The original article can be found in: Amandala By Miriam Longsworth
PAHO says the outbreak was identified within a short period of time and was addressed in a timely fashion.
Investigations by the Pan American Health Orgnization (PAHO) into the outbreak of an infectious organism in the Neonatal Intensive Care Unit (NICU) at the Karl Heusner Memorial Hospital (KHMH) has ended.
The possibility of a single cause for the outbreak has not been ruled out, but several deficiencies in the hospital system were found that could have contributed to the development and spreading of the enterobacter cloacae organism that caused the deaths of seven premature babies in the NICU during the first 20 days in May 2013.
PAHO conducted an on-site study at the hospital and produced a report on its findings. Deficiencies were found in several areas of the hospital system including the infection control program being used, the physical layout of the hospital, supportive areas (sterilization, antiseptics and disinfectants, microbiology laboratory) and the current practices for infection prevention and control.
While that investigation pinpointed no source for the outbreak of the enterobacter cloacae organism, PAHO has chronicled several faults in the systems of the hospital and offered several recommendations on how those areas could be improved.
At a press conference held today, Wednesday, CEO in the Ministry of Health, Dr. Peter Allen, explained that the bacterium was transmitted via intravenous methods, meaning through the veins, normally through a needle puncture.
“These are very vulnerable babies and often they can’t swallow or feed in the normal way, and often they receive their medication intravenously, so directly into their vein,” he said.
The PAHO report did mention that the most probable means by which the babies were infected was through intravenous therapy.
The report stated that, “Since this bacteria was isolated in blood samples and its transmission is via the oral-fecal route, the most plausible explanation for this infection is through contamination of any device for intravenous puncture or intravenous medication used in these patients. Their prematurity implies management with intravenous therapies permanently since their admission. The regular practice of using multi-dose syringes shared for many patients and kept in use for at least 48 hours confers a high risk of contamination by any holder.”
Allen said he wishes he was able to give an answer as to who could be held responsible for the deaths, but there are no definite answers at the time.
“What the report says is that the processes in hospitals in general are far too complex to indicate an individual, though it may be that an individual made an error,” he said. “The report says that it is not able to link the shortcomings to an individual,” he went on to say.
Several other deficiencies were found during the investigation conducted by PAHO. Allen said that the report has indicated that there was some type of systematic breakdown that points to the need to strengthen the system at the hospital. He added that this is not the end of the issue, because the Ministry will be implementing all the recommendations given by PAHO.
Despite all the findings of the internal and PAHO investigations, it is not conclusive that the intravenous therapy was the definite method through which all the babies were infected, and no one has been held responsible for the deaths of the neonates.
Several concerns have been raised on whether anyone would be held responsible for the deaths, but Allen said that although they want to resolve the issue, the solution is not always taking disciplinary action, but sometimes involves giving encouragement.
“We do want to motivate our staff and we really want to make sure that we encourage excellence,” he said. “Sometimes the resolution of a problem is an encouraging proactive action. Our principal objective is to make sure that we do whatever we can to make sure that nothing like this could ever happen again,” said Allen.
CEO of KHMH, Dr. Gary Longsworth, said that the outbreak has enlightened them on what else they need to do and what they need to do better.
Longsworth said that he has volunteered to be a member of the Infection Control Committee (ICC) as a result of the recommendation that there needs to be an improvement in how the administration is informed.
Other immediate upgrades that have been implemented include the installation of one hundred hand sanitizer dispensers throughout the hospital. Between 25 and 30 nurses are in training in improved methods of IV therapy usage and are being advised on medication purchasing and surface disinfection and sterilization improvement. The ICC has already drafted an infection control plan and an antibiotic policy.
Longsworth said that all the recommendations will be met in the short and medium term time frame. The NICU renovation is to begin in the next few weeks and is expected to be completed within six to eight weeks after commencement. A section of the pediatric ward has been renovated to temporarily house the patients of the NICU.
Longsworth said that the investigating team reported that the outbreak was identified within a short period of time and was addressed in a timely fashion. He referred to the NICU tragedy as a “temporary setback” and said that the hospital has been striving for excellence and has been successful over the years.
Minister of Health, Hon. Pablo Marin, extended his condolences to the families who have lost a child during the ordeal before commenting on the situation.
He said that the Ministry is not satisfied because there are a lot of things that need to be improved. He said that those things (renovations and other improvements) have been in planning for some time, but the outbreak has caused those plans to be pushed ahead sooner than was projected.
The Minister said that the Government has already taken certain measures and has begun organizing measures to better the conditions of the KHMH. Those measures include an investment of over $80,000 for training for nurses in intravenous therapy and access to sexual and reproductive health services, providing $150,000 for urgent renovations to the NICU, securing $500,000 to support construction of a new pediatric and neonatal care unit and $300,000 for renovation of the middle floor of the Central Medical Laboratory, as well as ensuring the availability, in partnership with the UNDP, of $80,000 for ground floor renovations at the Central Medical Laboratory.
In addition, the Government has initiated reviews to be done on infection control procedures in all public hospitals and is providing additional training opportunities for doctors and nurses at the hospital.
“We remain absolutely committed to making all the information available and absolutely committed to doing everything possible to make our babies safe for the future,” Minister Marin said. “Clearly the report is critical of many areas and makes strong recommendations. The Ministry of Health and KHMH will remain dedicated in accepting these recommendations and implementing all necessary actions at the earliest possible time.”
At the last press conference KHMH held on the matter, Minister Marin was present but didn’t say anything to the media. His silence at that press conference was questioned thereafter, so the Minister used today’s press conference to address the issue. His reason for not speaking was that no one directed any questions to him, he said.
The Minister added that he wanted to assure the public that their doctors and nurses are working towards providing the best medical service they possibly can.
