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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

37

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)

36

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


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

1

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

2

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

35

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



6 Fatal and Non-Fatal Chromobacterium violaceum infections in a

Malaysian Tertiary Hospital

ZR Zetti, A Umi Kalsom, S Anita




34

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.


3

Local Faculty

Dr Brenda ANG

Senior Consultant

Department of Infectious Diseases,

Tan Tock Seng Hospital

Deputy Clinical Director

Communicable Diseases Centre


Consultant

Department of Internal Medicine


A/Prof Dale FISHER

Associate Professor

Department of Medicine

National University Health System

A/Prof Gamini KUMARASINGHE

Senior Consultant

Department of Laboratory Medicine


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


A/Prof LEO Yee Sin

Head & Senior Consultant

Department of Infectious Disease


Dr LIM Poh Lian

Senior Consultant

Department of Infectious Diseases

Head

Travelers' Health & Vaccination Clinic


Dr LING Moi Lin

Senior Consultant

Director of Infection Control

Department of Pathology


A/Prof Raymond LIN


Division of Microbiology

Clinical Director

Division of Molecular Diagnostic Centre



4

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


Dr Colin NGEOW

Consultant

St Luke’s Hospital

A/Prof Helen OH

Senior Consultant


Changi General Hospital

Dr Surinder Kaur PADA

Associate Consultant


Alexandra Hospital

A/Prof POON Wing Hong

Director of Nursing

Ang Mo Kio Thye Hua Kwan Hospital

A/Prof Paul Anantharajah TAMBYAH

Associate Professor



Dr TAN Ai Ling


Diagnostic Bacteriology section of the

Department of Pathology


Dr TAN Thuan Tong

Consultant

Department of Infectious Disease


Dr TAN Woon Hui Natalie

Associate Consultant

Department Paediatric Medicine

KK Women’s and Children’s Hospital

Ms Hatijah Binti TOHID

Infection Control



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


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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31

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


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.


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

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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


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


29

Surveillance - The Indonesia perspective


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


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.


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


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


27

Doing Good Research in Infection Control in Southeast Asia


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.

http://www.experiment-resources.com/research-hypothesis.html

http://www.experiment-resources.com/defining-a-research-problem.html

http://www.experiment-resources.com/experimental-research.html

http://www.experiment-resources.com/what-is-research.html

http://www.experiment-resources.com/steps-of-the-scientific-method.html

http://www.experiment-resources.com/what-is-a-literature-review.html

http://www.experiment-resources.com/defining-a-research-problem.html

http://www.experiment-resources.com/conducting-an-experiment.html

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

ISA

RN

TH

AN

AR

AK

15:0

0 –

15:1

5

Su

rveil

lan

ce -

Th

e M

ala

ysi

a P

ers

pect

ive

Dr

Roza

ini

Bt.

MO

HD

. Z

AIN


12

Da

y 2

- S

atu

rday, 19 F

ebru

ary

2011

Tim

e

Pro

gra

mm

e

15:1

5 –

15:3

0

Aft

ern

oo

n T

ea

Brea

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25

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


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"


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.


13

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14

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


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


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.


16

Prevention of Surgical Site Infections: A Tale of Numerous Guidelines


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


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?


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.

PROGRAMME BOOKLET - new.icas.org.sg

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