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In early June 2015, SGH noted an increased frequency of newly-diagnosed hepatitis C virus infections in a renal ward. This triggered an urgent step up in checking for hepatitis C virus infection in patients with abnormal liver function test results staying in the same ward.

To date, 22 patients who were hospitalised during the period of April to June 2015 have been diagnosed with hepatitis C virus infection. Of these, four patients with multiple co-morbidities and severe sepsis have passed away, and while they were very ill with other serious conditions, we are not able to rule out the possibility that hepatitis C virus infection could have been a contributing factor. Another three deaths have been thoroughly evaluated and no link to the hepatitis C virus infection has been established. All cases were reviewed by a Medical Review Committee, set up in consultation with the Ministry of Health and chaired by an external senior hepatologist. One recent death is pending review.

Prof Ang Chong Lye, Chief Executive Officer, SGH:

"We would like to apologise unreservedly for the grief, pain and anguish this has caused our patients and their families. Our care team is closest to them. They too feel the pain deeply as the patients have been under their care for years.

Patient safety is non-negotiable. What happens to our patients is always our responsibility. We will spare no effort in reviewing our processes and examining all possible sources of infection to prevent recurrence. We have been in touch with affected patients and their families. We will continue to provide full support and the appropriate care in managing their condition."

Prof Fong Kok Yong, Chairman, Medical Board, SGH:

"Investigations are ongoing and there is as yet no conclusive evidence as to what caused the cluster of infections. To ensure early containment of infection, we have taken aggressive steps to rectify any shortcomings detected in the investigations; and eliminate, as far as practical, all possible sources of infection. Since these actions were taken, there had been no new cases of hepatitis C virus infection.

To ensure thoroughness in our investigations, we have started hepatitis C screening for the care team, including doctors and nurses who provide direct care to renal patients. We are extending the screening to other doctors who covered the ward during the period.

We will also be proactively contacting patients who were admitted to Wards 64A and 67 from January to June 2015 for screening."

Steps taken by the Hospital

Full investigations and involvement of our infection control team started the moment we noticed the clustering of seven cases within four weeks, which is unusual.

The infection control team was alerted immediately to review and examine the hospital processes and all possible sources/routes of infection.

Our initial investigation showed that all 22 patients were admitted and stayed in the newly-renovated Ward 67 with overlapping periods of stay between April and June 2015, while the original renal ward, Ward 64A, was being renovated.

All the patients have some form of renal disease and a majority had past history of end-stage renal failure and/or renal transplant done. Nine were transplanted within the past 12 months and 10 were transplanted more than a year ago. There are three non-transplant renal patients in the cohort of 22. Nearly half had recent high-dose immunosuppression therapy for renal allograft rejection.

For this cluster of 22 cases, investigations of recipients of the other renal allografts who shared the same donor (as the abovementioned patients) have excluded the renal donor as a source of the infection.

Genetic analysis of the hepatitis C virus isolated from these patients to establish the relatedness of the cases was done. Preliminary data suggested that they are a related, distinct cluster. Further validation testing is being carried out with the assistance of an external laboratory.

Our initial investigation indicated that the source of infection might be due to intravenous (IV) injectable agents. The Hospital took immediate precautionary measures to fortify our infection control measures, including stopping long established and accepted practices in healthcare institutions, such as multi-dosing, just to be safe.

To date, we have screened all patients with abnormal liver function test and no new hepatitis C case related to admission outside the high risk period (April to June 2015) has been identified.

We are proactively contacting all patients who were admitted to Wards 64A and 67 from January to June 2015 for screening.

Frequently Asked Questions

1. What is hepatitis C and how is it transmitted?
   Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). HCV is transmitted mainly by blood-borne routes although it can also be spread through other body fluid e.g. semen if patients have concomitant HIV infection. Hepatitis C virus infection is not air-borne like SARS.
   
   Acute hepatitis C virus infection is usually asymptomatic in normal individuals, i.e. non immunosuppressed patients, and is only very rarely associated with acutely life-threatening disease.
   
   2) How was the cluster of hepatitis C virus infection detected?
   In early June 2015, doctors in a renal ward noted an increased frequency of newly-diagnosed hepatitis C virus infections in the ward. This triggered an urgent step up in checking for hepatitis C virus infection in patients who had abnormal liver function test results staying in the same ward.
   
   3) Has the Hospital identified the source of the infection?
   We are still in the process of thoroughly reviewing and examining our processes and all possible sources of infection.
   
   4) Is the ward "contaminated"? Any plan to "clean up" the ward?
   Hepatitis C virus infection is not air-borne like SARS. "Cleaning up" the facility is irrelevant in this context. Nonetheless, we have taken the opportunity to tighten our infection control practice by conducting an additional round of environmental cleaning.
   
   5) How sure is the Hospital that the hepatitis C virus infection will not affect patients in other wards? What assurance can SGH patients and their families have that they are not at risk?
   Hepatitis C virus is spread mainly through blood, unlike SARS which is airborne. In the absence of venous access and unprotected open wound, it should be safe – especially for patient's family.
   
   For patients, strict sterile practice, with no sharing of needles and syringes, will prevent spread. Such standards are strictly observed. Nonetheless, we are reviewing all our processes and implementing more stringent measures.
   
   6) What is the treatment for hepatitis C virus infection?
   Treatment is available for hepatitis C virus infection to prevent the onset of complications, such as cirrhosis. Complications such as cirrhosis typically take years to occur, if left untreated for a prolonged period.
   
   Antiviral medicines can cure approximately up to 90% of persons with hepatitis C virus infection. Treatment needs and their response vary from patient to patient. Some patients may be asymptomatic (ie, may not show signs of disease) for years. Treatment is based on international guidelines and best practices.