Page 21 - Read Online

Vong et al. J Cancer Metastasis Treat 2020;6:54 I http://dx.doi.org/10.20517/2394-4722.2020.116 Page 3 of 11

a coordinated effort to ensure operational continuity with minimal disruption to cancer care while
maintaining patient and staff safety.

Infection control measures and general patient management algorithms
Infection control measures were ramped up rapidly at NCID and TTSH to ensure that all staff are
adequately protected from infection risk. NCID and TTSH wards were segregated into wards for non-
COVID-19, suspected and confirmed COVID-19 patients. Patients presenting with acute respiratory
infection (ARI) to the NCID Screening Centre (SC) or TTSH Emergency Department (ED) were identified
and separated from the general patient pool at the point of triage in order to reduce the risk of exposure to
other patients and healthcare staff. At subsequent medical assessment, SARS-CoV-2 reverse transcription-
polymerase chain reaction (RT-PCR) testing as well as laboratory and chest radiography were conducted
according to hospital protocols.

Suspect and confirmed COVID-19 patients were admitted to negative-pressure isolation rooms in NCID
for further management. Patients diagnosed with community-acquired pneumonia were admitted to
neutral pressure isolation rooms in TTSH under an enhanced pneumonia surveillance program and were
required to undergo SARS-CoV-2 testing before they could be de-isolated. The result of SARS-CoV-2 RT-
PCR testing is generally available in less than 6 hours when performed in NCID or TTSH, and this quick
turnaround time has been an important factor in the success and efficiency of the local screening and
containment measures. Suspect case definitions for COVID-19 were updated regularly based on evolving
epidemiological factors and disseminated by the Ministry of Health (MOH) to all doctors via email, and
patient management algorithms were updated accordingly by hospital management.

Other key measures undertaken include compulsory personal protective equipment (PPE) training and
N95 mask-fitting for all healthcare workers. Strict adherence to hospital PPE protocols is mandated when
reviewing patients who are suspect or confirmed cases of COVID-19. For routine patient care, surgical
mask and meticulous hand hygiene is practiced. All TTSH staff were provided with personal thermometers
for twice-daily online temperature recording. Staff with ARI were advised to seek medical attention
promptly at NCID or the TTSH Occupational Health Clinic for assessment and COVID-19 diagnostic
testing, and were provided at least 5 days of medical leave.

TTSH also put in place temperature screening and heath declaration measures for patients and visitors at
hospital entrances. Measures for physical distancing were implemented in our outpatient oncology clinics
and chemotherapy units. Patients attending outpatient appointments were limited to one accompanying
person at any one time. Designated consult rooms and PPE are employed for the assessment of patients
with ARI before they are appropriately redirected to NCID or the TTSH ED [Figure 1]. For patients
who are on quarantine orders due to close contact with confirmed COVID-19 cases or those on stay
home notices after return from abroad, non-urgent outpatient appointments were postponed until after
completion of the quarantine orders.

Clinical service reconfiguration
The COVID-19 pandemic has also led to service reconfiguration of our medical oncology department. One
of the first measures undertaken by our department during the start of the outbreak in Singapore was team
segregation, in order to reduce the loss of workforce and avoid quarantine of the whole department in the
event of COVID-19 exposure or infection. We segregated our department into 2 independently functioning
teams each comprising junior doctors, fellows and attendings geographically confined to the inpatient and
outpatient sectors. A similar approach has been reported by other cancer centres in Singapore as well [11,12] .
Large group gatherings were minimised; department meetings and education activities were conducted in
small groups and via secure video-conferencing platforms.