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Aung MO, Venkatachalam I, Sim JX, Wee LE, Aung MK, Yang Y, Conceicao EP, Arora S, Lee MA, Sia CH, Tan KB, Ling ML. Prediction model to identify infectious COVID-19 patients in the emergency department. Antimicrob Steward Healthc Epidemiol 2024; 4:e88. [PMID: 38774116 PMCID: PMC11106730 DOI: 10.1017/ash.2024.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 05/24/2024]
Abstract
Background Real-time reverse-transcriptase polymerase chain reaction (RT-PCR) has been the gold standard for diagnosing coronavirus disease 2019 (COVID-19) but has a lag time for the results. An effective prediction algorithm for infectious COVID-19, utilized at the emergency department (ED), may reduce the risk of healthcare-associated COVID-19. Objective To develop a prototypic prediction model for infectious COVID-19 at the time of presentation to the ED. Material and methods Retrospective cohort study of all adult patients admitted to Singapore General Hospital (SGH) through ED between March 15, 2020, and December 31, 2022, with admission of COVID-19 RT-PCR results. Two prediction models were developed and evaluated using area under the curve (AUC) of receiver operating characteristics (ROC) to identify infectious COVID-19 patients (cycle threshold (Ct) of <25). Results Total of 78,687 patients were admitted to SGH through ED during study period. 6,132 of them tested severe acute respiratory coronavirus 2 positive on RT-PCR. Nearly 70% (4,226 of 6,132) of the patients had infectious COVID-19 (Ct<25). Model that included demographics, clinical history, symptom and laboratory variables had AUROC of 0.85 with sensitivity and specificity of 80.0% & 72.1% respectively. When antigen rapid test results at ED were available and added to the model for a subset of the study population, AUROC reached 0.97 with sensitivity and specificity of 95.0% and 92.8% respectively. Both models maintained respective sensitivity and specificity results when applied to validation data. Conclusion Clinical predictive models based on available information at ED can be utilized for identification of infectious COVID-19 patients and may enhance infection prevention efforts.
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Affiliation(s)
- Myat Oo Aung
- Infection Prevention and Epidemiology Department, Singapore General Hospital, Singapore, Singapore
| | - Indumathi Venkatachalam
- Infection Prevention and Epidemiology Department, Singapore General Hospital, Singapore, Singapore
- Department of Infectious Disease, Singapore General Hospital, Singapore, Singapore
| | - Jean X.Y. Sim
- Infection Prevention and Epidemiology Department, Singapore General Hospital, Singapore, Singapore
- Department of Infectious Disease, Singapore General Hospital, Singapore, Singapore
| | - Liang En Wee
- Department of Infectious Disease, Singapore General Hospital, Singapore, Singapore
| | - May K. Aung
- Infection Prevention and Epidemiology Department, Singapore General Hospital, Singapore, Singapore
| | - Yong Yang
- Infection Prevention and Epidemiology Department, Singapore General Hospital, Singapore, Singapore
| | - Edwin P. Conceicao
- Infection Prevention and Epidemiology Department, Singapore General Hospital, Singapore, Singapore
| | - Shalvi Arora
- Infection Prevention and Epidemiology Department, Singapore General Hospital, Singapore, Singapore
| | - Marcus A.B. Lee
- Emergency Department, Singapore General Hospital, Singapore, Singapore
| | - Chang H. Sia
- Emergency Department, Singapore General Hospital, Singapore, Singapore
| | - Kenneth B.K. Tan
- Emergency Department, Singapore General Hospital, Singapore, Singapore
| | - Moi Lin Ling
- Infection Prevention and Epidemiology Department, Singapore General Hospital, Singapore, Singapore
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Arora S, Oo AM, Ismail BBS, Poon WB, Mun DLC, Ki KKK, Man WH, Tan KY, Aung MK, Conceicao EP, Yong Y, Weng DCY, Ying JSX, Venkatachalam I, Lee LC, Ling ML. Rapid Management of Serratia marcescens Outbreak in Neonatology Unit in Singapore: Risk factors and Infection Control Measures. Am J Infect Control 2024:S0196-6553(24)00500-5. [PMID: 38761850 DOI: 10.1016/j.ajic.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND To describe two consecutive Serratia marcescens outbreaks in neonatology unit of Singapore General hospital and determine risk factors associated with its acquisition in the second outbreak. METHODS Epidemiological investigations, environmental sampling and risk-factors analysis were used to guide infection control measures. Active surveillance sampling of nasopharyngeal aspirate and/or stool from neonates was conducted during both outbreaks. Whole-genome-sequencing was performed to determine clonal links. Retrospective case-control study was conducted in the second outbreak to identify risk factors for S. marcescens acquisition. RESULTS In the one-year period in 2022, two S. marcescens outbreaks were managed involving five neonates in March 2022 outbreak and eight neonates in November 2022 outbreak. Both outbreaks were caused by genetically unrelated S. marcescens clones, with a link to positive isolates from sinks in intensive care units and milk preparation room during outbreak 1. Neonatal jaundice(OR, 16.46; p-value= 0.023) and non-formula milk feeding(OR, 13.88; p-value= 0.02) were identified as independent risk factors during second outbreak. Multiple interventions adopted were cohorting of positive cases, carriage-screening, enhanced environmental cleaning, and emphasis on alcohol-based handrubs for hand-hygiene. CONCLUSION The two outbreaks in our institution were likely due to infection prevention practices lapses and favourable environmental conditions. Nosocomial S. marcescens outbreaks in neonatology units are difficult to control and require multidisciplinary approach with strict infection prevention measures to mitigate infection risks.
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Affiliation(s)
- Shalvi Arora
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore.
| | - Aung Myat Oo
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | | | - Woei Bing Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | | | | | - Wong Hei Man
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Kwee Yuen Tan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Yang Yong
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Darius Chan Yak Weng
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Jean Sim Xiang Ying
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Lai Chee Lee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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Tartari E, Garlasco J, Mezerville MHD, Ling ML, Márquez-Villarreal H, Seto WH, Simon A, Hennig TJ, Pittet D. Ten years of hand hygiene excellence: a summary of outcomes, and a comparison of indicators, from award-winning hospitals worldwide. Antimicrob Resist Infect Control 2024; 13:45. [PMID: 38637873 PMCID: PMC11027265 DOI: 10.1186/s13756-024-01399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Hand hygiene is a crucial measure for the prevention of healthcare-associated infections (HAIs). The Hand Hygiene Excellence Award (HHEA) is an international programme acknowledging healthcare facilities for their leadership in implementing hand hygiene improvement programmes, including the World Health Organisation's Multimodal Improvement Strategy. This study aimed at summarising the results of the HHEA campaign between 2010 and 2021 and investigating the relationship between different hand hygiene parameters based on data from participating healthcare facilities. METHODS A retrospective analysis was performed on datasets from HHEA forms, including data on hand hygiene compliance, alcohol-based handrub (ABHR) consumption, and Hand Hygiene Self-Assessment Framework (HHSAF) scores. Descriptive statistics were reported for each variable. The correlation between variables was inspected through Kendall's test, while possible non-linear relationships between hand hygiene compliance, ABHR consumption and HHSAF scores were sought through the Locally Estimated Scatterplot Smoothing or logistic regression models. A tree-structured partitioning model was developed to further confirm the obtained findings. RESULTS Ninety-seven healthcare facilities from 28 countries in three world regions (Asia-Pacific, Europe, Latin America) were awarded the HHEA and thus included in the analysis. HHSAF scores indicated an advanced hand hygiene promotion level (median 445 points, IQR 395-480). System change (100 [95-100] points) and institutional safety climate (85 [70-95] points) showed the highest and lowest score, respectively. In most cases, hand hygiene compliance was above 70%, with heterogeneity between countries. ABHR consumption above 20 millilitres per patient-day (ml/PD) was widely reported, with overall increasing trends. HHSAF scores were positively correlated with hand hygiene compliance (τ = 0.211, p = 0.007). We observed a positive correlation between compliance rates and ABHR consumption (τ = 0.193, p < 0.001), although the average predicted consumption was stable around 55-60 ml/PD for compliance rates above 80-85%. Logistic regression and partitioning tree analyses revealed that higher HHSAF scores were more likely in the high-ABHR consumption group at cut-offs around 57-59 ml/PD. CONCLUSION Ten years after its inception, the HHEA proves to be a valuable hand hygiene improvement programme in healthcare facilities worldwide. Consistent results were provided by the different hand hygiene indicators and the HHSAF score represents a valuable proxy measure of hand hygiene compliance.
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Affiliation(s)
- Ermira Tartari
- Faculty of Health Sciences, University of Malta, 2080, Msida, Malta.
- Infection Prevention and Control Unit, Department of Integrated Health Services, WHO Headquarters, Geneva, Switzerland.
| | - Jacopo Garlasco
- Infectious Diseases Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Moi Lin Ling
- Infection Prevention and Epidemiology, Singapore General HospitalSingapore, 169608, Singapore, Singapore
| | | | - Wing-Hong Seto
- School of Public Health, WHO Collaborating Centre, The University of Hong Kong, Hong Kong, China
| | - Anne Simon
- Infection Control and Prevention, CHU Helora, Haine-Saint-Paul, Belgium
| | | | - Didier Pittet
- Faculty of Medicine & Clean Hospitals, University of Geneva, Geneva, Switzerland
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4
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Wong HM, Mun CH, Loke WK, Lim WQ, Chee GWY, Tan SL, Teo JY, Yang YY, Tanoto H, Loh XJ, Lee CE, Tiang C, Wan WY, Cheong C, How KB, Ling ML, Tan BH. Moist heat as a promising method to decontaminate N95 masks: A large scale clinical study comparing four decontamination modalities-moist heat, steam, ultraviolet-C irradiation, and hydrogen peroxide plasma. Int J Infect Dis 2023; 136:151-157. [PMID: 37758170 DOI: 10.1016/j.ijid.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Early in the COVID-19 pandemic, there was a global shortage of masks. Although mask reprocessing was practiced, no clinical study has assessed systematically the impact of repeated cycles of wear and decontamination on the integrity of N95 filtering facepiece respirators (FFRs). METHODS We evaluated mask fit assessed by qualitative respirator fit test (QRFT) after each cycle of wear and decontamination, as well as four measures of mask integrity-bacterial filtration efficacy, particle filtration efficacy, differential pressure, and splash resistance through five cycles of wear and decontamination using one of the four modalities (moist heat, steam, ultraviolet-C irradiation, and hydrogen peroxide plasma). RESULTS A total of 60.6% (hydrogen peroxide plasma) to 77.5% (moist heat) of the FFRs passed five cycles of wear and decontamination, as assessed by the wearers passing QRFT all five times. Moist heat-decontaminated FFRs retained all technical measures of integrity through all five cycles. CONCLUSIONS This is the first large-scale study to assess systematically the impact (clinically and quantitatively) on N95 FFR integrity of repeated cycles of wearing followed by decontamination. Our results suggest that moist heat is a promising method for decontaminating N95 FFRs. Performing QRFT after every cycle of wear and decontamination ensures wearer safety. Although there is currently no mask shortage, reprocessing may reduce medical waste and improve sustainability.
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Affiliation(s)
- Hei Man Wong
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention & Epidemiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
| | | | | | | | | | | | - Jye Yng Teo
- Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Yi Yan Yang
- Institute of Bioengineering and Bioimaging, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Hendrix Tanoto
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Xian Jun Loh
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Chen Ee Lee
- Singapore Health Services Pte Ltd, Singapore
| | | | - Wei Yee Wan
- Duke-NUS Medical School, Singapore; Department of Microbiology, Singapore General Hospital, Singapore
| | - Charlene Cheong
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Kue Bien How
- Department of Infection Prevention & Epidemiology, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention & Epidemiology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore
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5
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Aravindhan A, Gan ATL, Lee EPX, Gupta P, Man R, Ho KC, Sung SC, Cheng CY, Ling ML, Tan HK, Wong TY, Fenwick EK, Lamoureux EL. Knowledge, attitudes and practices towards COVID-19 among multiethnic elderly Asian residents in Singapore: a mixed-methods study. Singapore Med J 2023; 64:657-666. [PMID: 34628802 PMCID: PMC10754368 DOI: 10.11622/smedj.2021152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Introduction We investigated the knowledge, attitudes and practice (KAP) towards coronavirus disease 2019 (COVID-19) and its related preventive measures in Singaporeans aged ≥60 years. Methods This was a population-based, cross-sectional, mixed-methods study (13 May 2020-9 June 2020) of participants aged ≥ 60 years. Self-reported KAP about ten symptoms and six government-endorsed preventive measures related to COVID-19 were evaluated. Multivariable regression models were used to identify sociodemographic and health-related factors associated with KAP in our sample. Associations between knowledge/attitude scores and practice categories were determined using logistic regression. Seventy-eight participants were interviewed qualitatively about the practice of additional preventive measures and data were analysed thematically. Results Mean awareness score of COVID-19 symptoms was 7.2/10. The most known symptom was fever (93.0%) and the least known was diarrhoea (33.5%). Most participants knew all six preventive measures (90.4%), perceived them as effective (78.7%) and practised 'wear a mask' (97.2%). Indians, Malays and participants living in smaller housing had poorer mean scores for knowledge of COVID-19 symptoms. Older participants had poorer attitudes towards preventive measures. Compared to Chinese, Indians had lower odds of practising three out of six recommendations. A one-point increase in score for knowledge and attitudes regarding preventive measures resulted in higher odds of always practising three of six and two of six measures, respectively. Qualitative interviews revealed use of other preventive measures, for example, maintaining a healthy lifestyle. Conclusions Elderly Singaporeans displayed high levels of KAP about COVID-19 and its related preventive measures, with a positive association between levels of knowledge/attitude and practice. However, important ethnic and socioeconomic disparities were evident, indicating that key vulnerabilities remain, which require immediate attention.
