PROGRAMME BOOKLET - new.icas.org.sg
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PROGRAMME BOOKLETPROGRAMME BOOKLETPROGRAMME BOOKLET
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The 2nd International Congress of Infection Control Association (Singapore) Organising
Committee wishes to thank the following for their kind and generous contributions:
Platinum Sponsor:
Gold Sponsors:
Exhibitors
3M Asia Pacific Pte Ltd 3M Singapore Pte Ltd
B Braun Singapore Pte Ltd BD Medical Systems
Bioquell Asia Pacific Pte Ltd Concile GmbH
GlaxoSmithKline Pte Ltd ICNet International
ICU Medical IDS Marketing (Singapore) Pte Ltd
Janssen-Cilag Singapore Molnlycke Health Care Asia-Pacific Pte Ltd
PG Books Pte Ltd Sourcelink Holdings Pte Ltd
Sure Clean
Infection Control Association (Singapore)
c/o Department of Pathology
Singapore General Hospital
Outram Road, Singapore 169608
URL: www.icas.org.sg
ACKNOWLEDGEMENTACKNOWLEDGEMENTACKNOWLEDGEMENTSSS
Wizlink Consulting Pte Ltd
51, Hindhede Walk, #01-07
Singapore 587975
Fax: (+65) 6640-1064
Email: [email protected]
ORGANISERORGANISERORGANISER
CONFERENCE SECRETARICONFERENCE SECRETARICONFERENCE SECRETARIATATAT
Others
Janssen-Cilag Singapore Webber Training Inc.
Yong Loo Lin School of Medicine, National University of Singapore
I
TABLE OF CONTENTSTABLE OF CONTENTSTABLE OF CONTENTS
COMMITTEE I
WELCOME MESSAGE 1
INVITED FACULTY 2
CONFERENCE INFORMATION 5
FLOOR PLAN 6
PROGRAMME 7
PLENARY LECTURES 14
KEYNOTE ADDRESS 15
INTERMEDIATE AND LONG TERM CARE FACILITIES AND MDROS 17
DISINFECTION AND STERILISATION 18
HAND HYGIENE 20
NEW GLOBAL THREATS IN INFECTION CONTROL 21
STAFF AND PATIENT SAFETY 23
THE BIG "4" 25
FREE PAPERS 32
POSTER LISTING 35
THE FUTURE OF INFECTION CONTROL 26
INFECTION CONTROL IN INTERMEDIATE & LONG TERM CARE FACILITIES 30
SURVEILLANCE 28
HOSPITAL ACCREDITATION AND INFECTION CONTROL 31
ACKNOWLEDGEMENTS 38
II
COMMITTEECOMMITTEECOMMITTEE
2nd International Congress of the Infection Control Association
(Singapore) Organising Committee
A/Prof Paul Anantharajah TAMBYAH
A/Prof Helen OH
Dr LING Moi Lin
Dr Maciej Piotr CHLEBICKI
Ms ANG Ser Lee
Ms CHEN Yin Yin
Ms LEE Shu Lay
Ms NG Woei Kian
Infection Control Association (Singapore) Executive Committee
Dr LING Moi Lin
President
A/Prof Helen OH
Vice-President
Ms LEE Shu Lay
Secretary
Ms Florence CHNG
Treasurer
Ms Lily LANG
Ms WONG Sook Cheng
Committee Members
Towards Safe Healthcare
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S/N Abstract Title
14 Hospital acquired Infection in Neonatal Department at Hung Vuong
Hospital
TH Phan, T Nguyen
Infection Control Deaprtment, Hung Vuong Hospital, Ho Chi Minh City, Vietnam
15 Hand Hygiene Implementation and Compliance of Nurses in
MEDISTRA Hospital , Jakarta Indonesia
L Kurniawan, Y Chairul, B Setiawan
Medistra Hospital, Jakarta, Indonesia
16 An Outbreak of Burkholderia Cepacia associated with Contamination
of Alcohol-free-mouthwash and Body Wipes
GH Chua¹, J Li¹, TY Tan², HML Oh3
¹Infection Control Unit
²Department of Laboratory Medicine
³Department of Medicine
Changi General Hospital, Singapore
17 Universal Screening for Methicillin-Resistant Staphylococcus Aureus
by Molecular Detection at Khoo Teck Puat Hospital
J Chan¹, C Willia2, SK Seet1, ML Foo3, PL Ong3, SBA Goh3, YM Chen4, GL Wee1
¹Department of Laboratory Medicine
²Department of Internal Medicine
³Infection Control 4Department of Nursing
Khoo Teck Puat Hospital, Singapore
18 Infection Control Response to a Van A Vancomycin Resistant
Enterococci Outbreak in a Tertiary Hospital
YM Ho, BF Poh¹, WK Ng¹, S Soe¹, B Ang2
¹Infection Control
²Infectious Disease
Tan Tock Seng Hospital, Singapore
2nd International Congress of the Infection Control Association (Singapore)
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S/N Abstract Title
7 Department of Medical Microbiology & Immunology, UKM Medical
Centre
S Anita, I Zalina, J Roslinda, R Ramliza
Department of Medical Microbiology & Immunology
University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
8 Effective Environmental Cleaning
KY Tan1, F Ibrahim1, ML Ling1, EC Lee2, YY Goh2, SH Yii2, CS Chua2, MM Aye2 1Infection Control 2Housekeeping
Singapore General Hospital, Singapore
9 Effective Reduction of CLABSI
F Fang1, CM Loo2, ML Ling3, S Rahmat1, H Tohid3 1Medical Intensive Care Unit 2Respiratory & Critical Care Medicine 3Infection Control
Singapore General Hospital, Singapore
10 Hospital Construction and Renovation: A Challenge to Infection
Control Compliance
HCJ Ong1, T See2, BF Poh2, WK Ng1, B Ang3 1Tan Tock Seng Hospital, Singapore 2Infection Control, Singapore General Hospital, Singapore 3Infectious Disease, Tan Tock Seng Hospital, Singapore
11 Hand Hygiene Interventions in National University Hospital,
Singapore
CJ Liew1, F Ooi1, D Fisher2 1Nursing Administration, Infection Control 2Department of Infectious Diesease
National University Health System, Singapore
12 Impact of Prolonged Peri-operative Antibiotic Prophylaxis on
Surgical Site Infections Post Coronary Artery Bypass Graft Surgery
A Vasudevan1, CN Lee2, PA Tambyah3 1,3Infectious disease 2Cardiac, Thoracic & Vascular Surgery
National University Health System, Singapore
13 Management of Bacteraemia at Khoo Teck Puat Hospital
J Chan
Department of Laboratory Medicine
AlexandraHealth, Khoo Teck Puat Hospital, Singapore
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WELCOME MESSAGEWELCOME MESSAGEWELCOME MESSAGE
Dear Friends and Colleagues,
The importance of infection prevention and control is gaining increasing attention in both
hospitals and community. This is greatly helped by the efficient internet communications that
is widely available to all, irrespective of country or age. However, as healthcare workers, we
have a responsibility to be aware of updates so that best practices are implemented in an effort
to deliver quality and safe care to our patients. It is my pleasure to welcome you to the 2nd
International Congress of the Infection Control Association of Singapore. I trust that you will
make new friends, renew old ties and come away rich in knowledge, ready to deliver safe care to
your patients.
Dr LING Moi Lin
President
Infection Control Association (Singapore)
Dear Delegates,
It is with great pleasure that I extend a warm welcome to everyone attending the 2nd
International Congress of ICAS.
The Congress will encompass the full gamut of Infection Control with a theme “Towards Safe
Healthcare.” There will be opportunities for many clinicians, microbiologists, infection control
nurses and others to exchange ideas and discuss mutual problems of interest during the two
days of the Congress. I am certain that you will enjoy the benefits of education and make use of
the chance to interact with new and old friends.
Do take time to enjoy the different types of cuisine and attractions that Singapore has to offer.
I wish you a successful and informative congress!
A/Prof Helen OH Co-chair
Organising Committee
Dear Delegates,
We would like to welcome you to the second international congress of the infection control
association of Singapore. I think you will find the program interesting and the speakers
stimulating. More importantly, there will be many opportunities to share lessons learned,
problems, issues and potential solutions among friends and colleagues from across Singapore,
the region and beyond. Our goal is simple - we want healthcare to be safer for our patients. We
want our patients to get better from their medical or surgical conditions without picking up
healthcare associated infections. We are determined to further the art and science of prevention
for safer healthcare for all. Enjoy the conference!
