Peritoneal dialysis (PD) is the only well-established home-based dialysis therapy in Singapore. As it is a home-based modality, PD should be considered as a preferred mode of kidney replacement therapy (KRT) for patients with kidney failure during this COVID-19 pandemic as it avoids frequent visits to hospitals and/or satellite dialysis centres. The highly infectious nature of this virus has led to the implementation of the Disease Outbreak Response System Condition orange status in Singapore since early February 2020. This paper summarises the strategies for management of several aspects of PD in Singapore during this COVID-19 pandemic, including PD catheter insertion, PD training, home visit and assisted PD, outpatient PD clinic, inpatient management of PD patients with or without COVID-19 infection, PD as KRT for COVID-19 patients with acute kidney injury, management of common complications in PD (peritonitis and fluid overload), and management of PD inventory.
Ambulatory Care/methods* ; COVID-19/prevention & control* ; Home Care Services ; Hospitalization ; Humans ; Infection Control/methods* ; Pandemics ; Peritoneal Dialysis/methods* ; Self Care/methods* ; Singapore/epidemiology*

BACKGROUNDIdentification of hospitalized carbapenem-resistant Enterobacteriaceae (CRE)-positive patient is important in preventing nosocomial transmission. The objective of this study was to illustrate the implementation of proactive infection control measures in preventing nosocomial transmission of CRE in a healthcare region of over 3200 beds in Hong Kong between October 1, 2010 and December 31, 2011.

METHODSThe program included active surveillance culture in patients with history of medical tourism with hospitalization and surgical operation outside Hong Kong within 12 months before admission, and "added test" as an opportunistic CRE screening in all fecal specimens submitted to the laboratory. Outbreak investigation and contact tracing were conducted for CRE-positive patients. Serial quantitative culture was performed on CRE-positive patients and the duration of fecal carriage of CRE was analyzed.

RESULTSDuring the study period, a total of 6533 patients were screened for CRE, of which 76 patients were positive (10 from active surveillance culture, 65 from "added test", and 1 secondary case from contact tracing of 223 patients with no nosocomial outbreak), resulting in an overall rate of CRE fecal carriage of 1.2%. The median time of fecal carriage of CRE was 43 days (range, 13-119 days). Beta-lactam-beta-lactamase-inhibitors, cephalosporins, and fluoroquinolones were associated significantly with high fecal bacterial load when used 90 days before CRE detection, while use of cephalosporins, carbapenems, and fluoroquinolones after CRE detection are significantly associated with longer duration of carriage. The duration of fecal carriage of CRE also correlates significantly with the initial fecal bacterial load (Pearson correlation: 0.53; P = 0.02).

CONCLUSIONProactive infection control measures by enhanced surveillance program identify CRE-positive patients and data obtained are useful for the planning of and resource allocation for CRE control.

Anti-Bacterial Agents ; therapeutic use ; Carbapenems ; therapeutic use ; Cephalosporins ; therapeutic use ; Drug Resistance, Bacterial ; Enterobacteriaceae ; drug effects ; Enterobacteriaceae Infections ; prevention & control ; transmission ; Fluoroquinolones ; therapeutic use ; Humans ; Infection Control ; methods

Introduction: Medication discrepancies can lead to serious consequences, and is more likely to occur in elderly patients and patients with chronic disorders due to polypharmacy. Such errors can contribute to drug-related problems, medication errors, adverse drug events and jeopardise patients’ health. The discharge period is a particularly vulnerable transitional interface as there is a higher risk of these dis- crepancies. The aim of this study was to assess the incidence of unintentional medication discrepancies during discharge of patients admitted to the medical wards of a tertiary referral centre. Materials and Methods: Data was prospectively collected over a period of three months (21st March to 21st June 2011). All the discharge prescriptions were carefully checked for errors: unintentional missed medica- tion, inappropriate or missing dose and unexplained dosage increase or reduction which required inter- vention, missing or inappropriate duration, illegible handwriting and inappropriate formulation. The types of pharmacy intervention were classified into ‘error’, ‘near-miss’ and ‘confirming’. Error is when a particular event had occurred in the ward prior to pharmacy intervention, near-miss is when there was intervention before a particular event had occurred, and an intervention was classed as ‘confirming’ when no changes were made in the actual prescriptions after pharmacy intervention. Results: There was a total of 845 discharge prescriptions consisting of 5,465 medications encountered during the study period. Overall, 18.7% (n=158) of the prescriptions required intervention, ranging from 11.8% to 22% per ward. The most common interventions was for unintended missed medications and dosage adjustments. Overall, 3% of all intervention required was classified as error whereas 49% classified as near-miss. Prescriptions from the Nephrology services required the most intervention. Conclusions: This study demonstrated the importance of conducting a medication reconciliation process in ensuring patients are discharged with the appropriate and correct medications. It is an effective way of reducing medication discrepancies and is an essential process for optimizing the safe and effective use of medi- cines.