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Affiliation(s)
- Amudha Aravindhan
- Population Research and Clinical Epidemiology Platform, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Alfred Tau Liang Gan
- Population Research and Clinical Epidemiology Platform, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ester Pei Xuan Lee
- Population Research and Clinical Epidemiology Platform, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Preeti Gupta
- Population Research and Clinical Epidemiology Platform, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ryan Man
- Population Research and Clinical Epidemiology Platform, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Kam Chun Ho
- Population Research and Clinical Epidemiology Platform, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- University of New South Wales, Australia
- Eye Health, Injury Division, Eye Health Program, The George Institute for Global Health, Australia
| | - Sharon Cohan Sung
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore
| | - Ching-Yu Cheng
- Population Research and Clinical Epidemiology Platform, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Moi Lin Ling
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Hiang Khoon Tan
- Division of Surgery and Surgical Oncology, National Cancer Centre, Singapore
- Department of Head and Neck Surgery, Singapore General Hospital, Singapore
- Head and Neck Centre, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Tien Yin Wong
- Population Research and Clinical Epidemiology Platform, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Eva Katie Fenwick
- Population Research and Clinical Epidemiology Platform, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ecosse Luc Lamoureux
- Population Research and Clinical Epidemiology Platform, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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6
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Apisarnthanarak A, Ling ML, Weber DJ. The role of environmental and healthcare-associated infections in Asia: Lessons learned from the coronavirus disease 2019 (COVID-19) pandemic. Antimicrob Steward Healthc Epidemiol 2023; 3:e100. [PMID: 37396196 PMCID: PMC10311687 DOI: 10.1017/ash.2023.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Anucha Apisarnthanarak
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Moi Lin Ling
- Infection Prevention & Epidemiology, Singapore General Hospital, Outram Road, Singapore, Singapore
| | - David J. Weber
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
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Ling ML, Ching P, Apisarnthanarak A, Jaggi N, Harrington G, Fong SM. APSIC guide for prevention of catheter associated urinary tract infections (CAUTIs). Antimicrob Resist Infect Control 2023; 12:52. [PMID: 37254192 DOI: 10.1186/s13756-023-01254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 05/24/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The Asia Pacific Society of Infection Control launched the APSIC guide for prevention of catheter associated urinary tract infections in July 2022. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities in the Asia Pacific region to achieve high standards in infection prevention and control practices during the management and care of patients with a urinary catheter. METHODS The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. RESULTS It recommends that healthcare institutions have a catheter associated urinary tract infection prevention program that includes surveillance and the use of the insertion and maintenance bundles. Implementation of the bundles is best done using a quality improvement approach with a multidisciplinary team. CONCLUSIONS Healthcare facilities should aim for excellence in care of patients with urinary catheters. It is recommended that healthcare facilities have a catheter associated urinary tract infection prevention program as part of their Infection Prevention and Control program.
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Affiliation(s)
- Moi Lin Ling
- Infection Prevention and Epidemiology, Singapore General Hospital, Outram Road, Singapore, 169403, Singapore.
| | - P Ching
- The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | | | - N Jaggi
- Artemis Hospital, Gurgaon, India
| | - G Harrington
- Infection Control Consultancy, Melbourne, Australia
| | - S M Fong
- Sabah Women and Children's Hospital, Kota Kinabalu, Malaysia
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8
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Ling ML, Ching P, Cheng J, Lang L, Liberali S, Poon P, Shin Y, Sim C. APSIC dental infection prevention and control (IPC) guidelines. Antimicrob Resist Infect Control 2023; 12:53. [PMID: 37254208 DOI: 10.1186/s13756-023-01252-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 05/09/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The Asia Pacific Society of Infection Control launched the Infection Prevention and Control Guidelines in July 2022. This document describes the guidelines and recommendations for safe practices in dental setting. It aims to highlight practical recommendations in a concise format designed to assist dental facilities at Asia Pacific region in achieving high standards in infection prevention and control practices, staff and patient safety. METHOD The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published international guidelines and recommendations relevant to each section. RESULTS It recommends standard precautions as a minimal set of preventive measures to protect staff and prevent cross transmission. Surgical aseptic technique is recommended when procedures are technically complex and longer in duration. Only trained staff are eligible to conduct reprocessing of dental instruments. The design, layout of the dental facility are important factors for successful infection prevention. The facility should also have a Pandemic Preparedness Plan. CONCLUSIONS Dental facilities should aim for excellence in infection prevention and control practices as this is part of patient safety. The guidelines that come with a checklist help dental facilities to identify gaps for improvement to reach this goal.
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Affiliation(s)
- M L Ling
- Singapore General Hospital, Outram Road, Singapore, 169403, Singapore.
| | - P Ching
- The University of Hong Kong, Hong Kong, China
| | - J Cheng
- Taipei Medical University, Taipei, Taiwan
| | - L Lang
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - S Liberali
- University of Adelaide, Adelaide, Australia
| | - P Poon
- Department of Health, Hong Kong, China
| | - Y Shin
- Seoul National University, School of Dentistry, Seoul, South Korea
| | - C Sim
- National Dental Centre, Singapore, Singapore
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9
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Wee LE, Arora S, Ko KKK, Conceicao EP, Coleman KK, Tan KY, Tohid HB, Liu Q, Tung GLT, See SWJ, Suphavilai C, Ling ML, Venkatachalam I. Environmental contamination and evaluation of healthcare-associated SARS-CoV-2 transmission risk in temporary isolation wards during the COVID-19 pandemic. Am J Infect Control 2022; 51:413-419. [PMID: 37010998 PMCID: PMC9613445 DOI: 10.1016/j.ajic.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022]
Abstract
Background Temporary isolation wards have been introduced to meet demands for airborne-infection-isolation-rooms (AIIRs) during the COVID-19 pandemic. Environmental sampling and outbreak investigation was conducted in temporary isolation wards converted from general wards and/or prefabricated containers, in order to evaluate the ability of such temporary isolation wards to safely manage COVID-19 cases over a period of sustained use. Methods Environmental sampling for SARS-CoV-2 RNA was conducted in temporary isolation ward rooms constructed from pre-fabricated containers (N = 20) or converted from normal-pressure general wards (N = 47). Whole genome sequencing (WGS) was utilized to ascertain health care-associated transmission when clusters were reported amongst HCWs working in isolation areas from July 2020 to December 2021. Results A total of 355 environmental swabs were collected; 22.4% (15/67) of patients had at least one positive environmental sample. Patients housed in temporary isolation ward rooms constructed from pre-fabricated containers (adjusted-odds-ratio, aOR = 10.46, 95% CI = 3.89-58.91, P = .008) had greater odds of detectable environmental contamination, with positive environmental samples obtained from the toilet area (60.0%, 12/20) and patient equipment, including electronic devices used for patient communication (8/20, 40.0%). A single HCW cluster was reported amongst staff working in the temporary isolation ward constructed from pre-fabricated containers; however, health care-associated transmission was deemed unlikely based on WGS and/or epidemiological investigations. Conclusion Environmental contamination with SARS-CoV-2 RNA was observed in temporary isolation wards, particularly from the toilet area and smartphones used for patient communication. However, despite intensive surveillance, no healthcare-associated transmission was detected in temporary isolation wards over 18 months of prolonged usage, demonstrating their capacity for sustained use during succeeding pandemic waves.
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Affiliation(s)
- Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Shalvi Arora
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Karrie Kwan-Ki Ko
- Department of Molecular Pathology, Singapore General Hospital, Singapore; Department of Microbiology, Singapore General Hospital, Singapore; Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | | | - Kwee Yuen Tan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Hatijah Binti Tohid
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Qinnan Liu
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | | | - Shawn Wee Jin See
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Chayaporn Suphavilai
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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10
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Chanchareonsook N, Ling ML, Sim QX, Teoh KH, Tan K, Tan BH, Fong KY, Poon CY. Failure of sterilization in a dental outpatient facility: Investigation, risk assessment, and management. Medicine (Baltimore) 2022; 101:e29815. [PMID: 35945734 PMCID: PMC9351878 DOI: 10.1097/md.0000000000029815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In 2017, an incident of failed sterilization of dental instruments occurred at a large dental outpatient facility in Singapore. We aim to describe findings of the investigation of the sterilization breach incident, factors related to risk of viral transmission to the potentially affected patients, and the contact tracing process, patient management, and blood test results at a 6-month follow-up. A full assessment of the incident was immediately carried out. The factors related to risk of viral transmission due to affected instruments were analyzed using 3 keys points: breached step(s) and scale of the incident, prevalence of underlying bloodborne diseases and immunity in the Singapore population, health status of potential source patients, and type of dental procedure performed, and health status of affected patients and type of dental procedure received. Up to 72 affected instrument sets were used in 714 potentially affected patients who underwent noninvasive dental procedures. The investigation revealed that there was a lapse in the final step of steam sterilization, resulting in the use of incompletely sterilized items. The assessment determined that there was an extremely low risk of bloodborne virus transmission of diseases to the patients. At the 6-month follow-up, there were no infected/colonized cases found related to the incident. Lapses in the sterilization process for medical and dental instruments can happen, but a risk assessment approach is useful to manage similar incidents. Quick response and proper documentation of the sterilization process can prevent similar incidents.