A/Prof Paul TAMBYAH Co-chair
Organising Committee
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INVITED FACULTYINVITED FACULTYINVITED FACULTY
International Faculty
A/Prof Anucha APISARNTHANARAK
Associate Professor & Chief
Infectious Diseases Division
Thammasat University Hospital
Pratumthani, Thailand
Dr Tim BOSWELL
Consultant Medical Microbiologist &
Infection Control Doctor
Department of Clinical Microbiology
Nottingham University Hospitals NHS Trust
Nottingham, UK
Ms Patricia CHING
Senior Nurse
WHO Collaborating Center-Infection Control
Hong Kong
Accreditation Manager
Queen Mary Hospital
Hong Kong, SAR China
Dr Rozaini Bte MOHD. ZAIN
Senior Principal & Assistant Director
Medical Development Division, MOH
Kuala Lumpur, Malaysia
Prof Stephan HARBARTH
Service de Prévention et Contrôle de
l'Infection
Hôpitaux Universitaires de Genève
Genève, Switzerland
Prof Trish M. PERL
Professor of Medicine
Department of Hospital Epidemiology and
Infection Control
Johns Hopkins University
The Johns Hopkins Hospital
Baltimore, Maryland, USA
Dr Hindra Irawan SATARI
Chief,
Division Infectious Diseases and Tropical
Paediatrics
Department Child Health
Faculty of Medicine, University of Indonesia
Chairman of Infection Control Committee
Cipto Mangunkusumo Hospital
Jakarta, Indonesia
Prof SETO Wing Hong
Chief of Service
Department of Microbiology
Chairman
Infection Control Officer
Queen Mary Hospital
Hong Kong, SAR China
Prof Barbara M. SOULE
Practice Leader
Infection
Control Services
Joint Commission Resources, Inc
Washington, USA
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POSTER LISTINGPOSTER LISTINGPOSTER LISTING
S/N Abstract Title
1 Biomarker for Detection of Viral Infection- Neopterin
R Renneberg1, TH Rainer2, CPY Chan1, MF Leung1, KWS Ip1, W Leung1, M Ip3, N
Lee 4, GWH Cautherley5, FYP Kwong 5, CA Graham2, D Fuchs6 1Department of Chemistry, Hong Kong University of Science and Technology 2Accident and Emergency Academic Unit, Chinese University of Hong Kong
Prince of Wales Hospital 3Department of Microbiology 4Department of Medicine and Therapeutics
Chinese University of Hong Kong 5R&C Biogenius Limited
Hong Kong
6Division of Biological Chemistry, Biocentre, Innsbruck Medical University
Australia
2 Level of Secretory Imunoglobulin A (S-IgA) Bronkiolus Kwashiorkor
Rat Model with 38kDA Adhesin Protein Mycbacterium Tuberculosis
WT Andri1, FN Khila1, S Tandya2 1Medical Department 2Clinical Pathology Department
Brawijaya University, Indonesia
3 Inhibitory Activity of Satureja Hortensis Alcoholic Extract and the
Time Effect on the Growth of Opportunistic Fungi , Aspergillus and
Candida in vitro
K Diba1, K Ghabaee2, B Heshmatian2, R Gharagaji2 1Medical Mycology Centre 2School of Medicine
Urmia University of Medical Sciences, Iran
4 Study on Infectious Control at Health Facilities in Penang State
RS Abdul, R Mohd, IC Gaik
State Health Department Penang, Malaysia Ministry of Health, Malaysia
5 Fatal Diphtheria in a Paediatric Patient in Malaysia
RNZ Zainol, NA Mohamed
Department of Medical Microbiology & Immunology
University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
6 Fatal and Non-Fatal Chromobacterium violaceum infections in a
Malaysian Tertiary Hospital
ZR Zetti, A Umi Kalsom, S Anita
Department of Medical Microbiology & Immunology
University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
2nd International Congress of the Infection Control Association (Singapore)
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Reducing Peripherally Inserted Central Catheter (PICC) Related Blood
Stream Infections In Patients Receiving Total Parenteral Nutrition (TPN)
J Li, TY Tan1, HH Han2 1Micro Lab 2Pharmacy
Changi General Hospital, Singapore
Background: Bacteraemic infections from intravascular catheters result in significant
morbidity and mortality. The usage of peripherally inserted central catheters (PICC) has
increased in recent years. The average infection rate for PICC lines is reported to be 2.2
infections per 1,000 catheter days. However, administration of total parenteral nutrition (TPN)
through PICC lines may increase the risk of infection and subsequent bacteraemia.
Aims: This study aimed to reduce PICC line related blood stream infections in patients
receiving TPN in Changi General Hospital.
Methods: Data on PICC line related blood stream infections were monitored for a year prior to
implementation of the project. At the start of the project, three interventions were implemented
over a three month period. Firstly, a new PICC Connector, microClave was introduced in May
2009. Secondly, staff were educated on the use of 2% chlorhexidine with 70% alcohol as the
preferred antiseptic solution when setting up TPN for patients. Finally, the protocol on setting
up TPN was made easily accessible for staff to refer. Rates of PICC line related infection were
monitored continuously through and after implementation of the interventions.
Results: A total of 151 patients who received their TPN through PICC were included in the
study (pre: 62: post: 89). Pre implementation PICC line related blood stream infection rate from
May 2008 to April 2009 was 6.34 infections per 1,000 catheter days. Post implementation from
May 2009 to April 2010, the rate fell to 0.90 infections per 1,000 catheter days. The reduction of
PICC line related blood stream infection was statistically significant (p<0.001).
Conclusions: Catheter-related bloodstream infections are more frequent in PICC lines used for
parenteral nutrition. The implementation of three interventions was effective in reducing PICC
related blood stream infection in patients receiving TPN over a one year period.
Towards Safe Healthcare
3
Local Faculty
Dr Brenda ANG
Senior Consultant
Department of Infectious Diseases,
Tan Tock Seng Hospital
Deputy Clinical Director
Communicable Diseases Centre
Dr Maciej Piotr CHLEBICKI
Consultant
Department of Internal Medicine
Singapore General Hospital
A/Prof Dale FISHER
Associate Professor
Department of Medicine
National University Health System
A/Prof Gamini KUMARASINGHE
Senior Consultant
Department of Laboratory Medicine
National University Health System
Ms Helen GOH
Manager
Infection Control
Ministry of Health, Singapore
A/Prof Serena KOH
Deputy Director
Standards and Quality Improvement Division
Ministry of Health, Singapore
Dr Asok KURUP
Consultant
Mount Elizabeth Hospital
Ms Lily LANG
Lecturer, School of Nursing
Parkway College
Ms LEE Shu Lay
Infection Control Manager
Nursing Administration
Thomson Medical Centre
Ms LEE Lai Chee
Infection Control Nurse Clinician
Singapore General Hospital
A/Prof LEO Yee Sin
Head & Senior Consultant
Department of Infectious Disease
Tan Tock Seng Hospital
Dr LIM Poh Lian
Senior Consultant
Department of Infectious Diseases
Head
Travelers' Health & Vaccination Clinic
Tan Tock Seng Hospital
Dr LING Moi Lin
Senior Consultant
Director of Infection Control
Department of Pathology
Singapore General Hospital
A/Prof Raymond LIN
Head & Senior Consultant
Division of Microbiology
Clinical Director
Division of Molecular Diagnostic Centre
National University Health System
2nd International Congress of the Infection Control Association (Singapore)
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A/Prof Matthias MAIWALD
Consultant in Microbiology
Singapore Department of Pathology and
Laboratory Medicine KK Women's and
Children's Hospital
Ms NG Toon Mae
Senior Manager
Community Care Development Division
Agency for Integrated Care
Ms NG Woei Kian
Nurse Clinician
Infection Control Unit
Tan Tock Seng Hospital
Dr Colin NGEOW
Consultant
St Luke’s Hospital
A/Prof Helen OH
Senior Consultant
Department of Medicine
Changi General Hospital
Dr Surinder Kaur PADA
Associate Consultant
Department of Medicine
Alexandra Hospital
A/Prof POON Wing Hong
Director of Nursing
Ang Mo Kio Thye Hua Kwan Hospital
A/Prof Paul Anantharajah TAMBYAH
Associate Professor
Department of Medicine
National University Health System
Dr TAN Ai Ling
Head & Senior Consultant
Diagnostic Bacteriology section of the
Department of Pathology
Singapore General Hospital
Dr TAN Thuan Tong
Consultant
Department of Infectious Disease
Singapore General Hospital
Dr TAN Woon Hui Natalie
Associate Consultant
Department Paediatric Medicine
KK Women’s and Children’s Hospital
Ms Hatijah Binti TOHID
Infection Control
Singapore General Hospital
Towards Safe Healthcare
33
Control of Nosocomial Spread of Pseudomonas aeruginosa susceptible to
Polymyxin only at a tertiary hospital in Singapore
KB How, ML Ling, JH Seah
Infection Control
Singapore General Hospital, Singapore
Background/Aim: Pseudomonas aeruginosa (PAE) is the fifth most common nosocomial
pathogen and accounted for about 10% of reported nosocomial infections. There is an increasing
prevalence of multidrug resistance among PAE isolates from ICU patients and is a significant
pathogen in immunocompromised patients. We had an outbreak of 13 patients from 2007-2009
in our Haematology wards.
