Healthcare-Associated Infections

10 July 2012

Question No. 480

Name of person: Mr Gerald Giam Yean Song

To ask the Minister for Health (a) what are the top five contributory factors for healthcare-associated infections (HAIs) in our public hospitals; (b) whether the HAI rate is linked to the high bed occupancy rates (BOR) in the public hospitals; and (c) what is the Ministry is doing to reduce HAIs in our hospitals.

Answer

1        Healthcare-associated infections (HAIs) are infections that patients acquire during their stay in healthcare facilities, like hospitals.  Our hospitals take HAIs seriously as it could delay and complicate a patient’s recovery.

2        There are various contributory factors for HAIs.  For example, HAIs could occur during surgery when a patient’s skin, the body’s natural defense against infection, is breached.  The use of in-body medical devices, such as urinary catheters, can predispose a patient to infections arising from such devices.  Patients with conditions such as diabetes and kidney failure are also more susceptible to infections because of their lowered immune status.  Some treatments such as chemotherapy for cancer may also lower a patient’s immunity thus increasing the risk for HAIs.  HAIs often occur as a result of a combination of factors. It is therefore not conclusive that high bed occupancy rate (BOR) directly leads to higher HAIs. In fact a recent study of BOR and Methicillin Resistant Staphylococcus aureus (MRSA) shows that there is a lack of consistent correlation between them.

3        To minimize transmission of bacteria and reduce HAIs, our public hospitals have instituted strict infection control measures.  These include stringent adherence to hand hygiene practices among healthcare staff, contact precautions to minimize physical contact and contact with medical devices, implementation of evidence-based infection prevention practices during treatment procedures, and regular surveillance of HAI rates in special care areas such as the intensive care units (ICUs). These infection prevention measures have reduced HAIs in our hospitals. 

4        For example, in the Medical ICUs, through stringent infection control measures, the ventilator associated pneumonias had decreased from 2.61 per 1,000 ventilator days in 2004 to 1.04 per 1,000 ventilator days in 2010.  Similarly blood stream infection associated with central lines (these are catheters inserted into patients’ veins for treatment and monitoring) in these ICUs had decreased from 0.97 per 1,000 central line days to 0.58 per 1,000 central line days over the same period. However, it is increasingly challenging to stem the rise of bacteria that are resistant to multiple antibiotics - infections caused by these bacteria are difficult and expensive to treat.

5        To better tackle the problem of antimicrobial resistance related to HAIs, my Ministry set up a national taskforce in 2009, comprising infectious disease specialists, infection control experts, pharmacists, microbiologists and public health experts to develop and implement measures to reduce drug resistant HAIs in our healthcare institutions.  These measures have been progressively implemented in the hospitals. One such measure is the setting up of antimicrobial stewardship programmes which will be progressively rolled out to seven public hospitals over the next four years to enhance the appropriate use of antibiotics thus reducing antimicrobial resistance in our hospitals. Some hospitals, such as TTSH, have piloted innovative ways to better control HAIs. Measures that work and are cost-effective will be rolled out across all our hospitals.

6        Finally, our hospitals have implemented measures to restrict the number of visitors in order to reduce the risk of transmission of infections. We can also play our part in reducing the transmission of HAIs by washing our hands before and after visiting our friends or relatives in the hospitals.