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Affiliation(s)
- N Chanchareonsook
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - ML Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - QX Sim
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - KH Teoh
- Clinical and Regional Health, National Dental Centre Singapore, Singapore
| | - K Tan
- Clinical Governance and Quality Management, National Dental Centre Singapore, Singapore
| | - BH Tan
- Department of Infectious Disease, Singapore General Hospital, Singapore
| | | | - CY Poon
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
- National Dental Centre Singapore, Singapore
- *Correspondence: CY Poon, Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore 168938, Singapore. (e-mail: )
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11
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Oo AM, Jin PH, Philip E, How MKB, Aung MK, Lee LC, Arora S, venkatachalam I, Sim JXY, Ling ML, Yang Y. 775. Risk Factors for Healthcare Associated Central Line-Associated Bloodstream Infection (CLABSI) to Identify Novel Infection Prevention Areas - A Case-Control Study. Open Forum Infect Dis 2021. [PMCID: PMC8644340 DOI: 10.1093/ofid/ofab466.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The International Nosocomial Infection Control Consortium surveillance reported Central line-associated bloodstream infection (CLABSI) rate of 4.1 per 1000 central-line days in 703 ICUs in 50 countries. Methods At the Singapore General Hospital (SGH) a 1,700-bed tertiary care hospital, we conducted a retrospective matched case control study over a 3-year period from 2018 to 2020, to identify risk-factors associated with the development of healthcare associated CLABSI in adult inpatients. Cases and controls were patients ≥18 years of age with central lines in situ for at least 48hrs from date of admission. Case definition was based on National Healthcare Safety Network (NHSN) framework to diagnose Bloodstream Infection (BSI) and CLABSI events. Controls had to be admitted within 30 days of the date of admission of the case patients and should not have developed CLABSI. Cases were matched to controls on a 1:2 ratio. Results 127 cases and 252 controls were included in the analysis. Cases and controls did not differ in age, gender, BMI, presence of diabetes mellitus or presently enforced infection prevention measures (e.g. Central line bundle care). More cases were receiving chemotherapy (10.2% versus 0.8%, p< 0.001), were on TPN (17.3% versus 8.3%, p=0.015) and had been admitted to critical care (73.2% versus 60.7%, p=0.017). Cases were also more likely to have peripherally inserted central venous catheters (37% versus 25%, p=0.017) and have the insertion done in the radiology department under radiological guidance (69.3% versus 55.2%, p=0.011). The median length of stay (LOS) was 44 days (IQR: 0 – 86.8) for cases and 19 days (IQR: 0 - 66.6) for controls (p< 0.001). Inpatient mortality was 25.2% (n=32) for cases 13.9% (n=35) for controls (p-value < 0.010). In multivariate analysis, receiving chemotherapy (OR 11.1, 95%CI: 2.2 – 54.3, p=0.003), being admitted to intensive care unit (ICU) (OR 2.0, 95%CI: 1.1 – 3.8, p=0.019), having a Peripherally Inserted Central Cather (OR 1.8, 95% CI 1.0-3.4, p=0.045), and being colonized with MRSA (OR 1.9, 95%CI: 1.2 – 3.2, p=0.013) were associated with healthcare associated CLABSI. Conclusion Novel approaches are required to reduce risk of healthcare associated CLABSI, focusing on interventions for chemotherapy administration, care within ICUs and PICC lines. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Yong Yang
- Singapore General Hospital, Singapore
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12
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Teo JY, Kng J, Periaswamy B, Liu S, Lim P, Lee CE, Tan BH, Loh XJ, Ni X, Tiang D, Yi G, Ong YY, Ling ML, Wan WY, Wong HM, How M, Xin X, Zhang Y, Yang YY. Exploring Reusability of Disposable Face Masks: Effects of Disinfection Methods on Filtration Efficiency, Breathability, and Fluid Resistance. Glob Chall 2021; 5:2100030. [PMID: 34754506 PMCID: PMC8562064 DOI: 10.1002/gch2.202100030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/12/2021] [Indexed: 06/13/2023]
Abstract
To curb the spread of the COVID-19 virus, the use of face masks such as disposable surgical masks and N95 respirators is being encouraged and even enforced in some countries. The widespread use of masks has resulted in global shortages and individuals are reusing them. This calls for proper disinfection of the masks while retaining their protective capability. In this study, the killing efficiency of ultraviolet-C (UV-C) irradiation, dry heat, and steam sterilization against bacteria (Staphylococcus aureus), fungi (Candida albicans), and nonpathogenic virus (Salmonella virus P22) is investigated. UV-C irradiation for 10 min in a commercial UV sterilizer effectively disinfects surgical masks. N95 respirators require dry heat at 100 °C for hours while steam treatment works within 5 min. To address the question on safe reuse of the disinfected masks, their bacteria filtration efficiency, particle filtration efficiency, breathability, and fluid resistance are assessed. These performance factors are unaffected after 5 cycles of steam (10 min per cycle) and 10 cycles of dry heat at 100 °C (40 min per cycle) for N95 respirators, and 10 cycles of UV-C irradiation for surgical masks (10 min per side per cycle). These findings provide insights into formulating the standard procedures for reusing masks without compromising their protective ability.
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Affiliation(s)
- Jye Yng Teo
- Institute of Bioengineering and Bioimaging31 Biopolis Way, The Nanos #07‐01Singapore138669Singapore
| | - Jessica Kng
- Institute of Bioengineering and Bioimaging31 Biopolis Way, The Nanos #07‐01Singapore138669Singapore
| | - Balamurugan Periaswamy
- Institute of Bioengineering and Bioimaging31 Biopolis Way, The Nanos #07‐01Singapore138669Singapore
| | - Songlin Liu
- Institute of Materials Research and Engineering2 Fusionopolis Way, Innovis, #08‐03Singapore138634Singapore
| | - Poh‐Chong Lim
- Institute of Materials Research and Engineering2 Fusionopolis Way, Innovis, #08‐03Singapore138634Singapore
| | - Chen Ee Lee
- Singapore Health Services Pte Ltd10 Hospital Boulevard, Level 19 SingHealth TowerSingapore168582Singapore
| | - Ban Hock Tan
- Infectious DiseasesSingapore General HospitalOutram RoadSingapore169608Singapore
- Infection Prevention & EpidemiologySingapore General HospitalOutram RoadSingapore169608Singapore
| | - Xian Jun Loh
- Institute of Materials Research and Engineering2 Fusionopolis Way, Innovis, #08‐03Singapore138634Singapore
| | - Xiping Ni
- Institute of Materials Research and Engineering2 Fusionopolis Way, Innovis, #08‐03Singapore138634Singapore
| | - Daniel Tiang
- Singapore Health Services Pte Ltd10 Hospital Boulevard, Level 19 SingHealth TowerSingapore168582Singapore
| | - Guangshun Yi
- Institute of Bioengineering and Bioimaging31 Biopolis Way, The Nanos #07‐01Singapore138669Singapore
| | - Yee Yian Ong
- Singapore Health Services Pte Ltd10 Hospital Boulevard, Level 19 SingHealth TowerSingapore168582Singapore
| | - Moi Lin Ling
- Infection Prevention & EpidemiologySingapore General HospitalOutram RoadSingapore169608Singapore
| | - Wei Yee Wan
- Singapore Health Services Pte Ltd10 Hospital Boulevard, Level 19 SingHealth TowerSingapore168582Singapore
| | - Hei Man Wong
- Infectious DiseasesSingapore General HospitalOutram RoadSingapore169608Singapore
- Infection Prevention & EpidemiologySingapore General HospitalOutram RoadSingapore169608Singapore
| | - Molly How
- Singapore Health Services Pte Ltd10 Hospital Boulevard, Level 19 SingHealth TowerSingapore168582Singapore
| | - Xiaohui Xin
- Singapore Health Services Pte Ltd10 Hospital Boulevard, Level 19 SingHealth TowerSingapore168582Singapore
| | - Yugen Zhang
- Institute of Bioengineering and Bioimaging31 Biopolis Way, The Nanos #07‐01Singapore138669Singapore
| | - Yi Yan Yang
- Institute of Bioengineering and Bioimaging31 Biopolis Way, The Nanos #07‐01Singapore138669Singapore
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13
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Marimuthu K, Mo Y, Ling ML, Hernandez-Koutoucheva A, Fenlon SN, Bertrand D, Lye DC, Ang BSP, Perencevich E, Ng OT, Cooper BS, Nagarajan N, Chen SL, Barkham T. Household transmission of carbapenemase-producing Enterobacteriaceae: a prospective cohort study. J Antimicrob Chemother 2021; 76:1299-1302. [PMID: 33417711 DOI: 10.1093/jac/dkaa561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To estimate the transmission rate of carbapenemase-producing Enterobacteriaceae (CPE) in households with recently hospitalized CPE carriers. METHODS We conducted a prospective case-ascertained cohort study. We identified the presence of CPE in stool samples from index subjects, household contacts and companion animals and environmental samples at regular intervals. Linked transmissions were identified by WGS. A Markov model was constructed to estimate the household transmission potential of CPE. RESULTS Ten recently hospitalized index patients and 14 household contacts were included. There were seven households with one contact, two households with two contacts, and one household with three contacts. Index patients were colonized with blaOXA-48-like (n = 4), blaKPC-2 (n = 3), blaIMP (n = 2), and blaNDM-1 (n = 1), distributed among divergent species of Enterobacteriaceae. After a cumulative follow-up time of 9.0 years, three family members (21.4%, 3/14) acquired four different types of CPE in the community (hazard rate of 0.22/year). The probability of CPE transmission from an index patient to a household contact was 10% (95% CI 4%-26%). CONCLUSIONS We observed limited transmission of CPE from an index patient to household contacts. Larger studies are needed to understand the factors associated with household transmission of CPE and identify preventive strategies.
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Affiliation(s)
- Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yin Mo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Thailand.,Division of Infectious Diseases, National University Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | | | - Shannon N Fenlon
- Laboratory of Bacterial Genomics, Genome Institute of Singapore, Singapore
| | - Denis Bertrand
- Computational and Systems Biology, Genome Institute of Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Brenda Sze Peng Ang
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Department of Infection Prevention and Control, Tan Tock Seng Hospital, Singapore
| | - Eli Perencevich
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ben S Cooper
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Thailand.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Niranjan Nagarajan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Computational and Systems Biology, Genome Institute of Singapore, Singapore
| | - Swaine L Chen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Laboratory of Bacterial Genomics, Genome Institute of Singapore, Singapore
| | - Timothy Barkham
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
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14
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Exner M, Bhattacharya S, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Ling ML, Merkens W, Oltmanns P, Pitten F, Rotter M, Schmithausen RM, Sonntag HG, Steinhauer K, Trautmann M. Reply to the letter to the editor by R. Papke. GMS Hyg Infect Control 2021; 16:Doc23. [PMID: 34354902 PMCID: PMC8299058 DOI: 10.3205/dgkh000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Moi Lin Ling
- Infection Prevention & Control, Singapore General Hospital, Singapore
| | | | | | - Frank Pitten
- IKI - Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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15
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Venkatachalam I, Conceicao EP, Aung MK, How MKB, Wee LE, Sim JXY, Tan BH, Ling ML. Healthcare workers as a sentinel surveillance population in the early phase of the COVID-19 pandemic. Singapore Med J 2021; 63:577-584. [PMID: 34157807 DOI: 10.11622/smedj.2021083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Healthcare workers (HCWs) are a critical resource in the effort to control the COVID-19 pandemic. They are also a sentinel surveillance population whose clinical status reflects the effectiveness of the hospital's infection prevention measures in the pandemic. METHODS This was a retrospective cohort study conducted in Singapore General Hospital (SGH), a 1,822-bed tertiary hospital. Participants were all HCWs working in SGH during the study period. HCW protection measures included clinical workflows and personal protective equipment developed and adapted to minimise the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. HCW monitoring comprised staff contact logs in high-risk locations, twice-daily temperature monitoring, assessment of HCWs with acute respiratory illnesses (ARIs) in the staff clinic and, in the event of an exposure, extensive contact tracing, detailed risk assessment and risk-based interventions. HCW surveillance utilised monitoring data and ARI presentations and outcomes. RESULTS In the ten-week period between 6 January 2020 and 16 March 2020, 333 (17.1%) of 1,946 HCWs at risk of occupational COVID-19 presented with ARI. 32 (9.6%) screened negative for SARS-CoV-2 from throat swabs. Five other HCWs developed COVID-19 attributed to non-clinical exposures. From the nine COVID-19 exposure episodes investigated, 189 HCW contacts were identified, of whom 68 (36.2%) were placed on quarantine and remained well. CONCLUSION Early in an emerging infectious disease outbreak, close monitoring of frontline HCWs is essential in ascertaining the effectiveness of infection prevention measures. HCWs are at risk of community disease acquisition and should be monitored and managed to prevent onward transmission.
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Affiliation(s)
- Indumathi Venkatachalam
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Molly Kue Bien How
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Liang En Wee
- SingHealth Infectious Diseases Residency Programme, SingHealth, Singapore
| | - Jean Xiang Ying Sim
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Ban Hock Tan
- Department of Clinical Quality and Performance Management, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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16
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Wee LE, Venkatachalam I, Sim XYJ, Tan KBK, Wen R, Tham CK, Gan WH, Ko KKK, Ho WQ, Kwek GTC, Conceicao EP, Sng CYE, Ng XHJ, Ong JY, Chiang JL, Chua YY, Ling ML, Tan TT, Wijaya L. Containment of COVID-19 and reduction in healthcare-associated respiratory viral infections through a multi-tiered infection control strategy. Infect Dis Health 2021; 26:123-131. [PMID: 33386294 PMCID: PMC7667403 DOI: 10.1016/j.idh.2020.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND During the ongoing COVID-19 pandemic, healthcare-associated transmission of respiratory viral infections (RVI) is a concern. To reduce the impact of SARS-CoV-2 and other respiratory viruses on patients and healthcare workers (HCWs) we devised and evaluated a multi-tiered infection control strategy with the goal of preventing nosocomial transmission of SARS-CoV2 and other RVIs across a large healthcare campus. METHODS From January-June 2020, a multi-tiered infection control strategy was implemented across a healthcare campus in Singapore, comprising the largest acute tertiary hospital as well as four other subspecialty centres, with more than 10,000 HCWs. Drawing on our institution's experience with an outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003, this strategy included improved patient segregation and distancing, and heightened infection prevention and control (IPC) measures including universal masking. All symptomatic patients were tested for COVID-19 and common RVIs. RESULTS A total of 16,162 admissions campus-wide were screened; 7.1% (1155/16,162) tested positive for COVID-19. Less than 5% of COVID-19 cases (39/1155) were initially detected outside of isolation wards in multi-bedded cohorted wards. Improved distancing and enhanced IPC measures successfully mitigated onward spread even amongst COVID-19 cases detected outside of isolation. COVID-19 rates amongst HCWs were kept low (0.13%, 17/13,066) and reflected community acquisition rather than nosocomial spread. Rates of healthcare-associated-RVI amongst inpatients fell to zero and this decrease was sustained even after the lifting of visitor restrictions. CONCLUSION This multi-tiered infection control strategies can be implemented at-scale to successfully mitigate healthcare-associated transmission of respiratory viral pathogens.