Methods: All patients in the outbreak had PAE susceptible to Polymyxin only grown in clinical
specimens. Environmental sampling was done and included sinks surfaces, sinks‟ drainage
system, douching spray head, shower head, tap outlet and air-conditioner. Both clinical and
environmental samples yielding the outbreak strain were typed using pulse-field gel
electrophoresis (PFGE). Different methods of cleaning were deployed to clean the sinks‟
drainage system to no avail. The Facilities/Plants Engineering helped to source for a new type of
drainage system to replace the old system. In addition, strict infections control practices
especially Contact Precautions and hand hygiene were instituted in the containment of this
outbreak.
Results: The outbreak strain was isolated from the sink drainage system and pulse-field gel
electrophoresis (PFGE) done showed identical DNA profiles. Repeated cultures for the sinks‟
drainage system after the replacement with the new drainage system yielded negative results
for the outbreak strain.
Conclusion: This outbreak highlighted the importance of simple easy-to-clean design in sinks
to minimize the colonization of environmental pathogens that may pose a threat to
immunosuppressed patients. Equally important is the regular maintenance of these areas.
32
FREE PAPER PRESENTATFREE PAPER PRESENTATFREE PAPER PRESENTATIONSIONSIONS
Prevention is Better Than Cure: The Impact of Strict Infection Control on
the Rate of EVD Related Ventriculitis in the Neurosurgical Unit of Hospital
SG Buloh, Malaysia
NH Shaharuddin, SK Chidambaram, CKC Lee
Infectious Disease Unit, Medical Department
Hospital Sungai Buloh, Malaysia
Background/Aim: External ventricular drain (EVD) is a temporary device typically placed in
the setting of acute hydrocephalus for intracranial pressure monitoring and therapeutic
diversion of CSF. It may also be placed for interim management of hydrocephalus during
antibiotic therapy for an infected internalized device that has been removed. All patients
requiring EVD are at risk for developing ventriculitis which is a significant cause of their
morbidity and mortality. The management of patients with EVD-related ventriculitis requires
rapid diagnosis and prompt initiation of appropriate antibiotic (1). Effective infection control
measures are mandatory to reduce the rate of EVD related ventriculitis (2). The objective of
this exercise was to reduce the rate of EVD related ventriculitis in the neurosurgical unit of
Hospital Sungai Buloh, Malaysia by implementing a strict infection control measures in the
EVD care.
Methods: All patients in the neurosurgical unit of Hospital Sungai Buloh, Malaysia admitted
for EVD insertion in the month of June to October 2010 were recruited for continuous
surveillance of EVD related ventriculitis. The EVD care checklist was implemented in their
care.
Results: A total of 55 patients (male: 35, female: 20) were involved. Eleven (20.0%) patients (8
males and 3 females) were diagnosed to have EVD related ventriculitis.
Conclusion: The conduct of continuous surveillance and adherence to an EVD care checklist
has significantly reduced the rate of EVD related ventriculitis in our neurosurgical unit.
References:
Van de Beek D, Drake JM and Tunkel AR. Nosocomial Bacterial Meningitis. NEJM 2010;
362:146-54.
Leverstein-van Hall MA, Hopmans TEM, Willem JB et al. A bundle approach to reduce the
incidence of external ventricular and lumbar drain-related infections. J Neurosurg 112:345–
353, 2010.
5
CONFERENCE INFORMATICONFERENCE INFORMATICONFERENCE INFORMATIONONON
Conference Venue Grand Copthorne Waterfront Hotel Singapore
Level 2, 392 Havelock Road Singapore 169663
Conference Registration Counter The Registration Counter, located at Level 2, Foyer, opens daily from 0800 - 1700 hours.
Conference Name Badge Upon registration you will receive your conference name badge. You are required to wear your
name badge to all sessions and events. Should you lose your name badge, please contact the
Conference Secretariat for a replacement. Please note that replacement fee applies.
Speakers’ Preparation Room The Speakers‟ Preparation Room is located at Level 2, Seagull Room. All speakers should
submit their presentations in Microsoft PowerPoint 2007 or lower version in a CD-ROM or
Thumb Drive, at least 30 minutes prior to their session.
Conference Secretariat The Conference Secretariat is located at Level 2, Penguin Room during the Conference Period.
Exhibition A state-of-the-art exhibition on medical equipment and allied applications will be held at Level
2, Waterfront Ballroom from 0800 - 1630 hours, daily.
CME / CNE Information (Applicable to Singapore registered Healthcare Professionals ONLY)
CME / CNE points will be accorded for attending the workshops and main sessions. Delegates
are required to sign on the attendance record at the beginning of the day and during lunch time,
on a daily basis, at the conference registration counter.
Lost and Found For lost and found items, please approach the Conference Registration Counter.
Conference Language English is the official language of this conference.
Liability The Organisers are not liable for any personal accidents, illnesses, loss or damage to private
properties of delegates during the Conference. Delegates are advised to arrange for appropriate
insurance coverage during the conference period.
Disclaimer Whilst every attempt will be made to ensure that all aspects of the Conference will take place as
scheduled, the Organising Committee reserves the right to make appropriate changes should
the need arises with or without prior notice.
6
Level 2, Grand Copthorne Waterfront Hotel, Singapore
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HOSPITAL ACCREDITATIHOSPITAL ACCREDITATIHOSPITAL ACCREDITATION ANDON ANDON AND
INFECTION CONTROLINFECTION CONTROLINFECTION CONTROL
Strategies to Achieve the Standards in the Prevention and Control of
Infections
Ms Barbara M. SOULE
This presentation will focus on the key infection prevention and control Standards, Measurable
Elements, and the International Patient Safety Goal for Infection Prevention from the Joint
Commission International (JCI). The presentation will include the rationale for the Standards,
the framework they establish for a high quality infection prevention program, and strategies for
successfully complying with the Standards Requirements. Tracer methodology and other
helpful approaches will be presented.
Risk Assessment in Mitigating Infection Control and Prevention
Ms Barbara M. SOULE
The risk assessment is an invaluable tool for directing resources and energy toward those
infection prevention priorities that will be most significant in reducing infection risk. This
presentation will focus on the role of the risk assessment, options for designing and completing
the assessment, and ways to turn the results into actionable processes through a well-designed
infection prevention and control plan. Specific examples will be provided for each of these
activities.
Accreditation (Infection Control) – the Singapore Experience
Dr LING Moi Lin
From 2004, earning the JCI accreditation is a much sought after status by most healthcare
centres in Singapore. The driving forces are high aspirations to deliver quality care to patients
and also as a marketing ploy. As these centres strive to meet the JCI standards for infection
control, awareness on the importance of infection control is being created amongst staff.
Opportunities exist to grow the infection control program as the quality and patient safety
message is promoted across the nation.
30
INFECTION CONTROL IN INTERMEDIATE AND INFECTION CONTROL IN INTERMEDIATE AND INFECTION CONTROL IN INTERMEDIATE AND
LONG TERM CARE FACILLONG TERM CARE FACILLONG TERM CARE FACILITIESITIESITIES
Infection Control at Long Term Care Facilities
A/Prof POON Wing Hong
Our understanding of infections and the development of infection-control programs for long-
term care facilities have progressed over the decade. There is still a limited evaluation of an
effective program or specific intervention to support the use of infection control resources.
With the increase in chronic diseases and ageing population, one has to understand the trend of
diseases at the long term care facilities. This paper will explore the common infections seen in
the long term care facilities such as urinary infection, respiratory infection, and skin and soft
tissue infections. Outbreaks also occur frequently, and some facilities have a high prevalence of
colonization of residents with antimicrobial-resistant organisms.
Developing A Risk Assessment And Measureable Infection Control Plan In
Your Facility
A/Prof Helen OH
Infection prevention and control programs generally are planned around local guidelines and
regulations to optimise quality healthcare. The planning, implementing and evaluation of the
program are coordinated through a team.
Every healthcare facility is unique and has specific needs that must be considered when
developing or organising an infection prevention plan. Some of the factors to be considered
include the size of the facility, the types of patient/resident population and the care provided.
This workshop will:
a) teach the participants to use an evidence-based risk assessment tool to develop an
infection prevention and control plan
b) develop written plans that are clear, concise, realistic, easy to understand and with
measurable outcomes for infection prevention and control within your facility
Performance Measurement and Regulatory Reform in Infection Control in
Transitional Care.
A/Prof POON Wing Hong
In the context of long term care facilities reforms, a system and cultural change is necessary if
long term care facilities is to continue to provide safe and high quality of care. The long term
care facilities system is complex and each has their own governance.
