Issue #4. May 2015
Institute of Infectious Diseases and Epidemiology
Message
from the Director
National Centre of Infectious Diseases (NCID) Ground Breaking Ceremony
Welcome to the fourth issue of the IIDE newsletter. Last year, we have taken another step to shape new transformations and meet the nation’s healthcare needs with the groundbreaking of Tan Tock Seng Hospital’s National Centre of Infectious Diseases (NCID). The NCID development, to be opened progressively from 2018, was planned with the future in mind, to synergize the clinical management of infectious diseases with public health surveillance and diagnosis, and to enhance Singapore’s ability to respond to infectious disease outbreaks. This year, there will be more exciting activities and events in IIDE. Partnering with multiple collaborators, we have just concluded the inaugural Courage Fund Infectious Disease Conference held on 11- 13 March 2015. In this issue, we are pleased to share more details of our journey with you and hope that you can continue to partner and work alongside us.
Prof Leo Yee Sin Director, Institute of Infectious Disease and Epidemiology Clinical Director, Communicable Disease Centre Senior Consultant, Department of Infectious Diseases Tan Tock Seng Hospital
Groundbreaking Ceremony
with facilities designed to complement outbreak management and infection control. Key features include a screening centre that can hold over 500 patients and ward cubicles that can be turned into isolation rooms. NCID’s facilities are expected to open progressively by end of 2018. Performance during the Ceremony
On 4 November 2014, the new National Centre of Infectious Diseases (NCID) held its ground-breaking ceremony officiated by Guest-of-Honour Mr. Gan Kim Yong, Minister for Health. Under the Health City Novena Master Plan, NCID aims to improve Singapore’s response to disease outbreaks by integrating the clinical management of infectious diseases with public health surveillance and outbreak management. NCID will be a 14-storey centre with 330 beds in 17 wards,
Prof Leo Yee Sin, Director, Institute of Infectious Diseases and Epidemiology, said “While we are always vigilant, prepared and proactive in our response to impending threats, we must never rest on our laurels to constantly improve our processes and capabilities to protect our community. As a leader in the clinical management of infectious diseases, the NCID will not only relieve the stress on our current healthcare systems but also enable us to respond and combat the crippling effects of such diseases effectively”.
past Events
Inaugural Courage Fund Infectious Diseases Conference
Top left: Dr Sebastian Maurer-Stroh, A/Prof Hsu Li Yang, Dr Jeffrey Cutter, Dr Naomi Komadina, A/Prof Vernon Lee, Mr Chua Tze Hoong (AVA), A/Prof Mark Chen, A/Prof Angela Chow,. Bottom Left: Dr Alan Hay, Prof Leo Yee Sin, Dr Hanns-Christoph Eiden, A/Prof Lim Poh Lian, Dr Derrick Heng
Advancing Surveillance of Emerging Infectious Diseases This 2 day symposium was organised by IIDE and the Global Initiative on Sharing All Influenza Data (GISAID). GISAID actively promotes the international sharing of influenza virus genetic sequences, related clinical and epidemiological data associated with human infection, and geographic and species-specific data associated with avian and other animal influenza viruses. The event attracted 86 healthcare professionals
Singapore AIDS Conference – Seeking Solutions The 9th Singapore AIDS Conference (SAC) was held on Saturday, 29 November 2014 at the Tan Tock Seng Hospital (TTSH). It was jointly organised by Action for Aids (AFA) and IIDE. Dr Amy Khor, Senior Minister of State for Health, graced the occasion and updated the community about changes in financial assistance for HIV treatment. These developments may help to reduce barriers to HIV testing and treatment. The theme for this year’s SAC was “Seeking Solutions”. Dr Anton Pozniak from London delivered the keynote address on the prospects of a cure for HIV. There were also two plenary lectures. Professor Thirumoorthy delivered the first plenary lecture on ethical issues in HIV medicine while Professor Leo Yee Sin delivered
Sp
from 17 countries. It discussed multi-sectoral collaboration and surveillance in combating emerging infectious diseases. In addition, a bioinformatics workshop was held on the second day. This workshop provided training on GISAID’s publicly accessible EpiFlu™ Database which can be used to monitor complex epidemiological relationships among animal and human influenza viruses and the detection and interpretation of evolutionary change.
From left: Prof Roy Chan, A/Prof Lee Cheng Chuan, Keynote Speaker Dr Anton Pozniak and Prof Leo Yee Sin
the second plenary lecture on the medical and non-medical cost of HIV infections. There were five symposia organised during the conference. They covered a wide range of topics such as HIV testing and prevention, high risk sexual behaviour in men who have sex with men (MSM) and ethical dilemmas in the management of people living with HIV. At the conference, Professor Leo Yee Sin (TTSH), Professor Roy Chan (AFA), Associate Professor Wong Mee Lian (National University of Singapore) and the Department of Sexually Transmitted Infections Control Clinic were presented the Red Ribbon awards for their efforts in HIV care and prevention.