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Affiliation(s)
- Liang En Wee
- Singhealth Infectious Diseases Residency, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Xiang Ying Jean Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | | | - Ruan Wen
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Chee Kian Tham
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Wee Hoe Gan
- Department of Occupational and Environmental Medicine, Singapore General Hospital, Singapore
| | - Kwan Ki Karrie Ko
- Molecular Laboratory, Department of Pathology, Singapore General Hospital, Singapore
| | - Wan Qi Ho
- Division of Medicine, Singapore General Hospital, Singapore
| | | | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Chong Yu Edwin Sng
- Singhealth Infectious Diseases Residency, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Xin Hui Jorin Ng
- Division of Preparedness and Response, Singapore General Hospital, Singapore
| | - Jie Yi Ong
- Division of Preparedness and Response, Singapore General Hospital, Singapore
| | - Juat Lan Chiang
- Division of Nursing, Singapore General Hospital, Singapore; Department of Facilities and Infrastructure Development, Singapore General Hospital, Singapore
| | - Ying Ying Chua
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Singapore
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17
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Hong F, Salmon S, Ong XY, Liew K, Koh Y, Young A, Ang B, Foo ML, Lee LC, Ling ML, Marimuthu K, Pada S, Poh BF, Thoon KC, Fisher D. Routine antiseptic baths and MRSA decolonization: diverse approaches across Singapore's acute-care hospitals. J Hosp Infect 2021; 112:87-91. [PMID: 33812940 DOI: 10.1016/j.jhin.2021.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
To determine the variation in practices on meticillin-resistant Staphylococcus aureus (MRSA) surveillance and management of MRSA-colonized patients amongst 17 acute healthcare facilities in Singapore, the Ministry of Health convened a sharing session with Infection Prevention and Control Leads. All hospitals practised close to universal MRSA entry swabbing in keeping with national policy. There were, however, major variations in the response to both positive and negative surveillance swabs across facilities including the role of routine antiseptic bathing and MRSA decolonization. Most undertaking decolonization considered its role to be in 'bioburden reduction' rather than longer-term clearance.
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Affiliation(s)
- F Hong
- Ministry of Health, Singapore
| | - S Salmon
- University of New South Wales, School of Population Health, UNSW Medicine, Australia; Indo-Pacific Centre for Health Security, Department of Foreign Affairs and Trade, Australia
| | - X Y Ong
- Ministry of Health, Singapore
| | - K Liew
- Ministry of Health, Singapore
| | - Y Koh
- Ministry of Health, Singapore
| | - A Young
- Ministry of Health, Singapore
| | - B Ang
- Infectious Diseases, Tan Tock Seng Hospital, Singapore; Infection Prevention and Control, Tan Tock Seng Hospital, Singapore
| | - M L Foo
- Infection Control, Khoo Teck Puat Hospital, Singapore
| | - L C Lee
- Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - M L Ling
- Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - K Marimuthu
- Infectious Diseases, National Centre of Infectious Diseases, Singapore
| | - S Pada
- Infectious Diseases, Ng Teng Fong General Hospital, Singapore
| | - B F Poh
- Infection Prevention and Control, Tan Tock Seng Hospital, Singapore
| | - K C Thoon
- Infectious Diseases, KK Women's and Children's Hospital, Singapore
| | - D Fisher
- Division of Infectious Diseases, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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18
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Morikane K, Russo PL, Lee KY, Chakravarthy M, Ling ML, Saguil E, Spencer M, Danker W, Seno A, Charles EE. Expert commentary on the challenges and opportunities for surgical site infection prevention through implementation of evidence-based guidelines in the Asia-Pacific Region. Antimicrob Resist Infect Control 2021; 10:65. [PMID: 33795007 PMCID: PMC8017777 DOI: 10.1186/s13756-021-00916-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Surgical site infections (SSIs) are a significant source of morbidity and mortality in the Asia-Pacific region (APAC), adversely impacting patient quality of life, fiscal productivity and placing a major economic burden on the country's healthcare system. This commentary reports the findings of a two-day meeting that was held in Singapore on July 30-31, 2019, where a series of consensus recommendations were developed by an expert panel composed of infection control, surgical and quality experts from APAC nations in an effort to develop an evidence-based pathway to improving surgical patient outcomes in APAC. METHODS The expert panel conducted a literature review targeting four sentinel areas within the APAC region: national and societal guidelines, implementation strategies, postoperative surveillance and clinical outcomes. The panel formulated a series of key questions regarding APAC-specific challenges and opportunities for SSI prevention. RESULTS The expert panel identified several challenges for mitigating SSIs in APAC; (a) constraints on human resources, (b) lack of adequate policies and procedures, (c) lack of a strong safety culture, (d) limitation in funding resources, (e) environmental and geographic challenges, (f) cultural diversity, (g) poor patient awareness and (h) limitation in self-responsibility. Corrective strategies for guideline implementation in APAC were proposed that included: (a) institutional ownership of infection prevention strategies, (b) perform baseline assessments, (c) review evidence-based practices within the local context, (d) develop a plan for guideline implementation, (e) assess outcome and stakeholder feedback, and (f) ensure long-term sustainability. CONCLUSIONS Reducing the risk of SSIs in APAC region will require: (a) ongoing consultation and collaboration among stakeholders with a high level of clinical staff engagement and (b) a strong institutional and national commitment to alleviate the burden of SSIs by embracing a safety culture and accountability.
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Affiliation(s)
- K Morikane
- Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan
| | - P L Russo
- School of Nursing and Midwifery, Monash University, Frankston, VC, Australia
| | - K Y Lee
- Department of Surgery, KyungHee University Medical Center, Seoul, South Korea
| | | | - M L Ling
- Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - E Saguil
- Philippine General Hospital, Manila, Philippines
| | - M Spencer
- Infection Prevention Consultant, Boston, MA, USA
| | - W Danker
- Ethicon, Johnson and Johnson Medical Device Companies, Somerville, NJ, USA
| | - A Seno
- Johnson and Johnson Medical Asia Pacific, Singapore, Singapore
| | - E Edmiston Charles
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
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19
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Wee LEI, Conceicao EP, Tan JY, Magesparan KD, Amin IBM, Ismail BBS, Toh HX, Jin P, Zhang J, Wee EGL, Ong SJM, Lee GLX, Wang AEM, How MKB, Tan KY, Lee LC, Phoon PC, Yang Y, Aung MK, Sim XYJ, Venkatachalam I, Ling ML. Unintended consequences of infection prevention and control measures during COVID-19 pandemic. Am J Infect Control 2021; 49:469-477. [PMID: 33157180 PMCID: PMC7610096 DOI: 10.1016/j.ajic.2020.10.019] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND In the current COVID-19 pandemic, aggressive Infection Prevention and Control (IPC) measures have been adopted to prevent health care-associated transmission of COVID-19. We evaluated the impact of a multimodal IPC strategy originally designed for the containment of COVID-19 on the rates of other hospital-acquired-infections (HAIs). METHODOLOGY From February-August 2020, a multimodal IPC strategy was implemented across a large health care campus in Singapore, comprising improved segregation of patients with respiratory symptoms, universal masking and heightened adherence to Standard Precautions. The following rates of HAI were compared pre- and postpandemic: health care-associated respiratory-viral-infection (HA-RVI), methicillin-resistant Staphylococcus aureus, and CP-CRE acquisition rates, health care-facility-associated C difficile infections and device-associated HAIs. RESULTS Enhanced IPC measures introduced to contain COVID-19 had the unintended positive consequence of containing HA-RVI. The cumulative incidence of HA-RVI decreased from 9.69 cases per 10,000 patient-days to 0.83 cases per 10,000 patient-days (incidence-rate-ratio = 0.08; 95% confidence interval [CI] = 0.05-0.13, P< .05). Hospital-wide MRSA acquisition rates declined significantly during the pandemic (incidence-rate-ratio = 0.54, 95% CI = 0.46-0.64, P< .05), together with central-line-associated-bloodstream infection rates (incidence-rate-ratio = 0.24, 95% CI = 0.07-0.57, P< .05); likely due to increased compliance with Standard Precautions. Despite the disruption caused by the pandemic, there was no increase in CP-CRE acquisition, and rates of other HAIs remained stable. CONCLUSIONS Multimodal IPC strategies can be implemented at scale to successfully mitigate health care-associated transmission of RVIs. Good adherence to personal-protective-equipment and hand hygiene kept other HAI rates stable even during an ongoing pandemic where respiratory infections were prioritized for interventions.
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Affiliation(s)
- Liang En Ian Wee
- Singhealth Infectious Diseases Residency, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Jing Yuan Tan
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Kamini Devi Magesparan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | | | | | - Hui Xian Toh
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Pinhong Jin
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Jing Zhang
- Department of Nursing Speciality Care Unit, National Heart Centre, Singapore
| | - Elaine Geok Ling Wee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Sheena Jin Min Ong
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Gillian Li Xin Lee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Amanda En-Min Wang
- Department of Nursing Speciality Care Unit, National Heart Centre, Singapore
| | - Molly Kue Bien How
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Kwee Yuen Tan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Lai Chee Lee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Poh Choo Phoon
- Department of Nursing Speciality Care Unit, National Heart Centre, Singapore
| | - Yong Yang
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Xiang Ying Jean Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore.
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20
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Exner M, Bhattacharya S, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Ling ML, Merkens W, Oltmanns P, Pitten F, Rotter M, Schmithausen RM, Sonntag HG, Steinhauer K, Trautmann M. Chemical disinfection in healthcare settings: critical aspects for the development of global strategies. GMS Hyg Infect Control 2020; 15:Doc36. [PMID: 33520601 PMCID: PMC7818848 DOI: 10.3205/dgkh000371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chemical disinfection is an indispensable means of preventing infection. This holds true for healthcare settings, but also for all other settings where transmission of pathogens poses a potential health risk to humans and/or animals. Research on how to ensure effectiveness of disinfectants and the process of disinfection, as well as on when, how and where to implement disinfection precautions is an ongoing challenge requiring an interdisciplinary team effort. The valuable resources of active substances used for disinfection must be used wisely and their interaction with the target organisms and the environment should be evaluated and monitored closely, if we are to reliable reap the benefits of disinfection in future generations. In view of the global threat of communicable diseases and emerging and re-emerging pathogens and multidrug-resistant pathogens, the relevance of chemical disinfection is continually increasing. Although this consensus paper pinpoints crucial aspects for strategies of chemical disinfection in terms of the properties of disinfectant agents and disinfection practices in a particularly vulnerable group and setting, i.e., patients in healthcare settings, it takes a comprehensive, holistic approach to do justice to the complexity of the topic of disinfection.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Moi Lin Ling
- Infection Prevention & Control, Singapore General Hospital, Singapore
| | | | | | - Frank Pitten
- IKI – Institut für Krankenhaushygiene & Infektionskontrolle GmbH, Gießen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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21
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Seneviratne CJ, Balan P, Ko KKK, Udawatte NS, Lai D, Ng DHL, Venkatachalam I, Lim KS, Ling ML, Oon L, Goh BT, Sim XYJ. Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: randomized control trial in Singapore. Infection 2020; 49:305-311. [PMID: 33315181 PMCID: PMC7734110 DOI: 10.1007/s15010-020-01563-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/24/2020] [Indexed: 12/16/2022]
Abstract
Purpose One of the key approaches to minimize the risk of COVID-19 transmission would be to reduce the titres of SARS-CoV-2 in the saliva of infected COVID-19 patients. This is particularly important in high-risk procedures like dental treatment. The present randomized control trial evaluated the efficacy of three commercial mouth-rinse viz. povidone–iodine (PI), chlorhexidine gluconate (CHX) and cetylpyridinium chloride (CPC), in reducing the salivary SARS-CoV-2 viral load in COVID-19 patients compared with water. Methods A total of 36 SARS-CoV-2-positive patients were recruited, of which 16 patients were randomly assigned to four groups—PI group (n = 4), CHX group (n = 6), CPC group (n = 4) and water as control group (n = 2). Saliva samples were collected from all patients at baseline and at 5 min, 3 h and 6 h post-application of mouth-rinses/water. The samples were subjected to SARS-CoV-2 RT-PCR analysis. Results Comparison of salivary Ct values of patients within each group of PI, CHX, CPC and water at 5 min, 3 h and 6 h time points did not show any significant differences. However, when the Ct value fold change of each of the mouth-rinse group patients were compared with the fold change of water group patients at the respective time points, a significant increase was observed in the CPC group patients at 5 min and 6 h and in the PI group patients at 6 h. Conclusion The effect of decreasing salivary load with CPC and PI mouth-rinsing was observed to be sustained at 6 h time point. Within the limitation of the current study, as number of the samples analyzed, the use of CPC and PI formulated that commercial mouth-rinses may be useful as a pre-procedural rinse to help reduce the transmission of COVID-19. ISRCTN (ISRCTN95933274), 09/09/20, retrospectively registered
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Affiliation(s)
- Chaminda J Seneviratne
- Singapore Oral Microbiomics Initiative, National Dental Research Institute Singapore (NDRIS), National Dental Centre Singapore, SingHealth, Singapore, Singapore. .,Duke NUS Medical School, Oral Health ACP, Singapore, Singapore.
