis centres in Singapore. MOH declined to reveal how many centres had not been adhering to the guidelines.
According to the Singapore Renal Registry's latest report, more than half of dialysis patients in 2013 had dialysis in centres run by voluntary welfare organisations such as the National Kidney Foundation (NKF) or Kidney Dialysis Foundation (KDF). A third went to private centres, while the rest received their treatment at public hospitals.
A spokesman for NKF, which has 28 centres and provides dialysis for nearly 3,000 patients, said it has always stuck to the guidelines and uses "separate equipment for hepatitis B cases".
It said that patients with hepatitis B are assigned to different dialysis centres from those with hepatitis C, so as to rule out any possibility of cross infection. As of August, it had around 117 hepatitis B and 73 hepatitis C patients under its care.
KDF's medical director Lina Choong, said all its centres use single-use dialysers - the artificial kidneys that help clean the blood - for hepatitis B patients. She also said KDF's clinical team "actively reviews" MOH guidelines and takes measures to prevent infection.
While private centres asked about the circular declined to comment, The Straits Times understands that some do not take in patients with hepatitis B at all.
Hepatitis B is spread through direct contact with the blood or other body fluids of an infected person. Symptoms include jaundice, dark urine, and nausea. Those with hepatitis B have a higher risk of developing liver cirrhosis or liver cancer.
While hepatitis B and C both attack the liver and can have similar symptoms, hepatitis B is much more common. An estimated one in 35 adult Singaporeans are hepatitis B carriers, according to the Health Promotion Board. Less than 1 per cent of the population is affected by hepatitis C.
However, people can be vaccinated against hepatitis B, while there is no vaccine for hepatitis C.
Liver specialist Mark Fernandes of GutCare Clinic said as a precautionary measure, patients should be screened for hepatitis B before starting dialysis. "Hepatitis B vaccinations should be offered to all patients undergoing dialysis who do not have immunity (to the virus)."
General practitioner Yik Keng Yeong said: "If there is no proper sterilisation at dialysis centres, you can very easily infect the people who do not have the virus."