Serious shortcomings of K.H.M.H. revealed by PAHO

Five weeks after thirteen babies died at the Karl Heusner Memorial Hospital, a report on the deaths was discussed with the media by the K.H.M.H. officials even though it has been ready for about a week. The investigations were conducted by a team from PAHO which comprised of international consultants including Ricardo Bustamante, an Epidemiologist from Chile, Paola Montes, an Infection Preventionist Consultant; Jorge Matheu, a surveillance Specialist, and Carlos Ayala, from PAHO. In short, the report states that “Standard precautions for hospital infection control and prevention and National Infection Prevention Guidelines lack of monitoring and of a supportive environment.” Even worse is that the Infection Control Committee of the referral hospital has been inactive. News Five’s Jose Sanchez reports.

Jose Sanchez, Reporting

In May 2013, seven newborns in the Neonatal Intensive Care Unit had the clinical signs and symptoms of sepsis, having enterobacter cloacae as the common pathogen. Between the fifth and seventeenth of May all the patients died. Today, Minister of Health, Pablo Marin, finally publicly expressed his condolences.

Pablo Marin

Pablo Marin, Minister of Health

“First, let me once again express my deepest condolences to the parents of the tiny babies who died as a result of this tragic outbreak of entero bacteria in the neonatal intensive care unit at the K.H.M.H. I have an excellent team of professionals—both national and international—who have been investigating this outbreak for the last month. My absolute priority is to the safety of our children. There can be nothing more important. Every member of the team here at the K.H.M.H. and the ministry has been engaged in this and continues to remain focus on this task. My personal role has been to keep the team working and mobilize the resources needed. I have felt it important in being a part of the team and have been meeting with the parents. For me this has been a first priority.”

The occasion was to reveal the Pan American Health Organization’s findings and recommendations to improve the nation’s only referral hospital, the K.H.M.H. The hospital’s C.E.O., Francis Gary Longsworth, also expressed regrets.

Francis Gary Longsworth

Dr. Francis Gary Longsworth, K.H.M.H.

“Out of evil can come a lot of good. We have met with the parents and we have shared their grief and their anger and we have pledged our support in the immediate term and in the medium and long term to all the families involved. I’d like to say also that there have been many expressions of support from the public. The first finding relates to the Infection Control Committee and the Infection Control Prevention Program at the K.H.M.H. and the outcome that PAHO arrived at is that this program and this committee are not working on a regular basis and that, although we have trained personnel on staff and in the committee, our methods of surveillance in the past leading up to the outbreak has been fairly non-specific and not targeted at any particular types of illnesses and diseases. The other set of findings relate to the laboratory. In order to investigate outbreaks or any disease for that matter, you need microbiology support from the laboratory and some deficiencies were documented by the team and they have made recommendations regarding improving the space; improving the training of individuals in the microbiology department.”

The details are much harsher than is summarized. The K.H.M.H. lab does not have capability for culture and susceptibility microbiological tests, so samples are sent to the Central Medical Lab. The Central Med. Lab has the equipment, but lacks the supplies to run those tests in a routine basis. Since February, the lab has been using home-made manual methods for the identification of gram negative bacteria. Manual methods also limited the susceptibility reports to a few antibiotics. The manual methods for culture and sensitivity also lacked quality control measures.

Dr. Francis Gary Longsworth

“The standard precautions that are used in the hospital setting to control and prevent outbreaks…the team felt that although prevention guidelines were in place; that monitoring and the lack of what they term a supportive environment for standard precautions were affecting compliance.”

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 forty-eight hours confers a high risk of contamination by any handler.

Dr. Francis Gary Longsworth

“The policy that was developed by the Infection Control Committee in 2011 not being implemented that was implemented. The recommendation of the PAHO team, which is supported by the two experts from Mexico, is that we must move owe step further and we should go to the individualized management of these babies. And that is where the IV Therapy Training that is being done at this moment; that is what people are being trained to do. To take it one step further. It is not that we did not do anything.”

Peter Allen

Peter Allen, C.E.O., Ministry of Health

“In an attempt to try to learn more and to at least express our sympathy. Obviously some of the families will wish to take legal action and that is their right. Nobody is going to deny them their right. But what is our role here is to listen to the recommendations of an international, independent investigating team and then to work with Karl Heusner to put those recommendations into effect.”

Reporting for News Five, Jose Sanchez.