Details of damning PAHO report on K.H.M.H.

An investigation by the Pan American Health Organization carried out by high level experts into the deaths of thirteen neonates at the Karl Heusner Memorial Hospital is in short, damning of the national referral hospital. It confirms that the Infection Control Committee of the K.H.M.H. was not functioning and that in fact the infection was passed on to the neonates intravenously. A number of other grave deficiencies were cited and tonight, we dig further into the twenty-six page report looking for answers into the most catastrophic incident at the K.H.M.H.  News Five’s Jose Sanchez has an update.

Dr. Francis Gary Longsworth, C.E.O., K.H.M.H.

“The world of microbes changes. The germs that we have today, the bacteria that we have today are not the bacteria that we had ten year ago or even five years ago. And this particular enterobacter that is responsible for the outbreak seemingly mutated during the outbreak. So the bacteria changed within minutes and hours of their existence and developed resistance over a period of hours and days.”

Jose Sanchez, Reporting

The key words he said are quote “seemingly change.” The bacteria seemingly changed, but it may have actually not changed at all. The Central Lab lacked supplies since February and technicians are forced to using home-made manual methods of identification with apparently “serious deficiencies on the media” which could cause the false appearance of other enterobacter cloacae strains. The PAHO report says, “The manual methods for culture and sensitivity lacked quality control measures…Different susceptibility patterns might be the result of inconsistencies on the media and not different infections by different strains of enterobacter cloacae with different susceptibility pattern. The laboratory capabilities and assurance as a resource to aid in the diagnostic of clinical infections and to assist in an epidemiological investigation are precarious and are compromising patient care.”

Francis Gary Longsworth

Medication in pediatrics and neonatology are left in syringes for up to seven days; that was observed in August, 2011. The high risk practice for contamination has been reduced to two days and the report questions why it has not been eliminated.

Dr. Francis Gary Longsworth

“Again, in the context of the report, a change was made. A change was made from several days of storage to a maximum of forty-eight hours of storage…so we did comply.”

Jose Sanchez

“But the report says, “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 on any device for intravenous puncture or intravenous medication used in these patients. Their prematurity implies management with intravenous therapies permanently since their admission.” And they also say that the forty-eight hours confers quote “a high risk of contamination by any handler?” that the forty-eight hours is still not enough. They are saying this went through blood intravenous. Is the hospital, are its managers or are its doctors responsible?”

Dr. Francis Gary Longsworth

“The report has not been able to conclude…”

Jose Sanchez

“Would it be the families? Who would it be?”

Dr. Francis Gary Longsworth

“It could have been from handling of the patient, use of intravenous lines, use of syringes; these are necessary parts of the treatment in the intensive care unit.”

Jose Sanchez

“Is the hospital going to apologize? Is the hospital going to say anything to these people? It is there…it is there in the PAHO report. You skipped over that part.”

Dr. Francis Gary Longsworth

“I don’t know if I quite understand the context in which you are saying. We do not know the source of the infection. It could have been brought from outside, it could have been transmitted within the unit by cross contamination, it could have been transmitted during invasive procedures; you would never know.”

Jose Sanchez

“The report also says that there have been sparse efforts in monitoring practices both to prevent and control nosocomial infections. There are no defined defined performance indicators, interventions applied do not obey unique pattern and as so are ad hoc and proved to be ineffective. You can say, well we don’t have any controls, so we can’t say that dah we. The parents won’t buy that sir.”

Dr. Francis Gary Longsworth

“No, but if you refer back to the report and the statement I made, worldwide they are unable…the experts who investigate these episodes which happen throughout the world—in forty-eight point six percent of cases, they are unable to determine a source. So this is not a unique situation for us.”

Jose Sanchez

“You able to test…you are blind. The hospital is blind in that particular part of its service. That is why you need an epidemiologist.”

Dr. Francis Gary Longsworth

“But we have taken that recommendation seriously.”

Jose Sanchez

“So by not having one, how can you say well we are not at fault since we can’t prove it since we don’t have the facilities to prove it?”

Dr. Francis Gary Longsworth

“We accept that the outbreak occurred, you know.”

We do know factors that may have aided in the outbreak. There is no preventive maintenance program for the sterilization equipment. False ceilings at different areas are either heavily damped or missing. Antiseptic and disinfectants not in the hospital guidelines are prepared locally. Two solutions widely used as a skin disinfectant, PAHO says should be discarded.  Numerous recommendations including the need for a permanent active surveillance program for nosocomial infections should be implemented urgently. Reporting for News Five, Jose Sanchez.

Click here to view a full report of PAHO’s investigation on K.H.M.H. The People’s United Party has also reacted to the PAHO findings. The P.U.P. says that the report points to a disgraceful and frightening breakdown in the K.H.M.H.’s infection control infrastructure and that there is a lack proper direction. According to the release, the report confirms that the current Ministry and Minister of Health have failed the Belizean people and must be held accountable for this failure which continues to manifest itself in new revelations of incompetence. The P.U.P. calls for two things, the return of Prime Minister Dean Barrow to provide leadership and for Pablo Marin’s head to roll.