This paper will discuss how to improve the care by using stories, audit evidence and research to
sustain the best practice in infection control so as to provide a better care, safety and quality in
long term care facilities.
7
PROGRAMME PROGRAMME PROGRAMME
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Wo
rk
sh
op
2
Hosp
ital
Acc
red
itati
on
an
d
Infe
ctio
n C
on
trol
L
un
ch
Sy
mp
osiu
m
Lu
nch
Sy
mp
osiu
m
ICA
S A
GM
Sy
mp
osiu
m 3
Ha
nd
Hygie
ne
Sy
mp
osiu
m 4
New
Glo
ba
l T
hre
ats
in I
nfe
ctio
n C
on
trol
Sy
mp
osiu
m 7
Th
e F
utu
re o
f
Infe
ctio
n C
on
trol
Sy
mp
osiu
m 8
Su
rveil
lan
ce
Tea
Brea
k, T
ou
r o
f E
xh
ibit
s &
Vie
win
g o
f P
oste
rs
Ple
na
ry
Lectu
re 1
Th
e F
utu
re o
f In
fect
ion
Con
trol
:
Ch
all
en
ges
an
d O
pp
ort
un
itie
s
Key
no
te 2
Gett
ing Y
ou
r W
ay i
n I
nfe
ctio
n C
on
trol
:
Th
e A
rt o
f P
ers
ua
sion
Key
no
te 3
Pre
ven
tion
of
Su
rgic
al
Sit
e I
nfe
ctio
ns:
A
Tale
of
Nu
mero
us
Gu
ideli
nes
Sa
tell
ite S
ym
po
siu
m
En
d o
f C
on
gress
Morning Afternoon
2nd International Congress of the Infection Control Association (Singapore)
8
Ma
in C
on
gre
ss
Da
y 1
- F
rid
ay
, 18
Fe
bru
ary
20
11
Tim
e
Pro
gra
mm
e
08:0
0 –
08:3
0
Regis
tra
tion
08:3
0 –
08:4
5
Op
en
ing
Cerem
on
y
08:3
0 –
08:4
5
Op
en
ing A
dd
ress
by G
uest
-of-
Hon
ou
r
Dr
Ma
vis
YE
O
Welc
om
e A
dd
ress
A/
Pro
f H
elen
OH
, O
rga
nis
ing C
o-C
ha
irp
erso
n
A/
Pro
f P
au
l A
na
nth
ara
jah
TA
MB
YA
H, O
rga
nis
ing C
o-C
ha
irp
erso
n
Dr
LIN
G M
oi
Lin
, P
resi
den
t of
Infe
ctio
n C
on
trol
Ass
oci
ati
on
(S
inga
pore
)
08:4
5 –
09:4
5
Key
no
te A
dd
ress 1
Ch
air
per
son
: D
r L
IM P
oh
Lia
n
08:4
5 –
09:4
5
Rece
nt
Ad
van
cem
en
ts i
n t
he C
on
trol
of
ICU
In
fect
ion
s
Pro
f S
tep
ha
n H
AR
BA
RT
H
09:4
5 –
10:0
0
Mo
rn
ing
Tea
Brea
k, T
ou
r o
f E
xh
ibit
s &
Vie
win
g o
f P
oste
rs
10:0
0 –
13:0
0
Sy
mp
osiu
m 1
: I
nte
rm
ed
iate
an
d L
on
g T
erm
Ca
re F
acil
itie
s a
nd
MD
RO
s
Ch
air
per
son
s:
A/
Pro
f D
ale
FIS
HE
R
M
s N
G T
oon
Ma
e
10:0
0 –
13:0
0
Sy
mp
osiu
m 2
: D
isin
fecti
on
an
d S
teril
isa
tio
n
Ch
air
per
son
s:
Ms
Patr
icia
CH
ING
M
s L
EE
Sh
u L
ay
10:0
0 –
10:4
5
Infe
ctio
n C
on
trol
Ch
all
en
ges
in t
he I
LT
C S
ett
ing
Dr
Coli
n N
GE
OW
10:0
0 –
11:0
0
Wh
at'
s N
ew
in
Dis
infe
ctio
n
Ms
Patr
icia
CH
ING
10:4
5 –
11:3
0
Are
We W
inn
ing t
he B
att
le A
gain
st M
RS
A?
Dr
LIN
G M
oi
Lin
11:0
0 –
12:0
0
New
Tre
nd
s in
Are
a D
eco
nta
min
ati
on
Dr
Tim
BO
SW
EL
L
11:3
0 –
12:1
5
VR
E:
Ha
s It
Dis
ap
peare
d f
rom
Sin
gap
ore
?
Dr
Ma
ciej
Pio
tr C
HL
EB
ICK
I
12:0
0 –
13:0
0
Ch
all
en
gin
g I
ssu
es
at
the E
nd
osc
op
y U
nit
Ms
LE
E S
hu
La
y
12:1
5 –
13:0
0
Th
e T
hre
at
of
MD
R-G
NB
Pro
f T
rish
M.
PE
RL
Towards Safe Healthcare
29
Surveillance - The Indonesia perspective
Dr Hindra Irawan SATARI
Surveillance is and activity which consists of collecting, interpretation and socialization of the
data continuously which might be an intervention program is possible based on the evidence.
The goal of the surveillance maybe different depends on severity of the disease and possibility of
intervention. So, surveillance activity should have a clear purpose. In this situation surveillance
is important and capable to identify a pandemi that can occur any time.
To achieve the goals, the minister of health in Indonesia trained health care workers from 339
hospitals to have the capability to identify cluster case, developed capacity or system center
laboratorium and regional to confirmed cases as early as possible. Established report system
how to report routine surveillance and outbreak surveillance to the local Health Office,
developed reporting system for school age (as a separate group), developed authority to the local
Health Office to make a fast and right decision to close the school as soon as necessary. Make
sure that specimen distribution or virus isolate fast to achieve fast diagnostic and possibility to
produce vaccine.
Needs of surveillance will change during pandemi, so the clear system should be there to
identify in early the possibility of out break.
Surveillance – Malaysia Perspective
Dr. Rozaini MOHD. ZAIN
Hospital infection control activities have long been established in the Health Ministry hospitals.
A national framework and structure for this vital mission is already in existence with the
National Infection and Antibiotic Control Committee, chaired by the Director General of Health
Malaysia.
Following a meeting in 2001, an Infection Control Unit was created under the Quality in
Medical Care Section, Medical Development Division with the objectives of coordinating,
standardizing and monitoring the infection control programme in the hospitals at the national
level. The activities in the hospitals are coordinated by an infection control team headed by
clinicians and aided by specially-trained Infection Control Nurses.
The outcomes of the implementation of various infection control activities are monitored
through the surveillance of health care-associated infections, alert organism infection, hand
hygiene compliance, antibiotic usage and antimicrobial resistance pattern. The surveillance of
all the above had lead to the initiation of various improvement activities that further reduced
hospital infection rates.
Ventilator Associated Pneumonia was identified as an important factor to the increase
incidences of pneumonia in hospitals following ICU audit. Ventilator care bundles and central
venous catheter care bundles were introduced in the ICU and High Dependency Ward that have
markedly reduced the pneumonia rates in state hospital. The „Clean Care, Safer Care‟
programme had increased the rate of hand hygiene compliance in hospitals and concurrently
reduces the MRSA rates. Targeted surveillance by hospitals with high rates of surgical site
infection incorporating surgical site care bundles, had succeeded in reducing the SSI rate over
the years.
28
SURVEILLANCESURVEILLANCESURVEILLANCE
Surveillance – The Singapore Perspective
A/Prof Serena KOH
Surveillance is an essential component of an effective infection prevention and control program
in any healthcare setting and plays a critical role in identifying trends in emerging infectious
diseases, multi-drug resistant organisms, and pathogen-specific infections so that infection
prevention measures can be instituted.
Nationally, we have set up a taskforce comprising of three workgroups for antimicrobial
stewardship and utilization, antimicrobial resistance and infection control involving infectious
diseases experts; infection control physicians and nurses; microbiologists; and pharmacists to
work together to review trends of antimicrobial utilization, antimicrobial resistance and
healthcare-associated infections at institutions and recommend appropriate national level
strategy and interventions.
Surveillance followed by actions for improvement can have significant impact on the rates of
healthcare-associated infections. In Singapore, data from surveillance have been used
successfully to reduce the occurrence of infections when used in identifying risk factors,
implement risk-reduction measures including monitoring of the effectiveness and sustainability
of the interventions with the goal to improve the quality of healthcare.
