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Responding to the COVID-19 Outbreak in Singapore: Staff Protection and Staff Temperature and Sickness Surveillance
Htet Lin Htun1, Dwee Wee Lim1,2, Win Mar Kyaw1
1Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore.
Insights
A robust health surveillance system effectively protected frontline healthcare workers during the COVID-19 outbreak. Enhanced N95 respirator use and monitoring prevented infections among staff at Tan Tock Seng Hospital.
Area of Science:
- Public Health and Epidemiology
- Infectious Disease Control
- Occupational Health
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, emerged in Wuhan, China, in December 2019.
- Singapore's Tan Tock Seng Hospital (TTSH) had existing N95 respirator fit-testing and web-based surveillance systems since the 2003 SARS outbreak.
- These routine systems were enhanced following Singapore's first imported COVID-19 case on January 23, 2020.
Purpose of the Study:
- To evaluate the effectiveness of TTSH's enhanced staff protection and surveillance strategy during the early COVID-19 outbreak.
- To assess the impact of a multipronged approach on protecting healthcare workers with potential COVID-19 exposures.
Main Methods:
- A cross-sectional study was conducted from January 23 to February 23, 2020, involving healthcare workers at TTSH and the National Centre for Infectious Diseases (NCID).
- A multipronged strategy included risk-based personal protective equipment (PPE), staff fever and sickness surveillance, and enhanced medical surveillance for unwell staff.
- Hospital-wide surveillance monitored 10,583 staff, with intensive monitoring for 1,524 frontline staff in COVID-19 areas.
Main Results:
- Daily monitoring identified a median of 8 staff illness episodes among frontline workers, with nearly 10% (29 staff) requiring hospitalization.
- Despite potential exposures and significant illness episodes, no frontline staff were found to be infected with COVID-19.
- TTSH/NCID managed 76% of Singapore's confirmed COVID-19 cases during the study period.
Conclusions:
- A robust staff protection and health surveillance system, routinely implemented and enhanced during outbreaks, is effective in preventing COVID-19 infection among frontline healthcare workers.
- The TTSH strategy demonstrated success in safeguarding staff during the critical early phase of the COVID-19 pandemic.
Background:
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by a novel coronavirus (SARS-CoV-2) and first reported in Wuhan, China, in December 2019. Since the severe acute respiratory syndrome (SARS) outbreak in 2003, Tan Tock Seng Hospital (TTSH) in Singapore has routinely fit-tested staff for high-filtration N95 respirators and established Web-based staff surveillance systems. The routine systems were enhanced in response to Singapore's first imported COVID-19 case on 23 January 2020.
Methods:
We conducted a cross-sectional study from 23 January to 23 February 2020 among healthcare workers to evaluate the effectiveness of the staff protection and surveillance strategy in TTSH, a 1600-bed multidisciplinary acute-care hospital colocated with the 330-bed National Centre for Infectious Diseases (NCID). As of 23 February 2020, TTSH/NCID has managed 76% of confirmed COVID-19 cases in Singapore. The hospital adopted a multipronged approach to protect and monitor staff with potential COVID-19 exposures: (1) risk-based personal protective equipment, (2) staff fever and sickness surveillance, and (3) enhanced medical surveillance of unwell staff.
Results:
A total of 10 583 staff were placed on hospitalwide fever and sickness surveillance, with 1524 frontline staff working in COVID-19 areas under close surveillance. Among frontline staff, a median of 8 staff illness episodes was seen per day; almost 10% (n = 29) resulted in hospitalization. None of the staff was found to be infected with COVID-19.
Conclusions:
A robust staff protection and health surveillance system that is routinely implemented during non-outbreak periods and enhanced during the COVID-19 outbreak is effective in protecting frontline staff from the infection.
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