INPATIENTS
We care for patients admitted to the hospital with a variety of community-acquired and healthcare-associated infections including those with influenza, tuberculosis, melioidosis, severe dengue, as well as other bacterial and viral infections. We care for HIV patients across the spectrum from those who present with late-stage AIDS to others with well controlled disease. All adult general medical patients who require isolation are also managed in our 21-bed negative pressure isolation ward.
Two consultation teams work closely with other clinical services in the hospital to treat patients with complex infections. Besides patients in various medical and surgical disciplines, we also consult on infections in liver, kidney and bone marrow transplant recipients, haematology / oncology patients and patients in the critical care units.
OUTPATIENTS
Patients who are referred to our ID specialists are seen at the 13b Medicine Clinic in the NUH Medical Centre, typically within a week of the referral request. In addition, care may be provided in one of our subspecialty clinics listed below.
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OUTPATIENT PARENTERAL ANTIBIOTIC THERAPY (OPAT)
The OPAT Clinic was established in 2004. Now with over 300 new cases a year, OPAT is predominantly a nurse-led clinic, providing outpatient antibiotic infusions to patients in the clinic or at home (especially using a self-administration system). OPAT services include the management of infections which require long-term antibiotics. The OPAT team manages vascular access devices during scheduled treatments. Additionally, patients and their families are educated on the management of the vascular access device, antibiotic side effect(s) and/or infusor pumps.
Home caregivers can be trained to administer intravenous antibiotic via an elastomeric pump. The training can commence while the patient is hospitalised. Patient education materials (
PICC and
Infusor) are available for the patients'/caregivers' reference. A 24-hour emergency support hotline is provided for patients/caregivers.
The NUH OPAT Programme has been the focus of numerous conference presentations, and the subject of 14 peer-reviewed publications, and has hosted dozens of visits by healthcare professionals within Singapore and internationally.
Of the over 300 patients that we see every year, most need less than 30 minutes door-to-door time and the readmissions rates are just 2%. In 2016, we established an international OPAT network with over 200 practitioners in 23 countries.
Click
here for more information on OPAT.
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DENGUE OUTPATIENT MANAGEMENT (DOM)
The DOM clinic manages dengue patients who meet a set of criteria safely without the need to be admitted to the hospital. The DOM service thus prevents over 500 admissions every year. Services offered in the DOM clinic include monitoring of the patients’ conditions daily, patient education on managing dengue and daily updates of full blood count results.
Click
here for more information on DOM.
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TRAVELLERS' HEALTH AND VACCINATION CLINIC
The NUH TRAVELLERS' HEALTH AND VACCINATION CLINIC (THVC) was established in 2002, providing pre- and post-travel health counselling along with any immunisations or medications that are needed for overseas travel.
In addition to medical advice about the risk of travel-related infections and diseases, travellers with special circumstances (pregnant women, elderly, immunocompromised individuals) can seek health advice that is specific to their condition. A broad range of travel immunisations and medications prescribed for the prevention of malaria and the treatment of travel-associated diarrhoea are available at the clinic.
The clinic also offers consultations for returning travellers. Screening tests for travel-related infections may be offered, depending on the exposure history and any symptoms that the traveller might have.
Vaccinations are also available to non-travellers who may have missed out on routine childhood vaccinations or may require vaccinations for specific reasons (for example, those with an immunocompromised state or high-risk occupation).
- Types of Vaccinations available:
- Hepatitis A
- Hepatitis B
- Hepatitis A and Hepatitis B combined vaccine
- Influenza
- Japanese Encephalitis (IXIARO and IMOJEV)
- Measles, Mumps, Rubella (MMR)
- Meningococcal conjugate (ACWY)
- Pneumococcal conjugate (PCV13) and polysaccharide (PPSV23)
- Inactivated polio (EIPV)
- Rabies (PCEC)
- Tetanus, diphtheria, and acellular pertussis (Tdap)
- Typhoid Fever (Typhim Vi)
- Varicella (Chickenpox)
- Yellow Fever
Click
here for more information on NUH THVC.
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ANTIMICROBIAL STEWARDSHIP PROGRAMME
The Antibiotic Stewardship Programme (ASP) was established at NUH in July 2009 as a collaboration project between the Department of Pharmacy and the Division of Infectious Diseases, and is funded by the Ministry of Health. It has grown to include three full-time pharmacists and three ID consultants. ASP has continued to increase its presence within NUH, now covering all wards outside of the intensive care units. The programme focuses on auditing the use of broad-spectrum antimicrobials and aims to reduce inappropriate use.
The ASP team comprises doctors and pharmacists who review all cases of broad-spectrum antimicrobial agent prescription at specific time points. The goal of the ASP programme is to reduce the emergence of resistant organisms within the hospital, as well as reduce the inappropriate use of antibiotics and the resultant adverse effects that patients may experience.
The NUH HIV Programme was established in 2010. The HIV Programme, also known as the Multidisciplinary Infectious Diseases (MID) Programme, was established in January 2010 to better address the needs of Persons Living with HIV/AIDS (PLHIV) diagnosed at and/or wishing to receive care at NUH. The HIV programme operates by providing inpatient and outpatient clinical care to PLHIV, education and training to healthcare workers, PLHIV and the community, as well as operational, clinical and behavioural research, community support and advocacy.
