BackgroundEarly diagnosis of human immunodeficiency virus (HIV) allows for appropriately timed interventions with improved outcomes, but HIV screening among asymptomatic persons and the general population in Singapore remains low. In 2008, Singapore’s Ministry of Health implemented HIV voluntary opt-out screening (VOS) for hospitalised adults. We evaluated the outcome of VOS and surveyed reasons for its low uptake in our institution.MethodsWe assessed the outcomes of the VOS programme from January 2010 to December 2013 at National University Hospital, a 1081-bed tertiary hospital in Singapore. We also examined reasons for opting-in and opting-out using an interviewer–administered structured questionnaire in a representative sample in January 2013.Results107,523 patients fulfilled VOS criteria and were offered HIV screening, of which 5215 (4.9%) agreed to testing. 4850 (93.1%) of those who opted-in had an HIV test done. Three (0.06%) tested positive for HIV. 238 patients (14.2%) were surveyed regarding reasons for opting-in or out of VOS. 21 (8.8%) had opted-in. Patients who opted-in were likely to be younger, more educated and reported having more regular sexual partners. Type of housing, number of casual sexual partners, sexual orientation, intravenous drug use, condom use and previous sexually transmitted infection were not associated with deciding to opt-in/out. Patients’ most common reasons for opting-out were: belief that they were at low risk (50.2%), belief that they were too old (26.8%), cost (6.9%) and aversion to venepuncture (6.5%). The most common reason for opting-in was desire to know their HIV status (47.6%).ConclusionThe success of an HIV-VOS program is largely determined by test uptake. Our study showed that the majority of eligible VOS patients opted-out of HIV screening. Given the considerable cost and low yield of this programme, more needs to be done to better equip patients in self-risk assessment and opting in to testing.

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Objectives: COVID-19 cases continue to climb in the community from the SARS-CoV-2 δ (delta) variant wave. To prepare for cases that may be nosocomial or detected late, the infection prevention team constructed a ‘hot ward’ tool kit to guide implementation of infection control measures. Methods: We engaged the NUH Facilities Management ventilation engineers to understand every ward’s mechanical ventilation setup. With this information, we created of “green” and “hot” zones within ward. After conducting assessments on individual wards, we created the “hot ward” tool kit: (1) 38 ward floor plans indicating ventilation setup, “green” zones, and “hot” zones; (2) a risk matrix to guide ward actions based on cycle threshold (Ct) value and duration of exposure; and (3) “hot ward” checklists. The tool kit was presented to infectious disease clinicians on the infection prevention team and senior nursing leaders for input and guidance. To ensure that these plans were practical, we conducted numerous site walks with HOD and ward nurse managers (ie, for the ICUs and psychiatric units). Finally, the tool kit was shared in a meeting with key stakeholders and senior leaders. It was also uploaded to the NUH COVID-19 quick-reference intranet page for easy staff access. Results: The tool kit was used by 2 general wards when cases of confirmed COVID-19 were detected among patients. Overall, the tool kit helped HOD and nurse managers with the immediate actions required and it provides useful guidance for the infection prevention team to assess and guide decisions regarding whether a ward lockdown is necessary. Conclusions: Although the guidance was useful, from the site walk we learned that the mechanical ventilation system of some wards is shared, making it challenging to prevent cross contamination between wards because any shared ventilation between unmasked areas can be pose a risk for both patients and staff. Additional measures were instituted to mitigate this risk.

Background and aims Demise of a baby has profound consequences on the parents and providing appropriate support is the responsibility of multi-disciplinary team.1 Aim To compare the uptake of bereavement services between two tertiary neonatal units (NNU), and to investigate factors influencing it. Methods The medical and bereavement records of all neonatal deaths from January 2006 to December 2011 studied. Data collected: parent and infant characteristics, mode of death and bereavement follow-up. The categorical data was compared by chi-square or Fisher’s exact test and continuous data by Wilcoxon signed-rank test using SPSS 22.0. Results 297 babies (182 in NNU1 and 115 in NNU2) were studied. Significantly higher proportion of NNU1 parents (61%) attended bereavement follow-up compared to NNU2 (34%; p < 0.01). The number of parents married/co-habiting (p = 0.01), worse obstetric history with more stillborn/miscarriages (p = 0.03) and non-Caucasian parents from lower socio-economic status (p = 0.01) was significantly higher in NNU1. More infants had care withdrawn in NNU2 (p < 0.01). There was no significant difference in rest of the infant and parent characteristics studied. Among the group who availed bereavement services (n = 149), significantly more infants were inborn (p = 0.01), male (p = 0.01), had post-mortem examination (p = 0.01) and parents of higher socio-economic status (p = 0.01) and married or co-habiting (p = 0.05). Conclusion Uptake of bereavement services varied across the NNUs. Significantly more parents of infants who were inborn, male, consented for post-mortem, from a higher socio-economic status and married or co-habiting attended bereavement follow up. Reference Mancini A et al. BAPM Palliative care guideline 2014;Pg 17

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