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Infect Dis Health ; 26(2): 123-131, 2021 05.
Article in English | MEDLINE | ID: covidwho-1002590


BACKGROUND: During the ongoing COVID-19 pandemic, healthcare-associated transmission of respiratory viral infections (RVI) is a concern. To reduce the impact of SARS-CoV-2 and other respiratory viruses on patients and healthcare workers (HCWs) we devised and evaluated a multi-tiered infection control strategy with the goal of preventing nosocomial transmission of SARS-CoV2 and other RVIs across a large healthcare campus. METHODS: From January-June 2020, a multi-tiered infection control strategy was implemented across a healthcare campus in Singapore, comprising the largest acute tertiary hospital as well as four other subspecialty centres, with more than 10,000 HCWs. Drawing on our institution's experience with an outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003, this strategy included improved patient segregation and distancing, and heightened infection prevention and control (IPC) measures including universal masking. All symptomatic patients were tested for COVID-19 and common RVIs. RESULTS: A total of 16,162 admissions campus-wide were screened; 7.1% (1155/16,162) tested positive for COVID-19. Less than 5% of COVID-19 cases (39/1155) were initially detected outside of isolation wards in multi-bedded cohorted wards. Improved distancing and enhanced IPC measures successfully mitigated onward spread even amongst COVID-19 cases detected outside of isolation. COVID-19 rates amongst HCWs were kept low (0.13%, 17/13,066) and reflected community acquisition rather than nosocomial spread. Rates of healthcare-associated-RVI amongst inpatients fell to zero and this decrease was sustained even after the lifting of visitor restrictions. CONCLUSION: This multi-tiered infection control strategies can be implemented at-scale to successfully mitigate healthcare-associated transmission of respiratory viral pathogens.

COVID-19/prevention & control , Cross Infection/prevention & control , Respiratory Tract Infections/prevention & control , SARS-CoV-2 , Health Personnel , Humans
J Am Coll Emerg Physicians Open ; 2020 Sep 25.
Article in English | MEDLINE | ID: covidwho-796085


The coronavirus disease 2019 (COVID-19) pandemic has placed large stressors on emergency departments (EDs) worldwide. As the pandemic progressed, EDs faced changing patient epidemiology and numbers. Our ED needed to rapidly transform to deal with the risk of COVID-19. Having limited floor space, we opted for a phased, dynamic response that allowed us to adapt the ED multiple times as the epidemiology of the pandemic evolved. The principles behind our response include guiding ED operations with data, enhancing infection control practices, and being prepared to transform areas of the ED to care for different groups of patients. Our experience can serve to guide other EDs in planning their response to surge capacity and ED operations during such pandemics.

Disaster Med Public Health Prep ; 15(3): e37-e42, 2021 06.
Article in English | MEDLINE | ID: covidwho-647029


Coronavirus disease 2019 (COVID-19), first documented in December 2019, was declared a public health emergency by the World Health Organization (WHO) on January 30, 2020 ( The disease, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has affected more than 9 million people and contributed to at least 490,000 deaths globally as of June 2020, with numbers on the rise ( numbers of patients seeking medical attention during disease outbreaks can overwhelm healthcare facilities, hence requiring an equivalent response from healthcare services. Surge capacity is a concept that has not only been defined as the "ability to respond to a sudden increase in patient care demands" (Hick et al., Disaster Med Public Health Prep. 2008;2:S51-S57) but also to "effectively and rapidly expand capacity" (Watson et al., Milbank Q. 2013;91(1):78-122).This narrative review discusses how Singapore's largest tertiary hospital has encapsulated the elements of surge capability and transformed a peacetime multi-story carpark into a flu screening area in response to the COVID-19 disease outbreak.

COVID-19/diagnosis , COVID-19/epidemiology , Mass Screening/organization & administration , Surge Capacity/organization & administration , Tertiary Care Centers/organization & administration , Disease Outbreaks , Humans , Pandemics , SARS-CoV-2 , Singapore/epidemiology