Dale A Fisher

Dale A Fisher
National University of Singapore | NUS · Department of Medicine

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174
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Publications

Publications (174)
Article
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Background: Methicillin-Resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide. Intrahospital transfers may impact MRSA acquisition risk experienced by patients. In this study, we investigated ward characteristics and connectivity that are associated with MRSA acquisition. Methods: We analysed electronic medical records on pati...
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For 20 years, the Global Outbreak Response and Alert Network (GOARN) has been a leader in the coordination of international outbreak response. On the premise that no single institution can provide all capacities required to successfully respond to a complex public health emergency or fulfil all outbreak response training needs, GOARN embarked on a...
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Background: We report the results of INICC surveillance study from 2013 to 2018, in 664 intensive care units (ICUs) in 133 cities, of 45 countries, from Latin-America, Europe, Africa, Eastern-Mediterranean, Southeast-Asia, and Western-Pacific. Methods: Prospective data from patients hospitalized in ICUs were collected through INICC Surveillance...
Article
Singapore’s hospitals had prepared operations to receive patients (potentially) infected with SARS-CoV-2, planning various scenarios and levels of surge with a policy of isolating all confirmed cases as inpatients. The National University Hospital, adopted a whole of hospital approach to COVID-19 with three primary goals: zero hospital-acquired COV...
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Background: By estimating N95 respirator demand based on simulated epidemics, we aim to assist planning efforts requiring estimations of respirator demand for the healthcare system to continue operating safely in the coming months. Methods: We assess respiratory needs over the course of mild, moderate and severe epidemic scenarios within Singapo...
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A Safe and Efficient, Naturally Ventilated Structure for COVID-19 Surge Capacity in Singapore - Natasha Bagdasarian, Ian Mathews, Ng Jet Yue Alexander, Eugene Liu Hern Choon, Clara Sin, Malcolm Mahadevan, Dale A. Fisher
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Background: On January 30, COVID-19 was declared a Public Health Emergency of International Concern-a week after Singapore's first imported case and 5 days before local transmission. The National University Hospital (NUH) is Singapore's third largest hospital with 1200 beds, heavy clinical workloads, and major roles in research and teaching. Main...
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Background: Klebsiella pneumoniae liver abscess (KLA) is emerging worldwide due to hypermucoviscous strains with a propensity for metastatic infection. Treatment includes drainage and prolonged intravenous antibiotics. We aimed to determine whether oral antibiotics were noninferior to continued intravenous antibiotics for KLA. Methods: This noni...
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To determine the effectiveness of our messaging for hand hygiene compliance by profession, we conducted a hospital-wide survey followed by profession-specific focus group discussions to investigate impact, perceptions and areas for improvement. Results showed a good understanding that hand hygiene is a crucial part of the infection-prevention progr...
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Where dengue virus infections are endemic, acute febrile illness is often managed as dengue fever (DF) without diagnostic testing. In a prospective study of 140 patients with clinical features of DF, 3 (2.1%) had acute HIV infection (AHI). We recommend testing for AHI in dengue-like febrile illness.
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Background: Since 2010, the incidence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing in Singapore. We analyzed the clinical and molecular epidemiology of CRE among adult inpatients in Singapore. Methods: Quarterly incidence of unique subjects (per 100000 patient-days) with positive clinical and surveillance cultures for CRE...
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Background: We conducted a national point prevalence survey (PPS) to determine the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in Singapore acute-care hospitals. Methods: Trained personnel collected HAI, AMU, and baseline hospital- and patient-level data of adult inpatients from 13 private and public acute-c...
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Background: Dengue is the commonest vector-borne infection worldwide. It is often associated with thrombocytopenia, and prophylactic platelet transfusion is widely used despite the dearth of robust evidence. We aimed to assess the efficacy and safety of prophylactic platelet transfusion in the prevention of bleeding in adults with dengue and throm...
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In contrast with northern Australia and Thailand, in Singapore the incidence of melioidosis and co-incidence of melioidosis and pneumonia have declined. Burkholderia pseudomallei deep abscesses increased 20.4% during 2003-2014. These trends could not be explained by the environmental and climatic factors conventionally ascribed to melioidosis.
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Singapore is endemic for Dengue virus, with approximately 10,000 to 20,000 annual cases reported in recent years. In 2012, Chikungunya was introduced, although the numbers of cases reported is much fewer. The current Zika virus pandemic originating in Brazil represents a threat to all regions with Aedes mosquitoes, particularly those well connected...
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Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control a...
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in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Health-care Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected pr...
