SGH is still hiding behind its stance that multi-dosing is a “long established and accepted practice in healthcare institutions”.
Is that true?
Healthcare experts in Canada had already warned the public not to engage in such a practice in the wake of, yes, a Hepatitis C outbreak at colonoscopy clinics.
When did this outbreak take place? September 2014 – almost a year before Singapore’s outbreak.
Public Health Ontario, on its website, states that “unsafe injection practices” involving the vials can cause disease transmission.
As far back as 2010, the World Health Organisation too strongly discouraged multi-dosing, saying it could cause cross-contamination between patients.
“Whenever possible, use a single-dose vial for each patient, to reduce cross-contamination between patients… Only use multidose vials if there is no alternative.”
What exactly is multi-dosing?
That’s when a vial of medicine is shared between patients.
Different syringes are used to extract the medicine which is then injected into patients, while the vial containing the medicine remains the same.
But all it takes is one contaminated syringe to spoil the whole vial, which then causes infection to spread in others injected with the same medicine.
Therein lies the danger.
What’s scary in the case of Singapore’s Hepatitis C outbreak is – did the infections only stop because the vial of medicine ran out?
Because had that source of medicine been larger, more people would have been infected given the SGH’s dawdling and pithy attempts NOT to shut down the infection, BUT to shut out everyone else from knowing about it.
But back to the history of infections due to multi-dosing.
In 2008, 5 people were infected at a US outpatient cardiology clinic with Hepatitis C (with 2 more suspected cases), also because of multi-dose vial contamination.
Warnings against the use of multi-dose vials has been documented in medical literature.
In a US patient advisory highlighting a separate 2008 incident:
“The consequence of sharing multidose vials was dramatically illustrated by an occurrence elsewhere that made national news. In February 2008, the Southern Nevada Health District reported findings from an investigation arising from a cluster of hepatitis C virus (HCV) infections in their area. The health district’s investigation uncovered that six patients infected with the HCV had undergone procedures at the Endoscopy Center of Southern Nevada.”
And there’s more documented cases of the dangers of multi-dosing, from Tehran to Germany.
Why then, the persistence in using multi-dose vials?
Well, they’re cheaper, says the WHO.
They’re also more convenient to use and easy to store.
Should those factors outweigh the dangers of contamination and infection?
The medical professionals at SGH decided they weren’t.
And now the worrying part – what about other hospitals in our top-class medical hub?
So yes, SGH administrators weren’t wrong when they said “we were following a long established and accepted practice in healthcare institutions”.
But can they stare down the eyes of those who lost their loved ones and tell them that?