Since 2010, the HIV programme has cared for over 450 PLHIV in both inpatient and outpatient settings and has provided training to over 1,000 healthcare workers within and outside of NUH through education initiatives such as the Red Ribbon Ambassadors Programme, the Healthcare Worker HIV Education Series and the Asia Pacific HIV Practice Course.
In November 2016, the HIV Programme led the first Asia Pacific HIV Practice Course (APHPC). The 4-day APHPC was designed to improve the knowledge and skills of healthcare workers within the HIV sector, throughout the Asia Pacific Region. The course was repeated in 2017 and was highly evaluated by participants from all countries. The APHPC will be conducted on a regular basis within Singapore and the Asia Pacific Region.
Click
here for more information on the APHPC.
Click
here for more information on the HIV programme.
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BE PREPARED (BePrep) CLINIC
In October 2016, the Be Prepared Clinic was launched. The BePrep Clinic is a confidential, holistic service that covers specialist expertise in Sexually Transmitted Infections (STIs) and HIV prevention. The BePrep Clinic provides counselling and testing for STIs and HIV, as well as risk-reduction packages, including Post Exposure Prophylaxis (PEP) and Pre Exposure Prophylaxis (PrEP).
The BePrep Clinic is run by Dr Dariusz Olszyna, who is a Senior Consultant at the Division of Infectious Diseases. Dr Dariusz received his medical training in Amsterdam and has been working in the field of HIV and Infectious Diseases for over 10 years.
Why is sexual health important?
- Getting tested regularly for Sexually Transmissible Infections (STIs) including HIV can help keep yourself and your sexual partners healthy
- Early treatment of STIs and HIV can reduce severity of infections and result in better health outcomes
- Talking to a qualified healthcare professional about your sexual health helps you to protect yourself and your sexual partners in a way that works for you and your lifestyle
The BePrep Clinic provides the following services tailored to individual needs:
- STI and HIV-risk assessments
- STI risk-reduction counselling
- STI and HIV screening
- STI treatment
- Vaccinations
- Comprehensive HIV risk-reduction package including Pre-exposure prophylaxis (PrEP)
- Direct linkage to HIV care (NUH Multi-Disciplinary Infectious Diseases Clinic) for patients who test positive for HIV during a visit to the BePrep Clinic
- Post-exposure prophylaxis (PEP) service
- HelpLine
Why visit the BePrep Clinic?
- You are worried or have questions about your sexual health
- You are wondering if PrEP is for you
- You need treatment for an STI
- You have symptoms of an STI or HIV
- You have had sex with someone who has tested positive for an STI or HIV
- You would like to have safer sex advice or counselling
- You would like to discuss how best to protect yourself from STIs and HIV
For more information about STIs, please visit:
For more information about HIV, please visit:
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INFECTION PREVENTION AND CONTROL (IPC)
The IPC team was established in 2015 when the Epidemiology and Infection Control teams merged. The IPC team plays a key role in ensuring the safety of NUH patients and staff. The threat of a pathogen emerging in the region and presenting to NUH (Ebola, MERS) has been a genuine concern and focus since we were affected by SARS in 2003. The team is competent in managing outbreaks and threats at the hospital level and has developed internationally-recognised best practice infection control training.
Members of our team have supported infection prevention activities and trainings across Singapore, in many Asian countries, as well as the Middle East and West Africa.
Through many interventions over the years, the team has overseen improved hand hygiene compliance and reduced MRSA colonisation and infection rates throughout the hospital. We continue to publish on a variety of infection prevention successes.
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INFECTIOUS DISEASES COMMUNITY PILOT PROGRAMME (IDCP)
The Division of Infectious Diseases Community Outreach Pilot (IDCP) Programme was initiated in 2015 to build the capacity of the regional health system which covers non-acute hospitals, nursing homes and family medical centres in the western region of Singapore. The primary objective of the IDCP Programme is to develop an integrated model of care which supports, empowers and builds the capacity of community healthcare providers. The development of this programme was motivated by Singapore’s ageing population, and an increase in the number of patients with multi-drug resistant organisms requiring ongoing care in the community. The aims of this programme include improved patient care in the community, a reduction in healthcare systems costs and a reduction in the burden of care on the hospital system and the patient.
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IMMUNOCOMPROMISED HOSTS PROGRAMME
Two arms of this programme are closely involved in the clinical management of patients before and after solid organ transplantation, and haematology-oncology patients. The teams provide inpatient and outpatient consultation and are embedded in routine multidisciplinary clinical discussions. The programme conducts pre-transplant screening, risk assessment and management of transplant recipients (including people living with HIV/AIDS) and donors. Patients receiving chemotherapy benefit from timely regular inputs from our dedicated service. We have helped to establish and regularly review work flows for:
- The management of febrile neutropenia
- Antimicrobial strategies and surveillance of broad spectrum antimicrobial usage and pathogen susceptibility
- Surveillance for opportunistic infections, in particular invasive fungal infections