Preventive Measures at Hospitals in light of Emergence of Drug-resistant Superbugs

21 Dr Chia Shi-Lu asked the Minister for Health in light of the emergence of drug-resistant bacteria and fungus including Candida auris (a) whether the Ministry will be revising its strategy on measures to deal with superbugs; and (b) how will preventive measures be strengthened in our hospitals and clinics.

22 Mr Leon Perera asked the Minister for Health in light of the dangers of multidrug-resistant pathogens such as candida auris, what measures are being planned to ensure that public confidence in our hospitals remains high.

Mr Gan Kim Yong: The emergence of microorganisms such as viruses, bacteria and fungi which are resistant to standard drugs and treatments, a phenomenon also known as Antimicrobial Resistance (AMR), is a global public health issue. While AMR can occur naturally in some microorganisms, the misuse and overuse of antimicrobials such as antibiotics globally in healthcare, as well as the animal and agricultural sectors, have led to accelerated development of AMR. Due to increased global connectivity, there is a growing risk of AMR being spread internationally. Singapore, being a global travel hub, is exposed to the importation of AMR organisms.

Candida auris is one example of an antimicrobial resistant fungus. It was first identified in 2009 in Japan and subsequently reported from other parts of the world, including Singapore. The first case of Candida auris here was reported in 2012. To date, a total of 16 cases have been detected in the public and private hospitals. Investigations showed that the cases are unlinked, and there is no report of local spread.

We have put in place a number of measures to address the development and spread of AMR in Singapore. These include regulation on the prescription and retail of antibiotics to minimise the risk of misuse and overuse, and public education campaigns on the proper use of antibiotics, such as HPB's "Use Antibiotics Right" campaign in 2018.

Within our public hospitals, there are Antimicrobial Stewardship Programmes to guide doctors in making appropriate antimicrobial drug use, and Infection and Prevention Control measures to reduce the risk of spread of antimicrobial-resistant organisms. Notwithstanding these measures, we can expect infections with antimicrobial-resistant organisms to occur from time to time as microbes can naturally acquire AMR and antimicrobials still need to be used for treating infections. Healthcare institutions must therefore remain vigilant in surveillance and maintain high levels of infection prevention and control to prevent spread of AMR. MOH also works with healthcare institutions to monitor antimicrobial resistance and healthcare-associated infections.

As AMR is a cross-border issue, MOH also participates in regional and global collaborations to tackle the AMR challenge.

We launched the National Strategic Action Plan on AMR in end 2017 to outline our long term approach towards AMR. This was the result of a joint review by MOH, National Parks Board, Singapore Food Agency, National Environment Agency and PUB, Singapore's national water agency. The plan is aligned to the global action plan on AMR. Under the plan, we are progressively implementing enhanced measures in the priority areas of Education, Surveillance, Research, Prevention & Control of Infection and Optimization of antimicrobial use. The AMR Coordination Office was also established as the national coordinating body to facilitate the implementation of the National Strategic Action plan on AMR.

Beyond actions taken by agencies and professionals, individuals too play a part in the prudent use of antibiotics or antimicrobials. We encourage patients and consumers to consult doctors on the best course of medical treatments, take antimicrobials according to doctor’s advice and only when indicated. Everyone of us must also practise good personal hygiene to protect ourselves from infection.