| | - Preethi Balan
- Singapore Oral Microbiomics Initiative, National Dental Research Institute Singapore (NDRIS), National Dental Centre Singapore, SingHealth, Singapore, Singapore.,Duke NUS Medical School, Oral Health ACP, Singapore, Singapore
| | - Kwan Ki Karrie Ko
- Department of Microbiology, Singapore General Hospital, SingHealth, Singapore, Singapore
| | - Nadeeka S Udawatte
- Singapore Oral Microbiomics Initiative, National Dental Research Institute Singapore (NDRIS), National Dental Centre Singapore, SingHealth, Singapore, Singapore
| | - Deborah Lai
- Department of Microbiology, Singapore General Hospital, SingHealth, Singapore, Singapore
| | - Dorothy Hui Lin Ng
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | | | - Kheng Sit Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Lynette Oon
- Department of Microbiology, Singapore General Hospital, SingHealth, Singapore, Singapore
| | - Bee Tin Goh
- Singapore Oral Microbiomics Initiative, National Dental Research Institute Singapore (NDRIS), National Dental Centre Singapore, SingHealth, Singapore, Singapore.,Duke NUS Medical School, Oral Health ACP, Singapore, Singapore
| | - Xiang Ying Jean Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
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22
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Wee LE, Cherng BPZ, Conceicao EP, Goh KCM, Wan WY, Ko KKK, Aung MK, Sim XYJ, Wijaya L, Ling ML, Venkatachalam I. Experience of a Tertiary Hospital in Singapore with Management of a Dual Outbreak of COVID-19 and Dengue. Am J Trop Med Hyg 2020; 103:2005-2011. [PMID: 32996452 PMCID: PMC7646785 DOI: 10.4269/ajtmh.20-0703] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
During the COVID-19 pandemic, distinguishing dengue from cases of COVID-19 in endemic areas can be difficult. In a tertiary hospital contending with COVID-19 during a dengue epidemic, a triage strategy of routine COVID-19 testing for febrile patients with viral prodromes was used. All febrile patients with viral prodromes and no epidemiologic risk for COVID-19 were first admitted to a designated ward for COVID-19 testing, where enhanced personal protective equipment was used by healthcare workers until COVID-19 was ruled out. From January to May 2020, 11,086 admissions were screened for COVID-19; 868 cases of COVID-19 were diagnosed in our institution, along with 380 cases of dengue. Only 8.5% (943/11,086) of suspected COVID-19 cases were concurrently tested for dengue serology due to a compatible overlapping clinical syndrome, and dengue was established as an alternative diagnosis in 2% (207/10,218) of suspected COVID-19 cases that tested negative. There were eight COVID-19 cases with likely false-positive dengue serology and one probable COVID-19/dengue coinfection. From April to May 2020, 251 admissions presenting as viral prodromes with no respiratory symptoms were screened; of those, 15 cases had COVID-19, and 2/15 had false-positive dengue IgM. Epidemiology investigations showed no healthcare-associated transmission. In a dengue epidemic season coinciding with a COVID-19 pandemic, dengue was established as an alternative diagnosis in a minority of COVID-19 suspects, likely due to early availability of basic diagnostics. Routine screening of patients with viral prodromes during a dual outbreak of COVID-19 and dengue enabled containment of COVID-19 cases masquerading as dengue with false-positive IgM.
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Affiliation(s)
- Liang En Wee
- Singhealth Infectious Diseases Residency, Singapore, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | | | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | | | - Wei Yee Wan
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Kwan Ki Karrie Ko
- Department of Molecular Pathology, Singapore General Hospital, Singapore, Singapore.,Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Xiang Ying Jean Sim
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Indumathi Venkatachalam
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
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23
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Wee LE, Conceicao EP, Tan JY, Venkatachalam I, Ling ML. Zero healthcare-associated respiratory viral infections amongst haematology inpatients: unexpected consequence of heightened infection control during COVID-19 outbreak. J Hosp Infect 2020; 107:S0195-6701(20)30492-8. [PMID: 34756843 PMCID: PMC7580702 DOI: 10.1016/j.jhin.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Liang En Wee
- Singhealth Infectious Diseases Residency, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Jing Yuan Tan
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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24
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Tan JY, Sim XYJ, Wee LE, Chua YY, Cherng BPZ, Ng IM, Conceicao EP, Wong TJ, Yang Y, Aung MK, Ling ML, Venkatachalam I. A comparative study on the clinical features of COVID-19 with non-SARS-CoV-2 respiratory viral infections. J Med Virol 2020; 93:1548-1555. [PMID: 32881022 DOI: 10.1002/jmv.26486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/14/2020] [Accepted: 08/30/2020] [Indexed: 01/05/2023]
Abstract
During this coronavirus disease 2019 (COVID-19) pandemic, physicians have the important task of risk stratifying patients who present with acute respiratory illnesses. Clinical presentation of COVID-19, however, can be difficult to distinguish from other respiratory viral infections. Thus, identifying clinical features that are strongly associated with COVID-19 in comparison to other respiratory viruses can aid risk stratification and testing prioritization especially in situations where resources for virological testing and resources for isolation facilities are limited. In our retrospective cohort study comparing the clinical presentation of COVID-19 and other respiratory viral infections, we found that anosmia and dysgeusia were symptoms independently associated with COVID-19 and can be important differentiating symptoms in patients presenting with acute respiratory illness. On the other hand, laboratory abnormalities and radiological findings were not statistically different between the two groups. In comparing outcomes, patients with COVID-19 were more likely to need high dependency or intensive care unit care and had a longer median length of stay. With our findings, we emphasize that epidemiological risk factors and clinical symptoms are more useful than laboratory and radiological abnormalities in differentiating COVID-19 from other respiratory viral infections.
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Affiliation(s)
- Jing Yuan Tan
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Xiang Ying Jean Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Ying-Ying Chua
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | | | - Ian Matthias Ng
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Edwin Philip Conceicao
- Department of Internal Medicine, Singapore General Hospital, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Tzu-Jung Wong
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
| | - Yong Yang
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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25
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Wee LE, Sim JXY, Conceicao EP, Aung MK, Ng IM, Ling ML. Re: 'Personal protective equipment protecting healthcare workers in the Chinese epicenter of COVID-19' by Zhao et al. Clin Microbiol Infect 2020; 26:1719-1721. [PMID: 32898713 PMCID: PMC7474831 DOI: 10.1016/j.cmi.2020.08.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Liang En Wee
- Singhealth Infectious Diseases Residency, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Jean Xiang Ying Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Ian Mathias Ng
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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26
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Mo Y, Hernandez-Koutoucheva A, Musicha P, Bertrand D, Lye D, Ng OT, Fenlon SN, Chen SL, Ling ML, Tang WY, Barkham T, Nagarajan N, Cooper BS, Marimuthu K. Duration of Carbapenemase-Producing Enterobacteriaceae Carriage in Hospital Patients. Emerg Infect Dis 2020; 26:2182-2185. [PMID: 32818397 PMCID: PMC7454053 DOI: 10.3201/eid2609.190592] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine the duration of carbapenemase-producing Enterobacteriaceae (CPE) carriage, we studied 21 CPE carriers for »1 year. Mean carriage duration was 86 days; probability of decolonization in 1 year was 98.5%, suggesting that CPE-carriers' status can be reviewed yearly. Prolonged carriage was associated with use of antimicrobial drugs.
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27
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Wee LE, Sim XYJ, Conceicao EP, Aung MK, Wong HM, Teh YE, Tan KY, Wijaya L, Tan TBH, Ling ML, Venkatachalam I. Early Recognition of Coronavirus 2019 Disease (COVID-19) Infection in Surgical Inpatients: The Importance of a Risk-Stratified Approach for Early Testing and Isolation. Surg Infect (Larchmt) 2020; 21:760-765. [PMID: 32716758 DOI: 10.1089/sur.2020.184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: In the ongoing coronavirus disease 2019 (COVID-19) pandemic, resuming provision of surgical services poses a challenge given that patients may have acute surgical pathologies with concurrent COVID-19 infection. We utilized a risk-stratified approach to allow for early recognition and isolation of potential COVID-19 infection in surgical patients, ensuring continuity of surgical services during a COVID-19 outbreak. Patients and Methods: Over a four-month period from January to April 2020, surgical patients admitted with concurrent respiratory symptom, infiltrates on chest imaging, or suspicious travel/epidemiologic history were placed in a dedicated ward in which they were tested for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). If emergency operations were necessary prior to the exclusion of COVID-19, patients were managed as per suspected cases of COVID-19, with appropriate precautions and full personal protective equipment (PPE). Results: From January through April 2020, a total of 8,437 patients were admitted to our surgical department; 5.9% (498/8437) required peri-operative testing for SARS-CoV-2. Because testing was in-house with turnaround within 24 hours, only a small number of emergency operations (n = 10) were conducted for suspected COVID-19 cases prior to results; none tested positive. The testing yield was lower in surgical inpatients compared with medical inpatients (odds ratio [OR] = 0.20, 95% confidence interval [CI], 0.12-0.32, p < 0.001). Three operations were conducted in known COVID-19 cases; all healthcare workers (HCWs) used full PPE. A risk-stratified testing strategy picked up previously unsuspected COVID-19 in six cases; 66.7% (4/6) were asymptomatic at presentation. Although 48 HCWs were exposed to these six cases, delayed diagnosis was averted and no evidence of spread to patients or HCWs was detected. Conclusion: A risk-stratified approach allowed for early recognition, testing, and isolation of potential COVID-19 infection in surgical patients, ensuring continuity of surgical services.
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Affiliation(s)
- Liang En Wee
- Singhealth Infectious Diseases Residency, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Xiang Ying Jean Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Hei Man Wong
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Yii Ean Teh
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Kwee Yuen Tan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Tan Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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28
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Wee LE, Sim XYJ, Conceicao EP, Aung MK, Goh JQ, Yeo DWT, Gan WH, Chua YY, Wijaya L, Tan TT, Tan BH, Ling ML, Venkatachalam I. Containment of COVID-19 cases among healthcare workers: The role of surveillance, early detection, and outbreak management. Infect Control Hosp Epidemiol 2020; 41:765-771. [PMID: 32391746 PMCID: PMC7248595 DOI: 10.1017/ice.2020.219] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Staff surveillance is crucial during the containment phase of a pandemic to help reduce potential healthcare-associated transmission and sustain good staff morale. During an outbreak of SARS-COV-2 with community transmission, our institution used an integrated strategy for early detection and containment of COVID-19 cases among healthcare workers (HCWs). METHODS Our strategy comprised 3 key components: (1) enforcing reporting of HCWs with acute respiratory illness (ARI) to our institution's staff clinic for monitoring; (2) conducting ongoing syndromic surveillance to obtain early warning of potential clusters of COVID-19; and (3) outbreak investigation and management. RESULTS Over a 16-week surveillance period, we detected 14 cases of COVID-19 among HCWs with ARI symptoms. Two of the cases were linked epidemiologically and thus constituted a COVID-19 cluster with intrahospital HCW-HCW transmission; we also detected 1 family cluster and 2 clusters among HCWs who shared accommodation. No transmission to HCWs or patients was detected after containment measures were instituted. Early detection minimized the number of HCWs requiring quarantine, hence preserving continuity of service during an ongoing pandemic. CONCLUSIONS An integrated surveillance strategy, outbreak management, and encouraging individual responsibility were successful in early detection of clusters of COVID-19 among HCWs. With ongoing local transmission, vigilance must be maintained for intrahospital spread in nonclinical areas where social mingling of HCWs occurs. Because most individuals with COVID-19 have mild symptoms, addressing presenteeism is crucial to minimize potential staff and patient exposure.
