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SARS SINGAPORE EXPERIENCE

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Title: Key Lessons On Singapore Experience Author: TTSH Last modified by: sammi Created Date: 8/13/2003 3:42:24 AM Document presentation format – PowerPoint PPT presentation

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Title: SARS SINGAPORE EXPERIENCE


1
SARS SINGAPORE EXPERIENCE
  • 2003 Asia Pacific SARS Prevention Forum
  • 29 Sept 2003
  • Taipei

2
TTSH - Daily Activities
140 Admissions
1,600 SOC Attendances
  • 180 Operations
  • 42 Inpatients
  • 58 Ambulatory
  • 360 ED Attendances
  • 75 Ambulance Cases

Overview of TTSH
Based on year 2002
3
INDEX CASE
  • Ms EM,
  • 23-yr-old Chinese female
  • Was in HK 20-25 Feb 03
  • Developed fever and headache since 25 Feb
  • Had dry cough on 28 Feb
  • Admitted on 1 March

CXR on 1 March 2003
Hsu LY, Leo YS et al
4
INDEX CASE
  • She progressively worsened while in hospital,
    with persistent fever despite the use of IV
    Levofloxacin.
  • Developed hypoxia and required close monitoring
    in HD

Hsu LY, Leo YS et al
5
INDEX CASEConclusion
  • IV Vancomycin and oral Oseltamivir were added,
    but these did not seem to help
  • She finally started improving around 10 March
    2003, and is due for discharge soon

11 March 2003
Hsu LY, Leo YS et al
6
Transmission of infection from TTSH, Mar Apr
2003
Index
Ward 5A
TKC
YT
Ward 7D
A
GTL
Ward 8A
J
P
TSC
GTL
TSC
Ward 6A
Community
Heng BH et al
7
Mark Chen, Leo YS et al
8
Location of transmission (n204)
  • No.
  • Hospital/Nursing Home 151 74.0
  • Household 35 17.2
  • Overseas 7 3.4
  • Pasir Panjang Wholesale Market 3 1.5
  • Community 3 1.5
  • Taxi 2 1.0
  • Flight 1 0.5
  • Undefined 2 1.0

Heng BH et al
9
Type of contact (n204)
  • No.
  • Healthcare worker 84 41.1
  • Family 49 24.0
  • Inpatients 24 11.8
  • Visitors to hospital 19 9.3
  • Friends/social contacts 13 6.4
  • Imported 7 3.4
  • Co-workers in market 3 1.5
  • Taxi drivers 2 1.0
  • Undefined 2 1.0
  • Flight stewardess 1 0.5

Heng BH et al
10
Distribution by nationality and gender (n204)
Singaporean 80.8 Filipino 7.8 Chinese
4.9 Indonesian 2.9 Malaysian 2.5 Indian
1.0
Heng BH et al
11
7 generations of SARS transmission
  • Index
  • 1st generation (n21)
  • 2nd generation (n39)
  • 3rd generation (n79)
  • 4th generation (n33)
  • 5th generation (n14)
  • 6th generation (n4)
  • 7th generation (n1)

Imported, 6 cases
Heng BH et al
12
Epidemic curve by generations
Heng BH et al
13
Age distribution of 204 cases of SARS
Heng BH et al
14
SARS Management
  • Disease Management
  • New pathogen
  • Holistic patient care
  • Safety of HCWs
  • Containment
  • Cases detect, insolate, manage
  • Expose contact tracing, quarantine
  • Prevent travel, personal/environment hygiene
  • Planning Ahead

15
SARS Management
  • Characteristic of New Pathogen
  • Incubation
  • Mode of transmission
  • Infectiousness
  • Period of infectiousness
  • Case manifestations

16
SARS Outbreak ManagementConfronting an Unknown
Enemy
  • Time is an essence
  • Determine outbreak
  • Etiologic agent
  • Characteristic of the new disease
  • Formulate counter-measure
  • Review
  • Harness support from all level

17
SARS Management
  • Containment
  • Hospital Infection Control
  • SARS intrahospital transmission
  • Patient to Patient
  • Patient to Staff
  • Patient to Visitor
  • Staff to Patient
  • Staff to Staff
  • Community
  • Home quarantine
  • National
  • Border control

18
Patient x Staff
  • Early identification/detection
  • Isolation
  • Staff don
  • PPE - N95 face mask - glove - goggle - hand
    washing

19
Patient x Patient
  • Early identification/detection
  • Isolation
  • Minimise patient movement

20
Patient x Visitor
  • No visitor
  • Video /Teleconference
  • Compassionate case, visitor in full PPE

21

Staff x Patient
Staff x Staff
  • Monitor temperature 3x /D
  • Report temperature
  • Designated staff clinic
  • No external medical leave
  • Early isolation if febrile
  • Full PPE

22
Effectiveness of Barrier Precautions in
Healthcare Workers
Leo YS et al
23
Heng BH et al
24
Correlation between duration to isolationand
secondary transmission
Interval between date of onset and isolation
Heng BH, Leo YS et al
25
16 June 2003
Chen M, Leo YS et al
26
SARS Challenges to the Health Care System
  • No treatment/no vaccine
  • Initial Symptom non specific and common
  • Epidemiology/pathogenesis poorly understood
  • Diagnostic tests have important limitations
  • Affect HCWs vital human resource
  • Intensive care strain on health care system

27
SARS Management
  • Planning Ahead
  • Vaccine
  • Better diagnostic tools
  • Re-define case definition post SARS
  • Enhanced surveillance
  • Preparedness
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