Surveillance for Nosocomial Infections: Thailand Perspective
A/Prof Anucha APISARNTHANARAK
Surveillance for nosocomial infections is a crucial part of infection prevention in both developed
and developing countries. With the limitation of resources and infrastructures (e.g., the lack of
national Infection Control committee, the lack of commitment from governmental section, the
lack of continuous effort for surveillance), national surveillance program for nosocomial
infections in developing countries can be challenging. In this session, I will discuss the national
nosocomial surveillance program in Thailand during pre-2003, during 2003-2009 and 2010 and
beyond. Limitations and problems of national surveillance program encountered in Thailand
during each time period will be discussed as well as the solutions to those limitations and
problems. In addition, future direction for national surveillance program for nosocomial
infections will be provided.
Surveillance -A Hospital Perspective
Ms Ng Woei Kian
Surveillance is an important component of an effective infection prevention and control
program. Over the years, surveillance methodology has evolved in response to changes in the
healthcare delivery system. In this session, it will be sharing on a hospital‟s transition to the use
of electronic surveillance and information technology.
Towards Safe Healthcare
9
Da
y 1
- F
rid
ay,
18 F
ebru
ary
2011
Tim
e
Pro
gra
mm
e
13:0
0 –
14:0
0
Lu
nch
Sy
mp
osiu
m b
y S
ch
ulk
e M
ay
r
Ch
air
per
son
s:
A/
Pro
f M
att
hia
s M
AIW
AL
D
14:0
0 –
15:3
0
Sy
mp
osiu
m 3
: H
an
d H
yg
ien
e
Ch
air
per
son
s:
Dr
LIN
G M
oi
Lin
Ms
NG
Woei
Kia
n
Sy
mp
osiu
m 4
: N
ew
Glo
ba
l T
hrea
ts i
n I
nfe
cti
on
Co
ntr
ol
Ch
air
per
son
s:
Dr
Bre
nd
a A
NG
A/
Pro
f H
elen
OH
14:0
0 –
14:3
0
Inn
ovati
ve W
ays
of
Measu
rin
g H
an
d H
ygie
ne C
om
pli
an
ce
Pro
f T
rish
M.
PE
RL
Infl
uen
za: T
hen
an
d N
ow
Pro
f S
ET
O W
ing H
on
g
14:3
0 –
15:0
0
Con
trol
of
MD
RO
s in
Eu
rop
e:
Su
ccess
Sto
ries
an
d
Ch
all
en
ges
Pro
f S
tep
ha
n H
AR
BA
RT
H
Infe
ctio
n C
on
trol
for
MD
R-T
B
Dr
Bre
nd
a A
NG
15:0
0 –
15:3
0
Cre
ati
ve A
pp
roach
es
to H
an
d H
ygie
ne P
rom
oti
on
Dr
Hin
dra
Ira
wa
n S
AT
AR
I
Imp
act
of
Med
ica
l T
ou
rism
on
In
fect
ion
Con
trol
A/
Pro
f H
elen
OH
15:3
0 –
16:0
0
Aft
ern
oo
n T
ea
Brea
k, T
ou
r o
f E
xh
ibit
s &
Vie
win
g o
f P
oste
rs
16:0
0 –
17:0
0
Ple
na
ry
Lectu
re 1
Ch
air
per
son
: P
rof
SE
TO
Win
g H
on
g
16:0
0 –
17:0
0
Th
e F
utu
re o
f In
fect
ion
Con
trol
: C
ha
llen
ges
an
d O
pport
un
itie
s
Dr
LIN
G M
oi
Lin
En
d o
f D
ay
1
17:1
5 –
19:0
0
Sa
tell
ite S
ym
po
siu
m : "
Sa
fe I
V P
ra
cti
ce: W
ha
t W
ork
s"
17:1
5 –
18:0
0
Pre
ven
tion
of
CA
-BS
I in
Th
ail
an
d:
Zero
is
Ach
ievable
wit
h B
est
Pra
ctic
es
A/
Pro
f A
nu
cha
AP
ISA
RN
TH
AN
AR
AK
18:0
0 –
18:4
5
Cu
rren
t pra
ctic
e i
n p
reven
tin
g C
RB
SI
in S
ingapore
Dr
Aso
k K
UR
UP
En
d o
f S
ate
llit
e S
ym
po
siu
m
19:3
0 –
22:0
0
Fa
cu
lty
Din
ner
2nd International Congress of the Infection Control Association (Singapore)
10
Ma
in C
on
gre
ss
Da
y 2
- S
atu
rd
ay
, 19
Fe
bru
ary
20
11
Tim
e
Pro
gra
mm
e
07:4
5 –
08:1
5
Re
gis
tra
tio
n
08:1
5 –
09:0
0
Ple
na
ry
Lectu
re 2
Ch
air
per
son
: A
/P
rof
LE
O Y
ee S
in
08:1
5 –
09:0
0
Deco
lon
isati
on
Pro
f T
rish
M.
PE
RL
09:0
0 –
10:4
5
Sy
mp
osiu
m 5
: S
taff
an
d P
ati
en
t S
afe
ty
Ch
air
per
son
s:
Dr
LIN
G M
oi
Lin
M
rs B
arb
ara
SO
UL
E
Sy
mp
osiu
m 6
: T
he B
ig "
4"
Ch
air
per
son
s:
Dr
Su
rin
der
PA
DA
P
rof
Tri
sh M
PE
RL
09:0
0 –
09:2
5
Do B
un
dle
s re
all
y w
ork
?
Mrs
Ba
rba
ra S
OU
LE
CA
UT
I
A/
Pro
f P
au
l A
na
nth
TA
MB
YA
H
09:2
5 –
09:5
5
Isola
tion
an
d P
ati
en
t S
afe
ty
Ms
Patr
icia
CH
ING
CL
AB
SI
Ms
Hati
jah
TO
HID
09:5
5 –
10:2
0
Pro
tect
ing H
CW
fro
m T
B
Pro
f S
ET
O W
ing H
on
g
VA
P
Dr
Ma
ciej
Pio
tr C
HL
EB
ICK
I
10:2
0 –
10:4
5
Infe
ctio
n C
on
trol
in S
peci
al
Sit
uati
on
s
Dr
Na
tali
e T
AN
SS
I
Pro
f T
rish
M.
PE
RL
10:4
5 –
11:0
0
Mo
rn
ing
Tea
Brea
k, T
ou
r o
f E
xh
ibit
s &
Vie
win
g o
f P
oste
rs
11:0
0 –
11:4
5
Free P
ap
er P
resen
tati
on
s
Ch
air
per
son
s:
Ms
NG
Woei
Kia
n
Dr
Ma
ciej
Pio
tr C
HL
EB
ICK
I
11:0
0 –
11:1
5
Pre
ven
tion
is
Bett
er
Th
an
Cu
re: T
he I
mp
act
of
Str
ict
Infe
ctio
n C
on
trol
on
th
e R
ate
of
EV
D R
ela
ted V
en
tric
uli
tis
in t
he
11:1
5 –
11:3
0
Con
trol
of
Noso
com
ial
Sp
read o
f P
seu
dom
on
as
Aeru
gin
osa
Su
scep
tible
to P
oly
myxin
On
ly a
t a T
ert
iary
Hosp
ital
in
Towards Safe Healthcare
27
Doing Good Research in Infection Control in Southeast Asia
A/Prof Anucha APISARNTHANARAK
While the definition of “good research” can be broad and depends on its clinical applications, the
strict definition of scientific research is performing a methodical study in order to prove a
hypothesis or answer a specific question. Finding a definitive answer is the central goal of any
experimental process. Research must be systematic and follow a series of steps and a rigid
standard protocol. These rules are broadly similar but may vary slightly between the different
fields of science. Scientific research must be organized and undergo planning, including
performing literature reviews of past research and evaluating what questions need to be
answered. Any type of „real‟ research requires some kind of interpretation and an opinion from
the researcher. This opinion is the underlying principle, or question, that establishes the nature
and type of experiment. In this session, I will provide the example of “good research” in
Infection Control in Southeast Asia as well as their clinical applications.
26
Training and Certification of Infection Preventionists
Ms Barbara M SOULE
The discipline of infection prevention and control is changing rapidly and it is critical that
professionals in the field remain current and take a leadership role in advancing the practice in
their organizations. What education is necessary? How can leadership skills be developed? What
role does certification play? What does the future hold for the education and preparation of IPs
to be leaders? This presentation will look into the crystal ball of the future to explore relevant
educational strategies for infection preventionists.
Adult Vaccination to Prevent Infection
A/Prof Helen OH
Immunization is a safe and effective way to prevent life threatening disease in children and
adults. The incidence of most vaccine preventable diseases has shown a significant reduction
recently. The control of infectious diseases, primarily by vaccines and other public health
measures, has doubled the life span during the 20th Century.
Adult immunizations are administered in primary series in previously non-immunized, booster
doses and periodic doses. The recommendations for adult immunizations include Diphtheria and
Tetanus vaccine, polio vaccine, Measles, Mump and Rubella vaccine, influenza virus vaccine,
pneumococcal vaccine, varicella vaccine and hepatitis B vaccine.