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Affiliation(s)
- Liang En Wee
- Singhealth Infectious Diseases Residency, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Xiang Ying Jean Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Jia Qing Goh
- Department of Clinical Quality and Performance Management, Singapore General Hospital, Singapore
| | - Dennis Wu Ting Yeo
- Department of Clinical Quality and Performance Management, Singapore General Hospital, Singapore
| | - Wee Hoe Gan
- Department of Occupational and Environmental Medicine, Singapore General Hospital, Singapore
| | - Ying Ying Chua
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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Wee LEI, Thien SY, Singh SR, Ling ML, Venkatachalam I. Containing COVID-19 in a specialised neurology centre: the risks of presymptomatic transmission. Neurol Sci 2020; 41:2013-2015. [PMID: 32594267 PMCID: PMC7320247 DOI: 10.1007/s10072-020-04548-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/21/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Liang En Ian Wee
- Singhealth Infectious Diseases Residency, Singapore, Singapore. .,Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
| | - Siew Yee Thien
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | | | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
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Chia SZG, How KBM, Chlebicki MP, Ling ML, Gan WH. A retrospective review of tuberculosis exposure among health care workers in a tertiary hospital. Am J Infect Control 2020; 48:650-655. [PMID: 31806237 PMCID: PMC7132713 DOI: 10.1016/j.ajic.2019.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/26/2022]
Abstract
he baseline prevalence of Latent Tuberculosis Infection (LTBI) among Healthcare workers screened for Tuberculosis exposure was 14.6%. Age above 40 years, non-Chinese ethnicity, and foreign nationality were associated with baseline LTBI. Only 2.5% of all healthcare workers screened for tuberculosis exposure experienced QFT-GIT conversion resulting in an incidence rate of 1.14 cases per 100 exposure episodes per year. Healthcare workers with more episodes of TB exposure are also more likely to develop post exposure LTBI.
Background We evaluated tuberculosis (TB) acquisition rate and risk factors among health care workers (HCWs) exposed to index TB patients. Methods We performed a retrospective cohort study on exposed HCWs from August 2016 to January 2018 at a tertiary hospital in Singapore. Demographic factors and TB exposure episodes per HCW were obtained. A modified Poisson regression model was used to identify factors associated with TB infection. Results A total of 32 TB exposure events occurred during the study period. A total of 881 HCWs with 1,536 exposure episodes were screened with QuantiFERON-TB Gold In-tube assay (QFT-GIT) at baseline and 8 weeks. A total of 129 (14.6%) HCWs had positive QFT-TB at baseline, whereas 22 (2.5%) HCWs had QFT-GIT conversion, with a latent TB infection (LTBI) rate of 1.14 cases per 100 exposure episodes per year. Foreign nationality, non-Chinese ethnicity, and age above 40 years were independently associated with baseline LTBI, whereas having >2 TB exposure episodes and working in internal medicine, medical subspecialties, and psychiatry wards were associated with QFT-GIT conversion. Discussion The QFT-GIT conversion rate among screened HCWs is low. Foreign HCWs with LTBI likely came from countries with higher TB transmission. Targeted prevention of repeated TB exposures can reduce QFT-GIT conversion. Conclusions The study results will guide TB contact tracing protocols in health care institutions.
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Affiliation(s)
- Shi Zhe Gabriel Chia
- Occupational and Environmental Medicine Department, Singapore General Hospital, Bukit Merah, Singapore.
| | - Kue Bien Molly How
- Occupational and Environmental Medicine Department, Singapore General Hospital, Bukit Merah, Singapore
| | - Maciej Piotr Chlebicki
- Occupational and Environmental Medicine Department, Singapore General Hospital, Bukit Merah, Singapore
| | - Moi Lin Ling
- Occupational and Environmental Medicine Department, Singapore General Hospital, Bukit Merah, Singapore
| | - Wee Hoe Gan
- Occupational and Environmental Medicine Department, Singapore General Hospital, Bukit Merah, Singapore
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Too CW, Wen DW, Patel A, Abdul Syafiq AR, Liu J, Leong S, Gogna A, Lo RHG, Tashi S, Lee KA, Kumar P, Lie SA, Tay YC, Lee LC, Ling ML, Tan BS, Tay KH. Interventional Radiology Procedures for COVID-19 Patients: How we Do it. Cardiovasc Intervent Radiol 2020; 43:827-836. [PMID: 32342154 PMCID: PMC7184805 DOI: 10.1007/s00270-020-02483-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022]
Abstract
With astonishing speed, COVID-19 has become a global pandemic. As it is uncertain when the pandemic will be controlled, it is crucial for procedurists of all stripes to be familiar and confident in performing procedures for COVID-19 patients to prevent intra-hospital infection. In this article, we will detail our approach on how to perform interventional procedures for COVID-19 patients at the bedside in the isolation room and with the patient transferred to the interventional radiology centre. These workflows have been developed in conjunction with multiple other stakeholders within our hospital, drawing from valuable lessons we have learnt from the SARS outbreak of 2003.
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Affiliation(s)
- Chow Wei Too
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore.
| | - David Wei Wen
- Department of Diagnostic Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Ankur Patel
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Abdul Rahman Abdul Syafiq
- Radiography Department, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Jian Liu
- Department of Diagnostic Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Sum Leong
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Apoorva Gogna
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Richard Hoau Gong Lo
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Sonam Tashi
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Kristen Alexa Lee
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Pradesh Kumar
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Sui An Lie
- Department of Surgical Intensive Care, Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Yoong Chuan Tay
- Department of Pain Medicine, Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Lai Chee Lee
- Infection Prevention and Epidemiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Moi Lin Ling
- Infection Prevention and Epidemiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Bien Soo Tan
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
| | - Kiang Hiong Tay
- Department of Vascular and Interventional Radiology, Division of Radiological Sciences Singapore General Hospital, Radiological Sciences Academic Clinical Program, Singhealth-Duke-NUS Academic Medical Centre, Outram Road, Singapore, 169608, Singapore
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Leong XYA, Chong SY, Koh SEA, Yeo BC, Tan KY, Ling ML. Healthcare workers' beliefs, attitudes and compliance with mobile phone hygiene in a main operating theatre complex. Infect Prev Pract 2019; 2:100031. [PMID: 34368687 PMCID: PMC8335933 DOI: 10.1016/j.infpip.2019.100031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022] Open
Abstract
Background Phone hygiene is increasingly recognized in infection prevention. We aimed to explore the beliefs, attitudes and performance of phone hygiene amongst healthcare workers (HCWs) in the major operation theatre (MOT) complex of a Singapore tertiary acute care hospital. We also monitored the impact of phone hygiene stations, introduced to improve phone hygiene. Methods We sent two online anonymous surveys to the Departments of Anaesthesia and MOT Nurses one month before and after we set up phone hygiene stations. Four phone hygiene stations displaying visual phone hygiene reminders and Mikrozid® sensitive wipes were set up at MOT entrances. Results A total of 205 and 91 HCWs responded to the first and second surveys respectively. In the first survey, 11.5% cleaned their phones daily while 9.4% never cleaned their phones. These changed to 16.9% and 3.8% respectively after the introduction of phone hygiene stations. 80.0% in the first survey said they would clean their phones more often if there were a readily accessible disinfection method in the MOT. A majority believed phones are a source of healthcare associated infection. Common reasons for not cleaning phones were 'lack of available resources' and 'I don't think about it.' Senior doctors were the least compliant to phone hygiene. Conclusion Phone hygiene is easily overlooked during our busy workday. Besides increasing awareness of phone hygiene, having a readily available disinfection method in the MOT complex is important to improve phone hygiene. We suggest HCWs clean their phones before entering and/or after leaving the MOT daily.
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Affiliation(s)
- Xin Yu Adeline Leong
- Department of Anaesthesia & Pain Medicine, Division of Anaesthesia and Perioperative Medicine, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Shin Yuet Chong
- Department of Anaesthesia, Division of Anaesthesia and Perioperative Medicine, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Si En Angel Koh
- Infection Prevention & Epidemiology Department, Singapore General Hospital, 169608, Singapore
| | - Bee Chin Yeo
- Division of Nursing, Major Operating Theatre / Endoscopy Centre, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Kwee Yuen Tan
- Infection Prevention & Epidemiology Department, Singapore General Hospital, 169608, Singapore
| | - Moi Lin Ling
- Infection Prevention & Epidemiology Department, Singapore General Hospital, 169608, Singapore.,Duke-NUS Graduate Medical School, Singapore
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Ling ML, Apisarnthanarak A, Abbas A, Morikane K, Lee KY, Warrier A, Yamada K. APSIC guidelines for the prevention of surgical site infections. Antimicrob Resist Infect Control 2019; 8:174. [PMID: 31749962 PMCID: PMC6852795 DOI: 10.1186/s13756-019-0638-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/31/2019] [Indexed: 01/25/2023] Open
Abstract
Background The Asia Pacific Society of Infection Control (APSIC) launched the APSIC Guidelines for the Prevention of Surgical Site Infections in 2018. This document describes the guidelines and recommendations for the setting prevention of surgical site infections (SSIs). It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in preoperative, perioperative and postoperative practices. Method The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results It recommends that healthcare facilities review specific risk factors and develop effective prevention strategies, which would be cost effective at local levels. Gaps identified are best closed using a quality improvement process. Surveillance of SSIs is recommended using accepted international methodology. The timely feedback of the data analysed would help in the monitoring of effective implementation of interventions. Conclusions Healthcare facilities should aim for excellence in safe surgery practices. The implementation of evidence-based practices using a quality improvement process helps towards achieving effective and sustainable results.
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Affiliation(s)
- Moi Lin Ling
- Infection Prevention & Epidemiology, Singapore General Hospital, Singapore, 169608 Singapore
| | - Anucha Apisarnthanarak
- Infectious Diseases, Division of Infectious Diseases, Thammasat University Hospital, Khlong Nueng, Thailand
| | - Azlina Abbas
- Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpor, Malaysia
| | - Keita Morikane
- Division of Clinical Laboratory and Infection Control Yamagata University Hospital, Yamagata, Japan
| | - Kil Yeon Lee
- Surgery, Medical College, Kyung Hee University Center, Gangdong-gu, South Korea
| | - Anup Warrier
- Infectious Diseases and Infection Control, Aster Medcity, Kochi, India
| | - Koji Yamada
- Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
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Bharadwaj S, Ho SK, Khong KC, Seet A, Yeo KC, Chan XY, Wong LL, Karlin RB, Chan DKL, Ling ML. Eliminating MRSA transmission in a tertiary neonatal unit-A quality improvement initiative. Am J Infect Control 2019; 47:1329-1335. [PMID: 31326262 DOI: 10.1016/j.ajic.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care facility-onset methicillin-resistant Staphylococcus aureus (HO-MRSA) colonization or infection is a major cause of health care-associated infection (HAI) worldwide. HAIs are preventable and considered a health care quality outcome indicator. A quality improvement project to eliminate HO-MRSA transmission was conducted in a tertiary care neonatal unit over a 9-month period, and sustainability data were monitored. The primary aim of this project was to achieve zero transmission of MRSA among all neonatal unit admissions, and secondary aims were to improve hand hygiene (HH) and environmental hygiene compliance to 100%. METHODS Existing inpatient admission processes, staff HH, and environmental hygiene practices were critically analyzed. Sequential interventions were implemented, including reinforcing staff awareness on infection control practices through regular education and updates, providing "just in time" feedback, ensuring easy availability of cleaning equipment, individualizing items for all patients, keeping personal belongings away from clinical areas, and revising admission work flow for ex-utero transferred babies from other hospitals. RESULTS The neonatal unit achieved zero MRSA transmission to previously noninfected and noncolonized patients over the 9-month period, and HH and environmental hygiene compliance improved from a preintervention median of 87.1% and 82.2%, respectively, to 100%, which has been sustained to date. CONCLUSIONS Intensive reinforcement of infection control practices, strict cohorting of ex-utero transfers, universal surveillance on admission, and improvement in HH and environmental hygiene compliance were key to infection prevention and control measures, resulting in elimination of MRSA transmission in our neonatal unit.
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Leong XYA, Yee FZY, Leong YY, Tan SG, Amin IBM, Ling ML, Tay SM. Incidence and analysis of sharps injuries and splash exposures in a tertiary hospital in Southeast Asia: a ten-year review. Singapore Med J 2019; 60:631-636. [PMID: 31328240 DOI: 10.11622/smedj.2019082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We aimed to report the ten-year incidence and trend of sharps injuries and splash exposures (SISE), and analyse the causative instruments and risk factors leading to these injuries to identify potential areas of improvement. METHODS A retrospective review of self-reported SISE incidents from 2005 to 2014 was conducted in Singapore General Hospital. Data was extracted from the electronic database of the Department of Infection Prevention and Control. Incidence of SISE was calculated per 1,000 healthcare workers (HCWs) per year. RESULTS Over the ten-year period, a total of 1,901 SISE were reported. The average SISE incidence per year was 110.5 per 1,000 doctors and 22.8 per 1,000 nursing staff, with an overall incidence of 28.9 per 1,000 HCWs. The incidence of SISE decreased from 30.3 to 22.0 per 1,000 HCWs per year from 2005 to 2014, while that for splash exposures increased from 1.9 to 3.7 per 1,000 HCWs per year. Doctors reported the highest number of SISE (43.7%), followed by nurses (37.7%). Top mechanisms of injury were intraoperative procedures (22.8%), drawing blood (14.4%) and splash exposures (13.7%). CONCLUSION Overall incidence of SISE decreased over the decade. Improved training and increasing use of safety devices, education and awareness could have contributed to the fall in incidence of sharps injuries; these measures should be reinforced and continued. However, the incidence of splash exposures increased over the same period. Preventive measures such as the use of protective goggles and face shields, together with personal protective equipment, should be emphasised and encouraged.