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Background: Ertapenem is a broad-spectrum antibiotic that is increasingly being utilized. Its dosing convenience renders it suitable for outpatient therapy, and its pharmacokinetic characteristics favour its use against complicated urinary tract infections (cUTIs). Despite this, sufficient clinical data are lacking for its use against cUTIs in the...
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In March 2014, our 1,100-bed tertiary hospital fully converted from a traditional system of reusable receptacles to a single-use disposable pulp receptacle system. Almost 12 months later, in February 2015, we undertook a large survey questionnaire to investigate user acceptance, perceptions, and any areas for improvement. The disposable pulp recept...
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Medical trainees face multiple barriers to participation in major outbreak responses such as that required for Ebola Virus Disease through 2014-2015 in West Africa. Hurdles include fear of contracting and importing the disease, residency requirements, scheduling conflicts, family obligations and lack of experience and maturity. We describe the succ...
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in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Health-care Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected pr...
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The seroprevalence of varicella in Southeast Asia is not well described especially in healthcare workers (HCW) in the region. We report the varicella seroprevalence among healthcare workers from a diverse range of countries working in a tertiary care hospital in Singapore. We audited the results of annual HCW health screening, which included a vari...
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We report a reduction in the vancomycin-resistant enterococci (VRE) rate from a peak of 1.5 cases per 1,000 admissions (95% confidence interval [CI], 1.0−2.1) in August 2012 to 0.5 per 1,000 admissions (95% CI: 0.3−1.0) by January 2015, associated with a bundle of interventions. Infect. Control Hosp. Epidemiol. 2015;00(0):1–3
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The objective of this paper is to describe paediatric infectious diseases consultations across Australia and New Zealand. We surveyed infectious diseases physicians at 51 hospitals over a period of 2 weeks in 2012. Compared with adult consults, paediatric consults were more frequently received from general paediatricians/physicians and intensive ca...
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Background. Limiting the spread of methicillin-resistant Staphylococcus aureus (MRSA) within healthcare facilities where the organism is highly endemic is a challenge. The use of topical antiseptic agents may help interrupt the transmission of MRSA and reduce the risk of clinical infection. Octenidine dihydrochloride is a topical antiseptic that ex...
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Little is known about the cellular mechanisms of innate immunity against dengue virus (DV) infection. Specifically, the γδ T cell response to DV has not been characterized in detail. In this article, we demonstrate that markers of activation, proliferation, and degranulation are upregulated on γδ T cells in PBMC isolated from individuals with acute...
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Soil has been considered the natural reservoir for the bacterium Burkholderia pseudomallei, which causes melioidosis. We examined 550 melioidosis cases that occurred during a 10-year period in the highly urbanized city of Singapore, where soil exposure is rare, and found that rainfall and humidity levels were associated with disease incidence.
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Abstract- IMPORTANCE OF THE STUDY. Ward rounding has been a historical clinical method of inter-professional collaboration to support inpatient care through the sharing of mental models by exchanging information and discussing plans of care, treatment goals, and discharge plans for the patient. The extant literature reports that rounds are frequent...
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Particle sorting methods in microfluidic platforms are gaining momentum for various biomedical applications. Bioparticles are found in different shapes and sizes. However, conventional separation techniques are mainly designed for separation of spherical particles. Thus, there is a need to develop new methods for effective separation of spherical a...
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We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN...
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Ertapenem is a broad-spectrum carbapenem antibiotic used to treat severe bacterial infections. In view of its dosing convenience, it is increasingly used as outpatient therapy. The objective of this study was to determine the pharmacokinetics and renal disposition of ertapenem in outpatients with complicated urinary tract infections. Ertapenem was...
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Objective: Prevalence of multidrug-resistant (MDR) gram-negative (GN) bacteria is increasing globally and is complicated by patient movement between acute and long-term care facilities (LTCFs). In Asia, the contribution of LTCFs as a source of MDR GN infections is poorly described. We aimed to define the association between residence in LTCFs and...
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Melioidosis is a problem in the developing tropical regions of Southeast Asia and Northern Australia where the the Gram negative saprophytic bacillus Burkholderia pseudomallei is endemic with the risk of fulminant septicaemia. While diabetes mellitus is a well-established risk factor for melioidiosis, little is known if specific hypoglycemic agents...
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The practice of an infectious diseases (ID) physician is evolving. A contemporary understanding of the frequency and variety of patients and syndromes seen by ID services has implications for training, service development and setting research priorities. We performed a 2-week prospective survey of formal ID physician activities related to direct in...
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ABSTRACT We report the results of an international nosocomial infection control consortium (INICC) survei study from January 2007 through December 2012 in 503 ICUs in Latin America, Asia, Africa, and E During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Heal Safety Network (NHSN) definitions for device-associ...