A special group at increased risk to diverse infectious diseases is the healthcare worker. All
healthcare workers should be immunized appropriately. Annual immunization with influenza
vaccine, booster doses of tetanus/diphtheria, measles, mumps and rubella vaccine as well as
adequate immunization against varicella are recommended. With the exposure to blood or body
fluids, immunization against hepatitis B is mandatory.
The education and awareness for immunization in adults needs special consideration. With the
advent of new, safe and effective adult vaccines, we can expect renewed interest in adult
immunization.
THE FUTURE OF INFECTTHE FUTURE OF INFECTTHE FUTURE OF INFECTION CONTROLION CONTROLION CONTROL Towards Safe Healthcare
11
Da
y 2
- S
atu
rday, 19 F
ebru
ary
2011
Tim
e
Pro
gra
mm
e
11:3
0 –
11:4
5
Red
uci
ng P
eri
ph
era
lly I
nse
rted
Cen
tral
Cath
ete
r (P
ICC
) R
ela
ted B
lood
Str
eam
In
fect
ion
s in
Pati
en
ts R
ece
ivin
g T
ota
l
Pare
nte
ral
Nu
trit
ion
(T
PN
)
11:4
5 –
13:0
0
Lit
era
ture R
ev
iew
Pa
nel
ists
:
Pro
f T
rish
M P
ER
L
Pro
f S
tep
ha
n H
AR
BA
TH
"W
ha
t's
hot
in I
nfe
ctio
n C
on
trol
"
Ms
LE
E L
ai
Ch
ee
A/
Pro
f P
au
l A
na
nth
TA
MB
YA
H
13:0
0 –
13:4
5
Lu
nch
Sy
mp
osiu
m b
y J
oh
nso
n &
Jo
hn
so
n
Ch
air
per
son
s:
A/
Pro
f G
am
ini
Ku
ma
rasi
ngh
e
Infe
cti
on
Co
ntr
ol
Asso
cia
tio
n (
Sin
ga
po
re)
AG
M
13:4
5 –
15:1
5
Sy
mp
osiu
m 7
: T
he F
utu
re o
f In
fecti
on
Co
ntr
ol
Ch
air
per
son
s:
Ms
Lil
y L
AN
G
A/
Pro
f H
elen
OH
14:0
0 –
15:3
0
Sy
mp
osiu
m 8
: S
urv
eil
lan
ce
Ch
air
per
son
s:
Dr
LIN
G M
oi
Lin
Ms
NG
Woei
Kia
n
13:4
5 –
14:1
5
Tra
inin
g a
nd
Cert
ific
ati
on
of
ICP
s
Ms
Ba
rba
ra S
OU
LE
13:4
5 –
14:1
5
Su
rveil
lan
ce -
Th
e S
ingap
ore
Pers
pect
ive
A/
Pro
f S
eren
a K
OH
14:1
5 –
14:3
0
Su
rveil
lan
ce -
Th
e T
ha
ilan
d P
ers
pect
ive
A/
Pro
f A
nu
cha
AP
ISA
RN
TH
AN
AR
AK
14:1
5 –
14:4
5
Ad
ult
Vacc
inati
on
to P
reven
t In
fect
ion
A/
Pro
f H
elen
OH
14:3
0 –
14:4
5
Su
rveil
lan
ce -
A H
osp
ital
Pers
pect
ive
Ms
NG
Woei
Kia
n
14:4
5 –
15:0
0
Su
rveil
lan
ce -
Th
e I
nd
on
esi
a P
ers
pect
ive
Dr
Hin
dra
Ira
wa
n S
AT
AR
I
14:4
5 –
15:1
5
Doin
g G
ood
Rese
arc
h i
n I
nfe
ctio
n C
on
trol
A/
Pro
f A
nu
cha
AP
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2nd International Congress of the Infection Control Association (Singapore)
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CAUTI
A/Prof Paul Ananth TAMBYAH
Catheter associated urinary tract infections are the most common healthcare associated
infections in hospitals and healthcare facillities worldwide. While the defintions can be
confusing, it is clear that the cathterized urinary tract is uniquely vulnerable to infection.
Understanding the pathogenesis of catheter associated UTIs is key to understanding
prevention. Numerous strategies have been attempted but there still remain challenges. There
are a number of new technologies on the horizon which offer promise to help prevent these
common infections.
CLABSI
Ms Hatijah Binti TOHID
Central line-associated bloodstream infections (CLABSI) are usually serious infections typically
causing a prolongation of hospital stay and increased cost and risk of mortality.
Preventable factors associated with increase risks such as substandard care of central line
catheter or poor observation of sterility during line insertion may result in CLABSI. The use of
the Central Line Bundle, a set of evidence based practice guides that focus on interventions
such as hand hygiene, maximal barrier precautions and chlorhexidine skin antisepsis, is an
effective strategy in reducing CLABSI as proven by studies done by Pronovost et al and
Berenholtz SM et al. This strategy can be duplicated easily in areas with high incidence of
CLABSI to provide a safer and better outcome for the patient.
VAP
Dr Maciej Piotr CHLEBICKI
Ventilator associated pneumonia remains is the second most common nosocomial infection. VAP
is associated with high mortality, increases a patient's hospital stay by approximately 7-9 days
and can increase hospital costs by an average of $40,000 per patient. Several prevention
strategies (especially when combined into "ventilator bundle") helped to reduce the incidence of
VAP in many hospitals around the globe.
THE BIG "4"THE BIG "4"THE BIG "4"
2nd International Congress of the Infection Control Association (Singapore)
24
Isolation and patient safety
Ms Patricia CHING
Patient safety has emerged as an important health care issue because of the consequences of
iatrogenic injuries. Infection control technique of patient isolation may dispose patients to errors
and adverse events. Critics of isolation polices have raised questions about quality of care
whether isolated patients receive less attention. Systematic reviews have been done showing
that patient impact on patients‟ mental well being, patient satisfaction was adversely affected,
an eight-fold increase in adverse events. However, few studies can be included for review as
there well-validated tools are lacking. It is crucial to develop related safety indicators to assess
the adverse effects of isolation to study the problem thoroughly. Patient education may be an
important step to mitigate the effect of adverse psychological effects of isolation. When planning
isolation facilities, extra manpower should be included.
Infection Control in Special Situations-Children and Neonates
Dr Natalie TAN Woon Hui
Health-care associated infections (HAI) in paediatrics include mainly bloodstream infections,
ventilator associated pneumonias, surgical site infections and urinary tract infections. Central
line-associated bloodstream infections (CLABSIs) are the most common HAIs among children in
intensive care units (ICUs).In addition to their clinical morbidity, these infections are also very
costly. Multi-centre paediatric collaborative efforts emphasizing best practices, including the use
of central line insertion and maintenance bundles, have been shown to decrease the rates of
CLABSI. Similarly, implementation of the pediatric ventilator associated pneumonia (VAP)
prevention bundle in one centre showed a reduction in rate of VAP.
Multidrug-resistant organisms (MDRO) such as methicillin-resistant Staphylococcus aureus
(MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant Gram-negative rods
cause a substantial proportion of HAIs and are associated with increased morbidity, mortality,
and cost. Community-associated MRSA (CA-MRSA) infections are increasing in frequency and
are particularly worrisome.
Candida colonization is a risk factor for invasive infection among very low birth weight (VLBW)
and extremely low birth weight (ELBW) infants with a significantly high attributable mortality
rate. Fluconazole prophylaxis for VLBW infants is already widely adopted in many centres.
Although there is evidence for its efficacy in prevention of invasive Candida infections, its use in
low prevalence settings remains questionable.
Towards Safe Healthcare
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PLPLPLENARY LECTURESENARY LECTURESENARY LECTURES
The Future of Infection Control: Challenges and Opportunities
Dr LING Moi Lin
Ongoing developments in the quality and patient safety arena in the early 21st century have
raised awareness of the importance of infection control in the healthcare setting. With the
emergence of new multi-drug resistant organisms e.g. KPCs and NDM-1, we face challenges in
getting an upper hand in the control of healthcare associated outbreaks. Achieving high
standards of patient care will mean higher compliance to infection control practices.
Unfortunately, these compliance rates are often not at desirable levels. The challenge lies in
integrating infection control practices as part of work norms. Opportunities abound as the role
of the infection control professional expands to meet new challenges. Appropriate training plays
a pivotal role in equipping the infection control professional well.
23
Do Bundles Really Work?
Ms Barbara M. SOULE
This talk will explore the evolution of care bundles in the United States and the rationale and
methodology that support this approach to improving patient safety. Care bundles will be
defined and described and examples presented to show results in various care settings and
across organizations in large collaboratives. Different features of care bundle approaches will be
presented as well as strategies that have led to success in using bundles to improve patient
outcomes.
Protecting the Healthcare Worker from Tuberculosis
Prof SETO Wing Hong
Tuberculosis (TB) is a worldwide disease and nosocomial transmission is known to occur.