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Affiliation(s)
- Xin Yu Adeline Leong
- Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore
| | | | - Yuan-Yuh Leong
- Division of Ophthalmology, Changi General Hospital, Singapore
| | - Soong Geck Tan
- Infection Prevention and Control Department, Singapore General Hospital, Singapore
| | | | - Moi Lin Ling
- Infection Prevention and Control Department, Singapore General Hospital, Singapore
| | - Sook Muay Tay
- Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore
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Yang Y, Lin Ling M, Beng Tan S, Østbye T, Earnest A, Seong Ng H. The burden of methicillin-resistant staphylococcus aureus infections among hospitalised patients in singapore. GeS 2018. [DOI: 10.21171/ges.v13i34.2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: MRSA has caused enormous burden to affected Western patients and society. However, only limited study results originated from the Asia-Pacific populations.
Aim: To assess the burden of Methicillin-resistant S. aureus infections (MRSA) among patients from a large tertiary care hospital in Singapore.
Methods: Retrospective study using data from the hospital discharge database to identify patients with MRSA and Methicillin-sensitive S. aureus infections (MSSA) using International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification (ICD-9-AM) codes.
Findings: Amongst 543,068 hospitalized patients between 2004 and 2010, 8,664(1.6%) were infected with S. Aureus, including 4,868(0.9%) with MRSA. Compared with uninfected controls, MRSA patients had longer hospital stay (geometric mean, GM, 12.2 vs. 3.0 days), higher hospitalization costs (GM, $6294.7 vs. $2295.7), higher in-hospital mortality rate (7.8% vs. 2.8%) and higher 30-day all-cause unscheduled readmission rate (36.3% vs. 23.7%, all p<0.001). The difference still existed after adjustment for age groups, gender, ethnicity, medical management, and Charlson comorbidity index. Similarly, MRSA patients had longer hospital stay, higher hospitalization costs, higher in-hospital mortality rate and 30-day all-cause unscheduled readmission rate compared with patients with MSSA.
Conclusion: MRSA infection was associated with poor clinical outcomes and higher economic burden in this population. Prevention and control measures should be implemented both inside and outside the hospital setting.
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Abstract
INTRODUCTION The association of Mycobacterium chimaera infection in patients undergoing cardiopulmonary bypass (CPB) with the use of heater-cooler units (HCU) has been reported in various literature. We described microbiological monitoring and the extent of microbiological contamination of HCUs utilized in our centre and strategies employed to reduce the high microbial load. METHODS Since August 2016, we have been following the new Instructions for Use from the manufacturer for the cleaning and disinfection of three units of Stöckert 3T and four units of Stöckert 1T HCU at the National Heart Centre Singapore. Microbiological monitoring began in January 2017 and included acid-fast bacilli (AFB) culture, Pseudomonas aeruginosa, total colony and total coliform count. Methods, such as increasing disinfection frequency and making the HCU inactive by keeping it empty in storage, were used to reduce the high colony count. RESULTS All three units of Stöckert 3T and two units of Stöckert 1T were contaminated with Mycobacterium chimaera. Pseudomonas aeruginosa and total coliform count were consistently <1 colony-forming unit (CFU)/100 mL in every water sample of each HCU. High colony counts were encountered initially in all units. Step-up frequency of disinfection was found to be not as effective as keeping the HCU inactive in bringing the total colony count to an acceptable level. CONCLUSIONS All monitoring and maintenance measures of HCUs need to be established and maintained to mitigate potential infection risks to patients. Strict adherence to all cleaning and disinfection processes and keeping the HCU inactive maintained the water quality of the HCU at acceptable levels.
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Affiliation(s)
- Tanee Chan
- 1 National Heart Centre Singapore, Singapore
| | | | | | - Kit Yi Chiu
- 1 National Heart Centre Singapore, Singapore
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Lee LXG, Seah J, Ismail BBS, Tan KY, Ling ML. Control of KPC-Producing Klebsiella Pneumoniae Using Multi-Prong Approach in Surgical Discipline Ward. Am J Infect Control 2018. [DOI: 10.1016/j.ajic.2018.04.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ling ML, Ching P, Widitaputra A, Stewart A, Sirijindadirat N, Thu LTA. APSIC guidelines for disinfection and sterilization of instruments in health care facilities. Antimicrob Resist Infect Control 2018; 7:25. [PMID: 29468053 PMCID: PMC5819152 DOI: 10.1186/s13756-018-0308-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/26/2018] [Indexed: 01/08/2023] Open
Abstract
Background The Asia Pacific Society of Infection Control launched its revised Guidelines for Disinfection and Sterilization of Instruments in Health Care Facilities in February 2017. This document describes the guidelines and recommendations for the reprocessing of instruments in healthcare setting. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in sterilization and disinfection. Method The guidelines were revised by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results It recommends the centralization of reprocessing, training of all staff with annual competency assessment, verification of cleaning, continual monitoring of reprocessing procedures to ensure their quality and a corporate strategy for dealing with single-use and single-patient use medical equipment/devices. Detailed recommendations are also given with respect to reprocessing of endoscopes. Close working with the Infection Prevention & Control department is also recommended where decisions related to reprocessing medical equipment/devices are to be made. Conclusions Sterilization facilities should aim for excellence in practices as this is part of patient safety. The guidelines that come with a checklist help service providers identify gaps for improvement to reach this goal. Electronic supplementary material The online version of this article (10.1186/s13756-018-0308-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moi Lin Ling
- 1Infection Prevention & Control, Singapore General Hospital, Singapore, 169608 Singapore
| | - Patricia Ching
- Hong Kong Infection Control Nurses Association (HKICNA), Hong Kong, Hong Kong
| | | | - Alison Stewart
- New Zealand Sterile Services Association (NZSSA), Waikiwi, New Zealand
| | | | - Le Thi Anh Thu
- Ho Chi Minh City Infection Control Society (HICS), Ho Chi Minh City, Vietnam
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Cai Y, Venkatachalam I, Tee NW, Tan TY, Kurup A, Wong SY, Low CY, Wang Y, Lee W, Liew YX, Ang B, Lye DC, Chow A, Ling ML, Oh HM, Cuvin CA, Ooi ST, Pada SK, Lim CH, Tan JWC, Chew KL, Nguyen VH, Fisher DA, Goossens H, Kwa AL, Tambyah PA, Hsu LY, Marimuthu K. Prevalence of Healthcare-Associated Infections and Antimicrobial Use Among Adult Inpatients in Singapore Acute-Care Hospitals: Results From the First National Point Prevalence Survey. Clin Infect Dis 2018; 64:S61-S67. [PMID: 28475790 DOI: 10.1093/cid/cix103] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background We conducted a national point prevalence survey (PPS) to determine the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in Singapore acute-care hospitals. Methods Trained personnel collected HAI, AMU, and baseline hospital- and patient-level data of adult inpatients from 13 private and public acute-care hospitals between July 2015 and February 2016, using the PPS methodology developed by the European Centre for Disease Prevention and Control. Factors independently associated with HAIs were determined using multivariable regression. Results Of the 5415 patients surveyed, there were 646 patients (11.9%; 95% confidence interval [CI], 11.1%-12.8%) with 727 distinct HAIs, of which 331 (45.5%) were culture positive. The most common HAIs were unspecified clinical sepsis (25.5%) and pneumonia (24.8%). Staphylococcus aureus (12.9%) and Pseudomonas aeruginosa (11.5%) were the most common pathogens implicated in HAIs. Carbapenem nonsusceptibility rates were highest in Acinetobacter species (71.9%) and P. aeruginosa (23.6%). Male sex, increasing age, surgery during current hospitalization, and presence of central venous or urinary catheters were independently associated with HAIs. A total of 2762 (51.0%; 95% CI, 49.7%-52.3%) patients were on 3611 systemic antimicrobial agents; 462 (12.8%) were prescribed for surgical prophylaxis and 2997 (83.0%) were prescribed for treatment. Amoxicillin/clavulanate was the most frequently prescribed (24.6%) antimicrobial agent. Conclusions This survey suggested a high prevalence of HAIs and AMU in Singapore's acute-care hospitals. While further research is necessary to understand the causes and costs of HAIs and AMU in Singapore, repeated PPSs over the next decade will be useful to gauge progress at controlling HAIs and AMU.
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Affiliation(s)
- Yiying Cai
- Department of Pharmacy, Singapore General Hospital.,Department of Pharmacy, National University of Singapore
| | | | - Nancy W Tee
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital
| | - Asok Kurup
- Infectious Diseases Care, Mount Elizabeth (Orchard) Hospital
| | - Sin Yew Wong
- Infectious Disease Specialists, Gleneagles Hospital
| | - Chian Yong Low
- Novena Medical Specialists, Mount Elizabeth (Novena) Hospital
| | - Yang Wang
- Division of Nursing, Raffles Hospital, Departments of
| | - Winnie Lee
- Department of Pharmacy, Singapore General Hospital
| | - Yi Xin Liew
- Department of Pharmacy, Singapore General Hospital
| | | | | | - Angela Chow
- Clinical Epidemiology, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital.,Saw Swee Hock School of Public Health, National University of Singapore, 13Infection Control, Singapore General Hospital
| | | | - Helen M Oh
- Division of Infectious Diseases, Changi General Hospital
| | | | - Say Tat Ooi
- Department of General Medicine, Khoo Teck Puat Hospital
| | - Surinder K Pada
- Department of Infectious Diseases, Ng Teng Fong General Hospital
| | - Chong Hee Lim
- Department of Cardiothoracic Surgery, National Heart Center
| | | | - Kean Lee Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Van Hai Nguyen
- School of Pharmacy, Memorial University, St John's, NL, Canada
| | - Dale A Fisher
- Division of Infectious Disease, National University Hospital, and.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Herman Goossens
- Laboratory of Medical Microbiology, University of Antwerp, Belgium; and
| | - Andrea L Kwa
- Department of Pharmacy, Singapore General Hospital.,Department of Pharmacy, National University of Singapore.,Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Paul A Tambyah
- Division of Infectious Disease, National University Hospital, and.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Li Yang Hsu
- Infectious Diseases and.,Saw Swee Hock School of Public Health, National University of Singapore, 13Infection Control, Singapore General Hospital
| | - Kalisvar Marimuthu
- Infectious Diseases and.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Marimuthu K, Venkatachalam I, Khong WX, Koh TH, Cherng BPZ, Van La M, De PP, Krishnan PU, Tan TY, Choon RFK, Pada SK, Lam CW, Ooi ST, Deepak RN, Smitasin N, Tan EL, Lee JJ, Kurup A, Young B, Sim NTW, Thoon KC, Fisher D, Ling ML, Peng BAS, Teo YY, Hsu LY, Lin RTP, Ong RTH, Teo J, Ng OT. Clinical and Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae Among Adult Inpatients in Singapore. Clin Infect Dis 2018; 64:S68-S75. [PMID: 28475792 DOI: 10.1093/cid/cix113] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Since 2010, the incidence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing in Singapore. We analyzed the clinical and molecular epidemiology of CRE among adult inpatients in Singapore. Methods Quarterly incidence of unique subjects (per 100000 patient-days) with positive clinical and surveillance cultures for CRE were estimated based on mandatory data submitted to the National Public Health Laboratory by public hospitals between 2010 and 2015. CRE-positive adult inpatients were prospectively recruited from 6 public sector hospitals between December 2013 and April 2015. Subjects answered a standardized epidemiologic questionnaire and provided samples for this study. Further clinical information was extracted from subjects' electronic medical records. Whole-genome sequencing was performed on study isolates to determine transmission clusters. Results Incidence of CRE clinical cultures among adult inpatients plateaued from 2013 (range: 7.73 to 10.32 per 100000 patient-days) following an initial increase between 2010 and end-2012. We prospectively recruited 249 subjects. Their median age was 65 years, 108 (43%) were female, and 161 (64.7%) had carbapenemase-producing Enterobacteriaceae (CPE). On multivariate analysis, prior carbapenem exposure (OR: 3.23; 95% CI: 1.67-6.25) and hematological malignancies (OR: 2.85; 95% CI: 1.10-7.41) were associated with non-carbapenemase-producing CRE (NCPE) (n = 88) compared with CPE (n = 161) subjects. Among 430 CRE isolates from the 249 subjects, 307(71.3%) were CPE, of which 154(50.2%) were blaKPC-positive, 97(31.6%) blaNDM-positive, and 42 (13.7%) blaOXA-positive. Klebsiella pneumoniae (n = 180, 41.9%), Escherichia coli (n = 129, 30.0%) and Enterobacter cloacae (n = 62, 14.4%) were the main Enterobacteriaceae species. WGS (n = 206) revealed diverse bacterial strain type (STs). The predominant blaKPC-positive plasmid was pHS102707 (n = 62, 55.4%) and the predominant blaNDM-positive plasmid was pNDM-ECS01 (n = 46, 48.9%). Five transmission clusters involving 13 subjects were detected. Conclusions Clinical CRE trend among adult inpatients showed stabilization following a rapid rise since introduction in 2010 potentially due to infection prevention measures and antimicrobial stewardship. More work is needed on understanding CPE transmission dynamics.