The inaugural Courage Fund Infectious Disease Conference (CFIDC) on 11- 13 March 2015 marked TTSH’s firm commitment to strengthen its Delegates at a breakout session defence against emerging outbreaks and to enhance clinical care of patients. This conference was an important event for the exchange of knowledge and expertise to tackle pressing health challenges posed by infectious diseases. The Courage Fund provided seed funding for CFIDC and IIDE (Tan Tock Seng Hospital) was one of the main organisers, together with National University of Singapore, National University of Singapore, Agency for Science, Technology and Research, Singapore General Hospital, Duke-NUS, Lee Kong Chian School of Medicine, Singapore Society of Pathology, Society of Infectious Disease Singapore and Singapore Infectious Diseases Initiative. Guest of Honour, Prof Tan Chorh Chuan, President of the National University of Singapore delivered the opening address for the conference. This was followed by the keynote address by Prof Malik Peiris who spoke on emerging viral infections: The One Health Approach. The two days were packed with parallel sessions with topics ranging from vector borne infections, emerging pathogens, vaccines and therapeutics, respiratory infections and antimicrobial resistance. There were also poster sessions and oral abstract presentations. 300 infectious disease experts, public health practitioners, healthcare workers and medical students attended this conference. Additionally, IIDE and the Singapore ID Clinical Research Network (SCRN) organised a preconference clinical research network meeting on “Clinical Trials in Bacteraemia” on 11 Mar 2015. The event was well-attended with 50 participants from the Asia-Pacific and Australasian regions.
From Left, Mdm Kay Kuok, Prof Leo Yee Sin, Prof Tan Chorh Chuan (Guest of Honour) and Prof Malik Peiris (Keynote Speaker)
tlight
Outreach Programmes in Patient Care Centre
Patient Care Centre (PCC), located within the grounds of the Communicable Disease Centre, is a community-based hospital project that was set up in 1997. PCC aims to extend care to patients with HIV/AIDS, the needy and disabled through the provision of opportunities for our beneficiaries to contribute back to society. Programmes and activities are run under the Tan Tock Seng Hospital Community Fund and outreach programmes are organised frequently to provide support to
St Joseph Institution International students helping out with gardening
the beneficiaries and to raise funds for PCC’s activities. 2014 was an exciting year for PCC as it organised several community outreach projects involving collaborations with local schools and communities. Anderson Junior College, NUS High School, NUS University Scholars Programme, St Joseph Institution International and United World College (SEA) participated in various volunteer and
Volunteers hard at work with the handicrafts
fundraising activities in PCC. Every month, the volunteers would join patients in making art and craft pieces to raise funds for PCC. PCC will continue with its effort to reach out to the community in 2015. St. Joseph Institution International students have organised a musical concert to raise funds for the centre. Funds raised will be channelled to support patients with their medications, nutrition and other relevant programmes.
Special Features
How TTSH preps for a potential Ebola outbreak Ebola virus disease is a severe, often fatal illness, with a mortality rate of up to 90%. Given the ongoing Ebola outbreak that has affected some countries in West Africa, it is necessary and important to prepare ourselves for management of Ebola infections. We take this opportunity to interview Dr Shawn Vasoo from the Department of Infectious Disease TTSH, who, is the main clinical lead for Ebola preparedness training. What is EVEREST? EVEREST is an acronym for our Ebola Team simulation training - and it stands for:
Ebola Virus disease (EVD) Viral Haemorrhagic Fever (VHF) REadiness Simulation Training Can you describe the training? The training lasts a full afternoon at SIMTAC (Simulation and Integrated Medical Training Advancement Centre) at TTSH, and has two components: Task Training, and Acute Medical Scenarios. The objectives of the course are for team members to develop competence and confidence in performing common medical tasks and responding to acute medical emergencies for suspect/confirmed EVD patients while in personal protective equipment (PPE) for EVD.
What are some of the special considerations in handling Ebola patients? Ebola virus disease (EVD) and other viral haemorrhagic fevers (VHF) are transmitted human to human via contact with infected body fluids. EVD carries a mortality rate of up to 50-90%. Enhanced personal protective equipment (PPE) is necessary for healthcare workers (HCWs) caring for patients with suspected/confirmed EVD/VHF, but HCWs may be unfamiliar with caring for patients, especially in PPE. Caring for such patients may be stressful due to the nature of the patient’s illness, unfamiliarity with performing common tasks in PPE, which is compounded if an acute medical condition arises. Performing procedures while being unfamiliar with PPE increases the risks of medical/ procedural errors and lapses in infection
control, with risk of infection of HCWs. All our training activities, including the drills, aim to prepare Team Members to care for patients with EVD, and other emerging pathogens. I understand that there is a lot of focus on training for medical procedures in EVD patients. Task trainings are station based and include procedures like: Venepuncture, Peripheral intravenous cannulation, urinary catheter insertion, intubation, spill Management and waste disposal. These are common procedures that trainees already know how to do. However, in the context of EVD, besides PPE, some procedural have been modified to enhance safety. The second component of the training is the Acute Medical Scenario - each participant gets to participate and also observe a scenario will run for approximately 10 minutes, which is followed by a structured debrief. EVEREST is part of the training for Ebola Core Team members, besides training in the usage of PPE, and on-the-ground ORPD (Operational Ready Preparedness Drills).