Authoritative preventive guideline as the one developed by the Centers for Disease Control
(CDC) in America has been published, but the expenses for implementation can be immense.
Developing countries therefore ought to develop protocols customized to the specific needs of the
locality. This was undertaken for all public hospitals in Hong Kong, where TB is endemic at 1
per 1000 annually. In the process, due attention was given to four important elements:
Element one: Integrating important principles from existing guidelines.
Element two: Collecting local epidemiological data
Element three: Taking into account local capabilities and priorities
Element four: Ongoing monitoring for efficacy
The principles in adaption will be described and the guideline for Hong Kong was implemented.
Ongoing monitoring indicates that TB incidence for healthcare workers in the hospitals
continue to be below that of the general population even after age adjustment. An important
principle which would be especially pertinent for developing countries is the use of natural
ventilation for isolation of TB patients. Data will be presented to show that this is highly
effective and affordable for the developing world.
STAFF AND PATIENT SASTAFF AND PATIENT SASTAFF AND PATIENT SAFETYFETYFETY
2nd International Congress of the Infection Control Association (Singapore)
22
Impact of Medical Tourism on Infection Control
A/Prof Helen OH
The medical tourism industry is growing fast. It involves travel for the purpose of delivering
healthcare or travel for the purpose of seeking healthcare.
Health care workers, who travel to areas of high disease endemicity, are exposed to potentially
infectious patients and staff and are placed in an environment that does not offer protection
present in the developed world. Providing vaccinations and prophylaxis and bringing PPE are
essential for risk mitigation.
Services typically sought by medical travellers include joint replacement (hip/knee), cardiac
surgery, dental surgery, transplantation surgery and cosmetic surgery. Outsourcing of medical
and surgical treatment may result in infectious and non-infectious complications.
Some countries such as India, Malaysia and Thailand have very different infectious disease-
related epidemiology compared to Europe and North America. Such communicable disease
exposures include
a) food and water borne infections such as hepatitis A, typhoid and paratyphoid, amoebic
dysentery
b) vector-borne diseases such as malaria, dengue fever
c) airborne infections such as TB
d) blood- borne pathogens such as HIV, Hepatitis B
The risk of nosocomial infections in intensive care is estimated to be 25% in developed countries
but it is twice that (25-40%) in developing countries. There have been numerous reports of
wound infections caused by MRSA, multi-drug resistant Acinetobacter and Pseudomonas
aeruginosa. The recent emergence of multi-resistant NDM-I enterobactericeae has raised the
possibility of its spread worldwide by patients carrying this bacteria from India, Pakistan and
Bangladesh. E. coli and Klebsiella pneumoniae are capable of producing metallo-beta-lactamase
-1 which are resistant to beta-lactam and carbapenems. Early detection and strict Infection
control polices are the best methods for controlling the spread of this new superbug.
15
KEYNOTE ADDRESSKEYNOTE ADDRESSKEYNOTE ADDRESS
Recent advancements in the control of ICU infections
Prof Stephan HARBARTH
The last 2 years provided important and clinically relevant research data for prevention of
infections in critically ill patients. My presentation will summarise the results of these
observational studies and clinical trials and discuss them in the context of the current relevant
scientific and clinical background. In particular, I will discuss recent epidemiologic data on the
epidemiology and impact of nosocomial infections in intensive care units, present new
approaches to prevention of ventilator-associated pneumonia, describe recent advances in
biomarker-guided antibiotic stewardship and attempt to briefly summarise specific challenges
related to the management of infections caused by multidrugresistant microorganisms and
influenza A (H1N1). Overall, infection remains one of the key challenges of critical care and
significantly contributes to morbidity and mortality. Papers published in the last 24 months
remind us that further reductions of nosocomial infection rates are possible – often with the
help of simple interventions.
Getting Your Way in Infection Control: The Art of Persuasion
Prof SETO Wing Hong
Microbiology and Epidemiology have made significant contributions to the field of Infection
Control. Most nosocomial infections, which can be prevented, are related to inappropriate
patient care practices. Therefore to prevent nosocomial infections, we must change patient care
practices, which is really managing the human factor. It is known that the implementation of
new infection control policies can be extremely difficult because of poor staff compliance. To
achieve staff compliance, infection control should learn from the Behavioural Sciences and
Quality Management. There are three related fields in the Behavioural Sciences that are shown
to be helpful in this respect: "Social Psychology, Consumer Behaviour and Organizational
Behaviour". A review of research conducted on the applications of these sciences in Infection
Control will be presented. Studies on the application from Quality Management techniques in
Infection Control will also be reviewed and reported. Although these studies have contributed
to more effective infection control practices, failure persists in certain areas like the
implementation of good hand washing practices. To further understand the dynamics of
infection control, a quantitative ethnographic study by a trained social researcher was
conducted for two years in Queen Mary Hospital. This has resulted in a better understanding of
our previous failures in enhancing handwashing. Based on the findings a strategy for enhancing
handwashing practices was developed and will be reported. The latest thinking on
implementing policies is to use a multi-model approach and much of these are adapted from
management paradigms. A summary will also be given.
2nd International Congress of the Infection Control Association (Singapore)
16
Prevention of Surgical Site Infections: A Tale of Numerous Guidelines
Prof Stephan HARBARTH
The risk of surgical site infection (SSI) is approximately 1-3% for elective clean surgery. Apart
from patient endogenous factors, the role of external risk factors in the pathogenesis of SSI is
well recognized. However, among the many measures to prevent SSI, only some are based on
strong evidence, for example, adequate perioperative administration of prophylactic antibiotics.
This highlights the need for a multimodal approach involving active post-discharge surveillance,
as well as measures at every step of the care process, ranging from the operating theater to
postoperative care. Multicenter or supranational intervention programs based on evidence-
based guidelines, 'bundles' or safety checklists are likely to be beneficial on a global scale.
Although theoretically reducible to zero, the maximal realistic extent by which SSI can be
decreased remains unknown. For many types of operations, the lowest rate of SSI that is
achievable by state-of the- art prevention measures is not zero; some infections are unavoidable.
Moreover, it is flawed to assume that most SSIs are the "fault" of the surgeon or some perceived
shortcoming of process; host factors (e.g., obesity, diabetes mellitus) may predominate in some
cases. Accurate identification of remediable flaws requires direct observation of actual work and
careful interpretation of existing guidelines.
21
Influenza: Then and Now
Prof SETO Wing Hong
The H1N1 pandemic is the first time we have a pandemic for 40 years. A review on the
infectious nature of the disease will be presented. Full data is available comparing the risk of
healthcare workers during the pandemic between clinical and non-clinical staff and this will be
summarized. There is now consensus that the disease is not airborne and that the infection
control measures will be rather similar to seasonal influenza. However certain particular
features will still be required and these will be reviewed. Especially pertinent is the debate over
the use of mask which will be discussed. Furthermore the possibility of infection control
utilizing this platform to further develop the field will be discussed.
Infection ControlInfection Control for MDRTB
Dr Brenda ANG
TB is the most common infectious disease in the world, affecting an estimated one-third of
world‟s population (2 billion people)
Any successes in national TB control programs are now threatened by the development and
spread of resistant strains.
MDRTB ( multidrug-resistant tuberculosis) is defined as TB caused by strains of Mycobacterium
tuberculosis that are resistant to at least isoniazid and rifampicin).
More worrisome is XDR-TB (extensively drug-resistant tuberculosis) defined as MDR-TB plus
resistance to a fluoroquinolone and at least one second-line injectable agent: amikacin,
kanamycin and/or capreomycin.
Drug-susceptible and drug resistant TB are spread the same way. Thus iinfection prevention
and control strategies are similar.
An Infection Prevention and Control Plan includes :
early recognition of patients with suspected or confirmed TB
use of respiratory/cough etiquette
separation of such patients
adequate facilities and environmental control measures
rapid diagnosis
healthcare worker education and protection
All these measures are important for any TB control program, but are even more imperative
when dealing with MDR and XDR TB cases.
NEW GLOBAL THREATS INEW GLOBAL THREATS INEW GLOBAL THREATS IN INFECTION CONTROLN INFECTION CONTROLN INFECTION CONTROL
20
Control of MDROs in Europe: Success Stories and Challenges
Prof Stephan Harbarth
Worldwide control of MDROs remains a challenge. Europe has achieved great progress in this
field over the last 10 years, although differences remain between countries For instance,
several data sources confirm a decrease in the incidence and the prevalence of MRSA. Since
2001, an unprecedented decline of MRSA infection rates in several European countries was
observed (UK, France, Belgium, Denmark, Finland, Turkey, Cyprus, Slovenia and Austria).
