When COVID-19 struck Singapore early last year, it was immediately clear that infection control and prevention was going to be a crucial frontline defence to prevent the spread of the virus. This is especially important for patients undergoing treatment at the National Cancer Centre Singapore (NCCS) as many are immunocompromised and considered to be a high-risk group. Because of this, it was imperative to keep NCCS free from any infection so that patients could safely continue treatment.
Thankfully, NCCS has Dr Yap Swee Peng, the Chairperson of the Infection Prevention and Control Committee, and Senior Nurse Clinician (SNC) Priscilla Han, lead in the Infection Control Unit, to steer the way.
“What is the role of infection control at NCCS?” Dr Yap Swee Peng, the head of the Infection Prevention and Control Committee in NCCS for six years, considers the question. “It is ensuring that no patient gets an infection while at NCCS nor passes it to staff, maintaining stringent hand hygiene measures and a high standard of environmental cleanliness and hygiene, and vaccinating and protecting our staff.”
While these measures were already in place at NCCS before February 2020, it became clear that stricter measures had to be implemented to ensure continuity of care for patients during the pandemic.
NCCS implemented Disease Outbreak Response (DORS) measures that included strict infection prevention, prudent resource and manpower allocation, and adaptation of treatments throughout NCCS. Also, Dr Yap oversaw the setup of a fever clinic to be the first point of screening for any patients who could potentially have COVID-19.
Outside the National Cancer Centre Singapore, staff screen patients who arrive with fever or any respiratory symptoms and perform triage at the fever clinic
The fever clinic at NCCS, housed outside the building, screens patients who arrive with fever or any respiratory symptoms, which may indicate possible COVID-19 infection. Patients are triaged by NCCS staff based on their symptoms and potential exposure, and are swabbed for COVID-19 if required. Patients are then either admitted to Singapore General Hospital if unwell, or sent home to await the results of the swab test, and their appointments are deferred to a later date.
Separating patients who may have suspected COVID-19 from other patients is one of the ways that NCCS has been able to avoid the transmission of the virus within NCCS. Still, this is not without its challenges.
A National Cancer Centre Singapore doctor in full personal protective equipment in the fever clinic
“We had to pivot very quickly to set up the fever clinic. It was a scramble to find the space for the temporary tentage and to create isolation rooms for higher risk patients,” reflected Dr Yap. “More training for our staff who run the fever clinic was needed to reassure the patients who are isolated in the clinic, as they are understandably anxious.”
In addition to the heightened measures for COVID-19, maintaining the standard for infection control measures in NCCS and assessing them is done by SNC Priscilla Han and team. A champion of infection control in NCCS since joining in 2009, SNC Priscilla monitors spaces and activities for infection control, and incorporates measures into risk management plans so that infection control is managed at a systemic level.
SNC Priscilla and her team train and educate staff to undergo proper hand hygiene training and the appropriate knowledge of infection control and preventive measures. They ensure that these standards are upheld in clinical areas. Her team also conducts audits and provides suggestions for improvement. Much of the information is incorporated into online training materials and made available on the NCCS intranet for self-learning. The biannual flu vaccination exercise is also conducted by her team.
Dr Yap Swee Peng (far left), Division of Radiation Oncology, and Senior Nurse Clinician Priscilla Han (second from right), Infection Control Unit, National Cancer Centre Singapore, and team in a picture taken before 2020
With COVID-19, the nurses’ team had to add one more duty to their roster. Fitting staff with N95 masks and training them on the proper way to use it together with donning of the personal protective equipment (PPE). Scheduling NCCS staff for mask and PPE fitting within a short time span was a challenge, as was the actual logistics of making sure there were enough masks and PPE.
“At the beginning of the pandemic, we also had to make sure we had a steady supply of the masks and it wasn’t clear if there would be enough masks for everyone,” shared SNC Priscilla.
Anxious patients, a shortage of supplies, scheduling difficulties and ensuring a smooth workflow while implementing social distancing, were a few of the challenges Dr Yap and SNC Priscilla had to contend with. However, it is clear that one thing kept them focused to put in the hard work and overtime for these past few months.
“At the end of the day, people trust us to look after their loved ones,” said SNC Priscilla. “So we must do it.”
This commitment to delivering the best care to patients allowed patients who required chemotherapy, radiotherapy or surgery, as well as patients who are on maintenance treatment, to continue to receive timely treatment without disruption at NCCS.
Dr Yap is already planning ahead. “I think it’s important to plan for future pandemics, what kind of procedures can we modify to minimise infection transmission in NCCS, even further?”
It is clear that the NCCS Infection Prevention and Control team will not rest as they work to ensure NCCS can deliver timely care to patients.
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