What are the different types of drills? In the beginning, a bigger team was trained, however, we have since then a multidisciplinary, smaller Ebola Core Team has been formed so
Dr Shawn Vasoo, Clinical lead for Ebola preparedness
that training efforts and be focussed. Internally, the Core Team is involved in ORPDs, and also drills with other restructured hospitals (e.g. KKWCH, who will provide a team to care for paediatric/obstetric patients on site at TTSH). We also have externally audited drills (Exercise Sparrowhawk), conducted by the Ministry of Health.
How did we prepare for the drills? “Just do it!” - Yes there was a lot of leg work, and coordinating to do prior to the drills - the Ebola Work Group (EWG, a TTSH Hospital Committee) was kept quite busy, and training and drills were a major focus of the EWG. Drills are multidisciplinary - involving different departments (e.g. ID, ICU, Anaesthesia, nursing, DLM, radiology, environmental services, Ops). Departments were very supportive in giving staff dedicated time for both EVEREST and the drills. So while there was “preparing” to do for drills, you may never or will never probably be 100% prepared for a drill, but the objective is to make everyone as prepared as possible when the button is pressed and an actual patient is admitted. The drills are meant to prepare staff, and also uncover any deficiencies for correction - which they did, and these were very helpful learning experiences for the team.
Group picture after a training session.
Singapore Immunocompromised Infections Intensive care Group (SIIIG) SIIIG Chairperson: Dr Ling Li Min
Infections in ICU and immunocompromised hosts are associated with significant costs and mortality. There are local experts already involved in multi-disciplinary collaborations with respect to infection management in these patients within their institutions. The Singapore Immunocompromised Infections Intensive care Group (SIIIG) came about to unite these clinicians, healthcare professionals and researchers for national-level clinical research which will impact clinical care for this population. Currently, members are from
Tan Tock Seng Hospital, Singapore General Hospital and National University Hospital System. SIIIG was established in July 2014 with a base funding of $330,000 from The Courage Fund Board. It is currently chaired by Senior Consultant, Dr Ling Li Min from Tan Tock Seng Hospital and co-chaired by Dr Lawrence Lee from National University Health System. For the next 2 years, SIIIG aims to build national capacity for Therapeutic Drug Monitoring (TDM) for beta-lactams and triazole. It involves blood-taking at specific
timings to determine drug levels. Currently, this will be performed for only ICU/ Haematology hosts as they exhibit variable and unpredictable clearance from day to day. The ability to determine beta-lactam or triazole levels, will revolutionise infection management for such patients.. SIIIG is a first in Singapore and first in the world to incorporate an intensive care aspect. In the near future, SIIIG seeks to be a platform for development and consolidation of expertise necessary for keeping Singapore at the forefront of cutting-edge infection management of immunocompromised and ICU hosts.
upcoming events
Awards & Accolades
Harvest Day Service Challenge (Team Award)
Outpatient Group 1 – OPAT
13 June 2015 I Holiday Inn Singapore Atrium
Outpatient Group 3 – SOCJ
Elsevier-ASTMH Clinical Research Award 2014 Asian Society for
Cardiovascular & Thoracic Surgery (ASCVTS) Leaders Programme
Dr Vincent Pang Junxiong Senior Research Fellow • Project title: Discovery and Validation of Prognostic Biomarker Models to Guide Triage among Adult Dengue Patients at Early Infection The Elsevier-ASTMH Clinical Research Award recognizes excellence in clinically oriented research presented by a student of work submitted and presented at the ASTMH Annual Meeting 2014.
Topic: Crisis Management
30 June 2015 I Blk 802, Multi-purpose Hall, IIDE (CDC)
newsroom
External Visitors
Division of Infection Control and Biosafety – Centers for Disease Control Taiwan, 25 & 26 November 2014
University of Health Sciences Cambodia – 28 November 2014
Wuxi Fifth People’s Hospital China – 2 December 2014
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Editorial Team • Dr Wong Chia Siong • Dr Barnaby Young • RN Amy John • Ms Koh Yi Ting • Ms Chloe Ho
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