This good news indicates that, for the first time, a diverse group of European countries with a
varying baseline prevalence of MRSA was capable of inversing the worrisome trend of
inexorably increasing MRSA rates, thus avoiding extreme peak levels observed in other parts of
the world. Reasons for the observed decline are numerous and will be discussed during this
presentation. These recent findings suggest that the spread of MDROs like MRSA can be curbed
in hospitals, provided that active control programs are implemented. For instance, following the
introduction of specific programs for limiting cross-transmission, first at regional level and
subsequently at national level, MRSA infection rates decreased by almost 50% between 1993
and 2006 in hospitals of the Paris region (Assistance Publique-Hôpitaux de Paris) and by 20%
since 2001 in more than 50 hospitals across France. This decrease has been attributed to the
gradual expansion of infection control structures as well as implementation of specific MRSA
control measures in French hospitals. In Belgium, national activities to contain antimicrobial
resistance have been coordinated by the Belgian Antibiotic Policy Coordination Committee
(BAPCOC) since 1999 and have also achieved great success. These experiences from European
countries are encouraging. They show that it is possible to turn the tide of MDROs through
prudent use of antibiotics and better infection control practices. The challenge is now to get all
European countries take similar action.
Creative Approaches to Hand Hygiene Promotion
Dr Hindra Irawan SATARI
Health care-associated infection (HCAI) places a serious disease burden and has a significant
economic impact on patients and health-care systems throughout the world. Hand hygiene is a
core element of patient safety for the prevention of healthcare-associated infections. Infection
control program in RSCM promote hand hygiene using clear and simple strategy in accordance
with the WHO Guidelines on hand hygiene in Health Care. The approaches consisted of
introducing a locally produced, alcohol-based handrub; monitoring hand hygiene compliance;
providing performance feedback; educating staff; posting reminder in the work place and
promoting hand hygiene. The strategy has been designed synchronization with important
moment, such as influenza A preparedness, hospital anniversary etc. Through the action
strategy, improvement of infrastructures for hand hygiene along with the enhancement of
knowledge and perception about hand hygiene and HCAI and of the patient safety climate is
achieved. Improvement was observed among doctor and nurses.
Promotion of hand hygiene is feasible and effective in Ciptomangunkusumo Hospital because of
motivation and support from the management and all of the healthcare worker. Access to
alcohol-based hand rubs was critical for its success. Hope this approach could be implemented in
developing countries.
HAND HYGIENEHAND HYGIENEHAND HYGIENE
17
Infection Control Challenges in the ILTC Setting
Dr Colin NGEOW
How do we fit in the big picture?
Why do ILTCs exist? In our age of healthcare integration, ILTCs actually act as hubs, not just
providing, but also linking and coordinating services for the neighboring community. ILTCs run
a myriad of services, from residential, rehabilitative, day care, domiciliary services, to family
and caregiver support. There is also a continuous two-way movement of patients / clients from
acute care institutions, through ILTCs to the community at large. With movement of people,
naturally comes exchange of pathogens. Bugs do not recognize institutional borders! How do we
run a diversity of services and at the same time link hands with other agencies and the
community?
Yet there is a mismatch between what is expected of ILTCs and the resources available to
ILTCs: We are small armies fighting big challenges. Challenges exist in terms of day-to-
day infection control, data collection and submission, isolation and transfer of potentially
infective patients, outbreak and pandemic preparedness, training and education, etc. While we
look to our partners for support, we must also adapt and evolve.
The purpose of infection control in ILTCs is not just to defend our institutions, but also entails a
larger community and national role. ILTCs are part of the big picture and we must see
this. Others like acute care institutions must also see ILTCs as part of the big picture:
partners and not handmaidens. Otherwise we will be in trouble: Defense against infectious
diseases is only as good as its weakest link…
Are We Winning the Battle Against MRSA?
Dr LING Moi Lin
The current era of „zero‟ healthcare-associated infections has given a new boost to many facets in
the infection control program of an acute hospital. The successes seen with the implementation
of the MRSA bundle has given many infection control professional much hope in reducing their
healthcare-associated MRSA infection rates. However, the challenge lies in its implementation
as a standard across a nation.
VRE: Has It Disappeared from Singapore?
Dr Maciej Piotr CHLEBICKI
VRE was first isolated in Singapore in 1994 and until 2004 was only sporadically encountered in
our public hospitals. After 2 outbreaks in 2004 and in 2005, VRE has become established in our
healthcare institutions. This lecture will summarize prevention strategies introduced after 2005
and their impact on the incidence of VRE.
INTERMEDIATE AND LONINTERMEDIATE AND LONINTERMEDIATE AND LONG TERM CAREG TERM CAREG TERM CARE
FACILITIES AND MDROSFACILITIES AND MDROSFACILITIES AND MDROS
18
What’s New in Disinfection?
Ms Patricia CHING
Semi-critical objects that touch mucous membranes or skin require a disinfection process that
kills all microorganisms and some bacterial spores. The process of disinfection is more
complicated than when Spaulding first described. The current issues on disinfection are
environmental decontamination, heat sensitive endocopes / ultrasound probes, disinfectant
compatibility, occupational and environmental safety. With the emergency of multidrug
resistant organisms and related hospital outbreak, novel technologies are developed for room
decontamination such as chemical vaporization, UV irradiation, steam disinfection. A review
will be presented to point out the pros and cons of different technologies. Many endo-cavity
diagnostic and therapeutic devices are heat sensitive and yet required quick turn around
because of high usage. New disinfectants and processes will be reviewed and reported.
Challenging issues at the endoscopy unit
Ms LEE Shu Lay
Endoscopy is an important tool for the identification and treatment of many medical conditions.
There should be virtually no risk of transmission of endogenous or exogenous microorganisms if
reprocessing is carried out appropriately, in accordance with reprocessing and infection control
guidelines.
However a significant challenge present at the endoscopy unit because of employees feeling
pressure to work quickly when reprocessing endoscopes. Reprocessing personnel have to rush
the process to quickly turn around the patient-used endoscope so that it is ready for the next
patient. In addition to the pressure on staff to rush the process there is also the challenge of
staff training. Staff training is often overlooked as technology is rapidly changing. Besides, the
manual cleaning phase is prone to human errors such as failing to clean channels or failing to
properly assess if channels are blocked or leaking. Infection transmission associated with
improper reprocessing of endoscope is still a concern. High level disinfection may be inadequate
which may allow infectious organisms to survive and transmitted to another patient through
the use of endoscopes.
There are also occupational health issues attributed to reprocessing endoscopes. Reported
health problems from employees include respiratory ailment related to fumes in the
reprocessing area and physical discomfort such as pain, flexibility, numbness or tingling.
DISINFECTION AND STEDISINFECTION AND STEDISINFECTION AND STERILISATIONRILISATIONRILISATION Towards Safe Healthcare
19
New Trends in Area Decontamination
Dr Tim BOSWELL
The traditional method for decontaminating healthcare environments involves the manual
application of detergent followed, if necessary, by liquid disinfectants. Despite the apparent
effectiveness of liquid disinfectants against a range of pathogenic bacteria in vitro, this
methodology often fails to ensure a clinical environment that is entirely free from potential
pathogens. This is explained by failure to apply disinfectant to all surfaces, failure to ensure
adequate contact times, inappropriate disinfectant concentration and resistance of some
pathogens e.g. Clostridium difficile, to some disinfectants. Studies have shown that ~50% of
surface touch points may be missed by routine cleaning. Others have shown environmental
persistence of pathogens such as C.difficile, norovirus, MRSA and Acinetobacter despite manual
cleaning and disinfection. Recently it has been shown that the risk of acquiring multi-drug
resistant Gram negative pathogens (Acinetobacter and Pseudomonas) is increased in isolation
rooms on ICUs if the previous room occupant was colonised, again suggesting inadequate
environmental decontamination between patients.
Area decontamination is the term used to describe new methods of decontaminating a defined
clinical area, usually by some form of aerosolization of disinfectant. Most studies of this type of
technology within healthcare settings have utilised different forms of hydrogen peroxide (H2O2),
including vaporised H2O2 and a dry-mist H2O2. These systems have demonstrated excellent
efficacy at reducing environmental contamination in single rooms that are contaminated with
MRSA and C.difficile, and when utilised routinely within hospitals, have been associated with
significant reductions in nosocomial C.difficile infection. These systems have also been deployed
for terminal disinfection following outbreaks or cases of VRE, norovirus, Acinetobacter, Serratia,
MRSA, influenza and lassa fever.
There are also reports of systems using ozone and ultraviolet light for area decontamination.
The downside of all these systems is that they can only be used in defined areas that are able to
be sealed, and exposure to patients and healthcare workers needs to be avoided. The whole
process to terminally disinfect a room using these systems takes 2-6 hours. Nevertheless there
is increasing interest in the use of this type of technology within healthcare in high risk
settings, as the terminal disinfection achieved appears to be considerably more reliable than
manual cleaning with disinfectants.