HAIs

9 July 2012

Question No. 216

Name of person: Mr Gerald Giam Yean Song

To ask the Minister for Health for each of the last three years (a) what has been the healthcare-associated infection (HAI) rate (measured per 100 hospital admissions) in each of the following hospitals: (i) Singapore General Hospital (ii) National University Hospital (iii) Tan Tock Seng Hospital (iv) Changi General Hospital (v) Alexandra Hospital (vi) Khoo Teck Puat Hospital; (b) how many patients are diagnosed with HAIs in these public hospitals; and (c) what are the annual direct medical and non-medical costs on the healthcare system and patients resulting from HAIs.

Answer

1        Leading health experts in the world, such as those from the United States Centres for Disease Control and Prevention (CDC), recommend targeted surveillance of high-risk areas such as Intensive Care Units (ICUs), or specific categories of healthcare procedures such as surgeries. General hospital-wide surveillance of HAIs is not recommended as it is impractical and less informative to guide implementation of infection prevention and control measures, compared to targeted surveillance.  Currently, our public hospitals monitor Surgical Site Infections (SSIs) for Hip Surgery and Coronary Artery By-pass Graft (CABG) procedures and HAIs occurring in ICUs such as Central Line Associated Blood Stream Infection (CLABSI) and Ventilator Associated Pneumonia (VAP) rates.  Acquisition rates of important HAI bacteria are also monitored e.g. Methicillin Resistant Staphylococcus aureus (MRSA).

2        Given the differences in patient types, conditions and the severity of these conditions, it is not meaningful to compare HAI rates across different hospitals.

3        For CLABSI and VAP, our public hospital rates for 2008, 2009 and 2010 were lower than the pooled mean rate for US hospitals participating in the US National Healthcare Safety Network (NHSN) (Tables 1 and 2). For example, in 2010, our CLABSIs rate per 1000 central-line days was 0.58, compared to the NHSN pooled mean of 1.80.   Our hospitals continue to be vigilant and seek to minimise HAIs.

Table 1 – Ventilator Associated Pneumonia (VAP) in Medical ICUs per 1,000 ventilator days

Table 2 – Central Line Associated Blood Stream Infections (CLABSIs) in Medical ICUs per 1,000 central-line days

4        Robust estimates of the costs of HAIs are not readily available.  Based on a recent local study, the incremental hospital costs for a patient due to multidrug resistant gram-negative bacteria infection (a type of HAI) was estimated to be $8,000, most of which was borne by government subsidy.