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Affiliation(s)
- Kalisvar Marimuthu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore
| | | | - Wei Xin Khong
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | | | | | - My Van La
- National Public Health Laboratory, Ministry of Health of Singapore
| | - Partha Pratim De
- Department of Laboratory Medicine, Tan Tock Seng Hospital.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Prabha Unny Krishnan
- National Public Health Laboratory, Ministry of Health of Singapore.,Department of Laboratory Medicine, Tan Tock Seng Hospital.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Raymond Fong Kok Choon
- Division of Infectious Diseases, Department of Medicine, Changi General Hospital, Singapore
| | - Surinder Kaur Pada
- Department of Infectious Diseases, Ng Teng Fong General Hospital, Singapore
| | - Choong Weng Lam
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore
| | - Say Tat Ooi
- Department of Infectious Diseases, Khoo Teck Puat Hospital, Singapore
| | | | - Nares Smitasin
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Eng Lee Tan
- Centre of Biomedical and Life Sciences, Singapore Polytechnic
| | - Jia Jun Lee
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | | | - Barnaby Young
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Nancy Tee Wen Sim
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Koh Cheng Thoon
- Yong Loo Lin School of Medicine, National University of Singapore.,Department of Pediatrics, KK Women's and Children's Hospital, Singapore
| | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore.,Division of Infectious Diseases, National University Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Control, Singapore General Hospital
| | - Brenda Ang Sze Peng
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yik-Ying Teo
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore.,NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Centre for Life Sciences (CeLS).,Department of Statistics & Applied Probability, Faculty of Science, National University of Singapore.,Life Sciences Institute, National University of Singapore.,Genome Institute of Singapore
| | - Li Yang Hsu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Saw Swee Hock School of Public Health, National University Health System
| | - Raymond Tzer Pin Lin
- National Public Health Laboratory, Ministry of Health of Singapore.,Department of Laboratory Medicine, National University Hospital, Singapore
| | - Rick Twee-Hee Ong
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Oon Tek Ng
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Ling ML, Apisarnthanarak A, Madriaga G. Reply to Wang et al: Table 1. Clin Infect Dis 2016; 63:429-30. [DOI: 10.1093/cid/ciw307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chlebicki MP, Ling ML, Koh TH, Hsu LY, Tan BH, How KB, Sng LH, Wang GCY, Kurup A, Kang ML, Low JGH. First Outbreak of Colonization and Infection With Vancomycin-ResistantEnterococcus faeciumin a Tertiary Care Hospital in Singapore. Infect Control Hosp Epidemiol 2016; 27:991-3. [PMID: 16941331 DOI: 10.1086/507289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Accepted: 04/21/2005] [Indexed: 11/03/2022]
Abstract
We report the first outbreak of vancomycin-resistantEnterococcus faeciumcolonization and infection among inpatients in the hematology ward of an acute tertiary care public hospital in Singapore. Two cases of bacteremia and 4 cases of gastrointestinal carriage were uncovered before implementation of strict infection control measures resulted in control of the outbreak.
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Ling ML, Apisarnthanarak A, Jaggi N, Harrington G, Morikane K, Thu LTA, Ching P, Villanueva V, Zong Z, Jeong JS, Lee CM. APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI). Antimicrob Resist Infect Control 2016; 5:16. [PMID: 27152193 PMCID: PMC4857414 DOI: 10.1186/s13756-016-0116-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 04/24/2016] [Indexed: 02/05/2023] Open
Abstract
This document is an executive summary of the APSIC Guide for Prevention of Central Line Associated Bloodstream Infections (CLABSI). It describes key evidence-based care components of the Central Line Insertion and Maintenance Bundles and its implementation using the quality improvement methodology, namely the Plan-Do-Study-Act (PDSA) methodology involving multidisciplinary process and stakeholders. Monitoring of improvement over time with timely feedback to stakeholders is a key component to ensure the success of implementing best practices. A surveillance program is recommended to monitor outcomes and adherence to evidence-based central line insertion and maintenance practices (compliance rate) and identify quality improvement opportunities and strategically targeting interventions for the reduction of CLABSI.
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Affiliation(s)
- Moi Lin Ling
- Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | | | | | | | | | | | | | | | - Zhiyong Zong
- West China Hospital of Sichuan University, Chengdu, China
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Ling ML, Apisarnthanarak A, Thu LTA, Villanueva V, Pandjaitan C, Yusof MY. APSIC Guidelines for environmental cleaning and decontamination. Antimicrob Resist Infect Control 2015; 4:58. [PMID: 26719796 PMCID: PMC4696151 DOI: 10.1186/s13756-015-0099-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
This document is an executive summary of APSIC Guidelines for Environmental Cleaning and Decontamination. It describes best practices in routine cleaning and decontamination in healthcare facilities as well as in specific settings e.g. management of patients with isolation precautions, food preparation areas, construction and renovation, and following a flood. It recommends the implementation of environmental hygiene program to keep the environment safe for patients, staff and visitors visiting a healthcare facility. Objective assessment of cleanliness and quality is an essential component of this program as a method for identifying quality improvement opportunities. Recommendations for safe handling of linen and bedding; as well as occupational health and safety issues are included in the guidelines. A training program is vital to ensure consistent adherence to best practices.
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Affiliation(s)
- Moi Lin Ling
- />Singapore General Hospital, Outram Road, 169608 Singapore
| | | | | | | | - Costy Pandjaitan
- />Association of Infection Prevention Control Nurse, Jakarta, Indonesia
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Ling ML, Tee YM, Tan SG, Amin IM, How KB, Tan KY, Lee LC. Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore. Antimicrob Resist Infect Control 2015; 4:26. [PMID: 26106476 PMCID: PMC4477303 DOI: 10.1186/s13756-015-0066-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background Carbapenem resistant Enterobacteriaceae (CRE) is increasingly reported worldwide. A similar increase is seen in Singapore since identification of its first case in 2008. The aim of this study was to identify local risk factors for carriage of CRE in patients from an acute tertiary care hospital in Singapore. Method A matched case-control study was conducted on inpatients treated from January 1, 2011 till December 31, 2013. Two hundred and three cases of CRE infection or colonization were matched with 203 controls. CRE types were identified by PCR. Statistical analysis of data including a multivariate logistic regression analysis was done using SPSS 21.0. Results CREs were commonly seen in Klebsiella pneumoniae (42.2 %), Escherichia coli (24.3 %) and Enterobacter cloacae complex (17.2 %) in the 268 isolates. NDM-1 was the commonest CRE type seen (44.4 %), followed by KPC (39.9 %) whilst OXA-48 only constituted (7.8 %). Univariate analysis identified key risk factors associated with CRE as history of previous overseas hospitalization (OR: 33.667; 95 % CI: 4.539-259.700), admission to ICU (OR: 11.899; 95 % CI: 4.986-28.399) and HD/ICA (OR: 6.557; 95 % CI: 4.057-10.596); whilst a multivariate analysis revealed exposure to antibiotics penicillin (OR: 4.640; 95 % CI: 1.529-14.079] and glycopeptide (OR: 5.162; 95 % CI: 1.377-19.346) and presence of central line device (OR: 3.117; 95 % CI: 1.167-8.330) as significant independent predictors. Conclusions The identification of risk factors amongst our local population helped to refine the criteria used for target active surveillance screening for CRE amongst inpatients at time of hospital admission.
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Affiliation(s)
- Moi Lin Ling
- Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Yong Ming Tee
- Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Soong Geck Tan
- Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Ismawati M Amin
- Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Kue Bien How
- Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Kwee Yuen Tan
- Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Lai Chee Lee
- Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
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Tartari E, Allegranzi B, Ang B, Calleja N, Collignon P, Hopman J, Lang L, Lee LC, Ling ML, Mehtar S, Tambyah PA, Widmer A, Voss A. Preparedness of institutions around the world for managing patients with Ebola virus disease: an infection control readiness checklist. Antimicrob Resist Infect Control 2015; 4:22. [PMID: 26056563 PMCID: PMC4459682 DOI: 10.1186/s13756-015-0061-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In response to global concerns about the largest Ebola virus disease (EVD), outbreak to-date in West Africa documented healthcare associated transmission and the risk of global spread, the International Society of Chemotherapy (ISC) Infection Control Working Group created an Ebola Infection Control Readiness Checklist to assess the preparedness of institutions around the globe. We report data from the electronic checklist that was disseminated to medical professionals from October to December 2014 and identify action needed towards better preparedness levels. FINDINGS Data from 192 medical professionals (one third from Africa) representing 125 hospitals in 45 countries around the globe were obtained through a specifically developed electronic survey. The survey contained 76 specific questions in 7 major sections: Administrative/operational support; Communications; Education and audit; Human resources, Supplies, Infection Prevention and Control practices and Clinical management of patients. The majority of respondents were infectious disease specialists/infection control consultants/clinical microbiologists (75; 39 %), followed by infection control professionals (59; 31 %) and medical doctors of other specialties (17; 9 %). Nearly all (149; 92 %) were directly involved in Ebola preparedness activities. Whilst, 54 % indicated that their hospital would need to handle suspected and proven Ebola cases, the others would subsequently transfer suspected cases to a specialized centre. CONCLUSION The results from our survey reveal that the general preparedness levels for management of potentially suspected cases of Ebola virus disease is only partially adequate in hospitals. Hospitals designated for admitting EVD suspected and proven patients had more frequently implemented Infection Control preparedness activities than hospitals that would subsequently transfer potential EVD cases to other centres. Results from this first international survey provide a framework for future efforts to improve hospital preparedness worldwide.
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Affiliation(s)
- Ermira Tartari
- />Infection Control Unit, Mater Dei Hospital, Msida, Malta
| | | | - Brenda Ang
- />Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Neville Calleja
- />Department of Health Information and Research, Ministry of Health, Valletta, Malta
| | - Peter Collignon
- />Infectious Diseases Unit and Microbiology, Canberra Hospital, Canberra, Australia
| | - Joost Hopman
- />Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lily Lang
- />National Healthcare Groups Polyclinics, Singapore, Singapore
| | - Lai Chee Lee
- />Infection Control, Singapore General Hospital, Singapore, Singapore
| | - Moi Lin Ling
- />Infection Control, Singapore General Hospital, Singapore, Singapore
| | - Shaheen Mehtar
- />Faculty of Medicine and Health Sciences, Stellenbosch University, Cape town, South Africa
| | - Paul A. Tambyah
- />Division of Infectious Diseases, National University of Singapore, Singapore, Singapore
| | - Andreas Widmer
- />Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Andreas Voss
- />Radboud University Medical Center, Nijmegen, The Netherlands
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Chung SJ, Ling ML, Seto WH, Ang BS, Tambyah PA. Debate on MERS-CoV respiratory precautions: surgical mask or N95 respirators? Singapore Med J 2015; 55:294-7. [PMID: 25017402 DOI: 10.11622/smedj.2014076] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Since the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in mid-2012, there has been controversy over the respiratory precaution recommendations in different guidelines from various international bodies. Our understanding of MERS-CoV is still evolving. Current recommendations on infection control practices are heavily influenced by the lessons learnt from severe acute respiratory syndrome. A debate on respiratory precautions for MERS-CoV was organised by Infection Control Association (Singapore) and the Society of Infectious Disease (Singapore). We herein discuss and present the evidence for surgical masks for the protection of healthcare workers from MERS-CoV.
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Affiliation(s)
- S J Chung
- Department of Infectious Diseases, Singapore General Hospital, Level 3, The Academia, 20 College Road, Singapore 169856.
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Chung SJ, Ling ML, Seto WH, Ang BS, Tambyah PA. Authors’ reply. Singapore Med J 2014; 55:507. [DOI: 10.11622/smedj.2014125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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