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Abstract- IMPORTANCE OF THE STUDY. Currently, there is a paucity of evidence in the literature to show that handoff strategies improve the quality of handoff outcomes. Studies that show the usefulness and outcomes obtained from sign-outs may motivate junior clinicians, who have limited time to perform their clinical responsibilities, to support sig...
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To identify demographic, clinical and laboratory risk factors for death due to dengue fever in adult patients in Singapore. Multi-center retrospective study of hospitalized adult patients with confirmed dengue fever in Singapore between 1 January 2004 and 31 December 2008. Non-fatal controls were selected by matching age and year of infection with...
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Community associated methicillin-resistant Staphylococcus aureus (CA-MRSA) subtype USA300 remains relatively well confined within North American shores. Between August and November 2010, a large international school in Singapore recorded 27 skin and soft tissue infections, 8 of which were confirmed USA 300. This study reports the outbreak investiga...
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Background: Klebsiella pneumoniae liver abscess is the most common etiology of liver abscess in Singapore and much of Asia, and its incidence is increasing. Current management includes prolonged intravenous antibiotic therapy, but there is limited evidence to guide oral conversion. The implicated K1/K2 capsule strain of Klebsiella pneumoniae is al...
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Patients newly colonised with methicillin-resistant Staphylococcus aureus (MRSA) are at higher risk of clinical MRSA infection. At present, there are limited data on the duration or magnitude of this risk in a hospital population with a known time of MRSA acquisition. A retrospective cohort study of 909 adult patients known to have newly identified...
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Meticillin-resistant Staphylococcus aureus (MRSA) has been entrenched in Singapore hospitals since the 1980s, with an excess of 600 non-duplicate cases of infections (120 bacteraemia episodes) each year in our 995-bed university hospital. Approximately 5% of our hospital beds are used as isolation facilities. To study the impact of an MRSA control...
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Objective: The primary objective of this study was to validate a novel method of assessing hand hygiene compliance using ultrasound transmitters in patient zones and staff tagged with receivers. The secondary objective was to assess the impact of audio reminders and quantified individual feedback. Design: An observational comparison against manu...
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Elizabethkingia meningoseptica is a nosocomial-adapted Gram-negative bacillus intrinsically resistant to antibiotics commonly used in the intensive care setting. An outbreak investigation commenced when five patients developed E. meningoseptica infection in two intensive care units (ICUs). Analysis of laboratory data, case reviews, ICU workflows an...
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Objective: To report the results of a surveillance study on surgical site infections (SSIs) conducted by the International Nosocomial Infection Control Consortium (INICC). Design: Cohort prospective multinational multicenter surveillance study. Setting: Eighty-two hospitals of 66 cities in 30 countries (Argentina, Brazil, Colombia, Cuba, Domin...
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Surgical Intensive Care Unit (SICU) maintains one bronchoscope for use on its patients. An internal decision to change manual bronchoscope re-processing practices occurred in July 2012. In September and October, four consecutive patients cultured Pseudomonas aeruginosa from bronchial washings following bronchoscopy.
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Elizabethkingia meningoseptica is a nosocomial-adapted, Gram negative bacillus with intrinsic resistance to most antibiotics. An outbreak investigation was commenced when five patients developed E. meningoseptica bacteraemia within a three week period in the Cardiothoracic Intensive Care Unit (CTICU) and Surgical ICU (SICU).
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BACKGROUND: and hygiene compliance is generally assessed by observation of adherence to the "WHO five moments" using numbers of opportunities as the denominator. The quality of the activity is usually not monitored since there is no established methodology for the routine assessment of hand hygiene technique. The aim of this study was to objectivel...
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Background The National University Hospital, Singapore routinely undertakes standardized Hand Hygiene auditing with results produced by ward and by staff type. In 2010 concern was raised over consistently low compliance by nursing students averaging 45% (95% CI 42%–48%) prompting us to explore novel approaches to educating our next generation of nu...
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Abstract OBJECTIVE: To investigate the validity of recommendations in treatment guidelines to use higher than approved doses of oseltamivir in patients with severe influenza. DESIGN: Double blind randomised trial. SETTING: Thirteen hospitals in Indonesia, Singapore, Thailand, and Vietnam. PARTICIPANTS: Patients aged ≥ 1 year admitted to hospital wi...
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Outpatient parenteral antibiotic therapy (OPAT) facilitates early discharge, easing demands on inpatient resources and allowing patients the opportunity to restore home life. In Singapore, two large hospitals established a common prospective database in 2006. This study presents an analysis of all enrolled cases over 6 years to consider factors pot...