Hepatitis C Outbreak at Singapore General Hospital – Update on Follow-up Actions by MOH

1.            Following the release of the report of the Independent Review Committee (IRC) tasked to look into the Hepatitis C outbreak at the Singapore General Hospital (SGH)’s renal ward, the Ministry of Health (MOH) in December 2015 set up a Taskforce to Strengthen Outbreak Detection and Response, led by Minister of State for Health, Mr Chee Hong Tat.

2.            In its report submitted to MOH on 5 December 2015, the IRC found that the outbreak was due to multiple overlapping factors, including gaps in infection control procedures and protocols at SGH’s renal ward. On the overall system response to the outbreak, the IRC noted that while the current national surveillance system worked well for detecting community outbreaks of known infectious diseases, the Hepatitis C virus (HCV) outbreak had highlighted a gap in the current system. As an unusual healthcare-associated infection (HAI) with unique characteristics, HCV was not easily picked up through regular surveillance. Within MOH, there was also no designated division with the responsibility and capabilities to deal with an unusual HAI like HCV. These resulted in delayed recognition and escalation of the HCV outbreak.

3.            The Taskforce was to address the IRC’s recommendations on improving the national healthcare system’s ability to detect and respond to infectious disease outbreaks in hospitals and the community. It has held several meetings and engagement sessions to discuss its preliminary proposals on strengthening outbreak detection and response over the past few months. These include the setting up of the National Outbreak Response Team and a review of the list of notifiable diseases under the Infectious Diseases Act and the modes of notification, timelines and escalation process. The Taskforce is on track to complete its review by June 2016.

MOH Sets up National Outbreak Response Team to Strengthen Early Outbreak Detection and Response

4.            MOH has set up a National Outbreak Response Team on 1 March 2016, comprising experts from across the healthcare fraternity, to augment the efforts of healthcare institutions to deal with disease outbreaks. The list of team members is in Annex A. The National Outbreak Response Team will respond to an outbreak as directed by the Director of Medical Services, depending on factors like the nature of the infectious disease and outbreak setting.

5.            In addition, the Taskforce has recommended simplifying the processes for notification and reporting of infectious diseases by doctors and laboratories. Besides online notification, doctors who prefer to notify MOH by fax will be given one central fax number instead of having multiple contact numbers. The reporting timeline will be standardised to “within 72 hours” except for a pre-specified list of diseases which require quicker reporting. For urgent cases, doctors and laboratories can call the MOH hotline directly.

6.            In response to feedback from healthcare professionals, MOH will also streamline the reporting by doctors and laboratories. Currently, doctors will first report suspected cases to MOH followed by a second report after they receive the laboratory confirmation. Under the new arrangement, MOH will use notifications and data from laboratories and match results directly so that doctors only need to notify once.

7.            The Taskforce is reviewing other measures in consultation with stakeholders before completing its review in mid-2016. MOH has decided to implement the above recommendations earlier, to improve the response to infectious diseases in Singapore. The Taskforce will provide a further update on its remaining recommendations at the end of the review.

Update on HR Actions

8.            MOH also set up a Human Resource (HR) Panel in December 2015 to examine the roles, responsibilities and actions of key MOH staff in the outbreak. The MOH HR Panel was chaired by Ms Yong Ying-I, Permanent Secretary at the Public Service Division, with Prof K Satkunanantham, Chairman of the Health Sciences Authority and Mr Han Neng Hsiu, Deputy Secretary (Administration) at the Ministry of Defence as members.

9.            The HR Panel studied the IRC report in detail, and also interviewed and obtained statements from the relevant MOH staff where necessary.  The Panel completed its work and submitted its recommendations to the Public Service Commission (PSC). 

10.         The PSC considered the respective roles and responsibilities of the MOH staff, and their involvement in the incident.  After careful deliberation, the PSC decided that disciplinary action be taken against four MOH officers holding Director-level or equivalent roles for their failure to intervene early and to ensure the infectious disease notification and reporting system was effective and rigorous. The disciplinary sanctions include warnings, stern warnings and financial penalties.  The four officers have accepted the outcomes.

Conclusion

11.         As we address the lapses and improve our healthcare system, our concern and focus are on the patients and their families, whose well-being remains our top priority. We sincerely apologise to the patients and their families who have been affected by the outbreak. MOH will continue to work with SGH to ensure that they receive the necessary support and care to manage their conditions.

MINISTRY OF HEALTH

17 MARCH 2016

______________________________________________________________________

Annex A

National Outbreak Response Team  

Members