Effective infection prevention and control strategies in a large, accredited, psychiatric facility in Singapore

The Institute of Mental Health in Singapore continues to attempt to prevent the introduction of COVID-19, despite community transmission. Essential services are maintained and quarantine measures are currently unnecessary. To help similar organizations, strategies are listed along three themes: sustaining essential services, preventing infection, and managing human and consumable resources.


Infection prevention and control strategies
Providing essential mental health services Providing mental health services is the mission of the IMH. However, certain aspects may need to be balanced to safeguard the sustained provision of services. First, care should always be provided with the least restrictive means. Finding this balance requires careful and constant assessment of risks and the effectiveness of current strategies. For example, completely suspending family visits may help reduce the risk of SARS-Cov-2 transmission considerably, but such a policy would be detrimental to the recovery of patients, and under the current risk assessment, it is a step too far.
The decision to reduce access to or suspend individual services entirely depends on (1) the risk of infection posed by the service, (2) the needs of patients, and (3) service alternatives. For example, outpatient services may introduce infection because physicians have inpatient and outpatient duties. Reducing the volume of outpatient services could help decrease risks. Patients with low levels of need are served via telehealth consultations. Medications are delivered by courier to reduce the volume of patients entering the facility.

Preventing the introduction of infectious contagions
A guiding principle of the infection prevention and control strategies is to recognize that patients and staff need to be equally considered to ensure that infections are avoided. Several general prevention strategies are used under normal risk of infection, 9 and they are considered normal accreditation obligations. Special strategies introduced to keep infectious contagions out of the facilities are listed in Table 1.

Resource management
The sustainability of strategies is vital, especially when expecting a long pandemic. As such, policy makers must be mindful of the supply of consumables and labor. Managing consumables may depend on local supply chains. In Singapore, a national-level strategy ensures that personal protective equipment is available. Allocation is monitored down to the individual mask. This measure ensures that the demand for consumables can be quantified precisely.
Business continuity planning is a priority. To avoid quarantine of entire departments, each department has been split into individual units that conduct all the essential functions of the larger department. This isolates the departments similar to the encapsulated operation of the wards.
To ensure that staff are available, nonessential vacation allowances have been suspended. Because suspended travel may incur financial costs, one of the first items communicated to staff included the Ministry's intention to compensate staff for disruptions to personal travel. This action reduced anxiety and allowed personnel to focus on their duties.
Communication is vital. Regular updates are given to staff to inform them of essential developments, which are communicated via town halls, e-mails, and social media, depending on urgency. Senior management also increased the frequency of their presence in the wards to ensure staff engagement.
Recognition is important. Special compensation was announced for frontline staff. Although the actual reward for going above and beyond the call of duty may not come immediately, it is essential that staff be notified early that they will be recognized for their added effort.
In conclusion, infection prevention and control strategies come with varying degrees of immuration. Deploying a multipronged approach that addresses care and safety of staff and patients while underscoring the sustainability service provision is vital. It is imperative that healthcare organizations respond with overly cautious strategies and that they subsequently monitor the effect of these measures to balance the protection of patients with the tenet of providing the least restrictive service. In matters that are time sensitive, leaders should avoid fatiguing their staff with repeated policy changes because it will lead to complacency. The challenges of prolonged pandemics are felt by everyone, and ultimately, it is important to recognize and validate the contribution of individuals.