Other fac­tors also added to neona­tal deaths at JDWNRH

Bhutan Times - - Home - Sonam Pen­jor

The re­cent nine neona­tal deaths at Jigme Dorji Wangchuck National Re­fer­ral Hos­pi­tal (JDWNRH) were also added by other fac­tors to hos­pi­tal-ac­quired in­fec­tions (HAI).

Med­i­cal Su­per­in­ten­dent of Jigme Dorji Wangchuck National Re­fer­ral Hos­pi­tal (JDWNRH), Gosar Pemba said that out of the nine cases, two were not be­cause of HAI rather it was due to other fac­tors.

The press re­lease from the JDWNRH states that two ba­bies were born at only six months of preg­nancy weigh­ing around one kg and another four ba­bies were born at only seven months of preg­nancy weigh­ing lit­tle over one kg with pre­dis­pos­ing con­di­tions in the mother; six out of nine mothers had se­vere preg­nancy in­duced hy­per­ten­sion which is well es­tab­lished risk fac­tor for neona­tal deaths and ad­di­tional three ba­bies had con­gen­i­tal heart dis­eases and blood re­lated dis­eases.

The press re­lease stated that all ba­bies were born preterm with mean de­liv­ery pe­riod of 7.3 months of preg­nancy and with pre­dis­posed con­di­tions. The rate of HAI in­creases with the de­gree of both pre­ma­tu­rity and low birth weight.

How­ever, HAI is com­mon in all health fa­cil­i­ties, and in spite of all the nec­es­sary In­fec­tion Con­trol mea­sures, out­break could oc­cur due to many ex­ter­nal fac­tors.

“HAI is a com­mon prob­lem among neonates in Neo-na­tal In­ten­sive Care Unit (NICU) and glob­ally, it is one of the lead­ing causes of death in this group of pa­tients. In South East Asia, HAI re­lated mor­tal­ity in neonates is as high as 75 per­cent and Bhutan is no ex­cep­tion.”

The new-born ba­bies ad­mit­ted to NICU usu­ally have many risk fac­tors which pre­dis­poses them to HAI. In this group of new-born ba­bies that suc­cumbed to in­fec­tion, the ba­bies were born pre­ma­ture with risk fac­tors such as im­ma­tu­rity of the im­mune sys­tem, bar­rier func­tion of the skin and gas­troin­testi­nal tract, and the in­va­sive di­ag­nos­tic and ther­a­peu­tic pro­ce­dure which our new-born un­dergo and there­fore, eas­ily be­come sus­cep­ti­ble to one of the com­monly found bac­te­ria caus­ing HAI, Kleb­siella Pneu­mo­nia.

The first signs of the bac­te­ria Kleb­siella Pneu­mo­nia were ob­served on 16th July 2018 in the NICU when the blood re­port of a few neonates showed pres­ence of the bac­te­ria. The mat­ter was re­ported to the in­fec­tion preven­tion and con­trol fo­cal per­son of JDWNRH. The Fo­cal per­son im­me­di­ately en­forced the in­fec­tion preven­tion and con­trol prac­tices and the in­fected ba­bies were seg­re­gated from the non­in­fected ones.

The press re­lease from the min­istry of health stated that the Min­istry of Health and the JDWNRH has taken im­me­di­ate in­ter­ven­tions through mass clean­ing, steam­ing and fog­ging, treat­ment of hos­pi­tal wa­ter reser­voir, en­vi­ron­men­tal sur­veil­lance in NICU and Neona­tal Ward, ad­di­tional de­ploy­ment of staff and san­i­tary sup­plies, qual­ity check for an­tibi­otics, iso­la­tion of in­fected chil­dren and ster­il­iza­tion of feed­ing equip­ment.

In­de­pen­dent in­ves­ti­ga­tions con­ducted by the JDWNRH, Drug Reg­u­la­tory Author­ity and the Min­istry of Health rec­om­mended the JDWNRH man­age­ment to strictly abide by the stan­dards and prac­tices for in­fec­tion con­trol, im­prove man­age­ment through as­sign­ment of ap­pro­pri­ate health work­ers espe­cially in the crit­i­cal care ar­eas and en­sure safety of wa­ter.

“All nec­es­sary mea­sures have been un­der­taken and it is said that the out­break is ef­fec­tively un­der con­trol.”

The Min­istry of Health has also re­minded all health fa­cil­i­ties to strictly en­force the stan­dards and prac­tices for in­fec­tion con­trol to im­prove qual­ity and safety of health ser­vices across the coun­try.

In NICU, gen­er­ally four to six ba­bies die ev­ery month of which one to two is re­lated to HAI. In the 3rd week of July 2018, there were five neona­tal deaths re­lated to HAI due to which the out­break was de­clared as it met the out­break cri­te­ria. Sev­eral life sav­ing mea­sures were put in place soon af­ter the out­break was no­ti­fied on 26th July 2018, due to which we were able to save 15 ba­bies out of the to­tal 24 con­firmed cases ad­mit­ted dur­ing the pe­riod. The first death oc­curred on 23rd July and the last one was on 6th Au­gust.

Mean­while, the press re­lease states that the pos­si­ble cause for this out­break was found to be con­tam­i­nated hos­pi­tal wa­ter sup­ply which was used for clean­ing the units, wash­ing hands, feed­ing ma­te­ri­als and other equip­ment.

The re­port from the Royal Cen­tre for Disease Con­trol (RCDC) car­ried out on 31st July 2018 showed pres­ence of high level of Coli Form. Other fac­tors which con­trib­uted to ag­gra­va­tion of the HAI, could be at­trib­uted to the short­ages of doc­tor and nurses, lim­ited fa­cil­ity to seg­re­gate pa­tients, com­pla­cency of the par­ents in ster­il­iz­ing the feed­ing ma­te­ri­als, poor hand hy­giene, and un­con­trol­lable pa­tient vis­i­tors, who de­spite in­stal­la­tion of bio­met­ric sys­tem to re­strict vis­i­tors, shows very poor com­pli­ance and even quar­rel with se­cu­rity guard and staff on daily ba­sis.

The stan­dard re­quire­ment of nurses in the Neona­tal In­ten­sive Care Unit (NICU) and other ICUs is 1:1 (1 nurse per 1 pa­tient), whereas, the cur­rent ra­tio in JDWNRH is 1:4. In the Nurs­ing depart­ment, JDWNRH have a short­age of 173 nurses. Sim­i­larly, the hos­pi­tal has a short­age of ward boy/girl and clean­ers. There is only one Neona­tol­o­gist in JDWNRH while there should have been at least 3 Neona­tol­o­gist as per the norm.

Newspapers in English

Newspapers from Bhutan

© PressReader. All rights reserved.