JDWNRH keep an eye on NICU
Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) takes measures to control recent outbreak of healthcare associated infections in Neonatal Intensive Care Unit ( NICU) from now onwards.
The action was taken due to deaths of 9 babies infected with healthcare associated infection in NICU between July 23 to August 6, this year possibly due to health care associated infection.
The hospital management held meeting on October 1 to discusss the implementation of the recommendations from interim government.
According to the JDWNRH press release, the deceased babies cases were referred from district hospitals due to pregnancy related complications and had to undergo emergency caesarean section. All the babies were born preterm (WHO: gestational age <37 weeks) and low birth weight of less than 2 kgs requiring admission in NICU, press release states.
It also states that babies in severe medical conditions, preterm delivery, low birth weight and increased medical procedures performed as required would have put these babies at higher risk of acquiring infections.
In addition, the cleaning of environment with substandard disinfectant, understaffing and less trained, overcrowding with visitors, inadequate infrastructure and poor compliance of the parents in sterilizing feeding materials could have been some of the contributing factors which have put babies at higher risk of infection. The other probable cause being water contamination in the hospital acccording to JDWNRH.
Immediately after the outbreak, JDWNRH took measures like daily chlorination and regular monitoring of the water quality by the Royal Centre for Disease Control (RCDC), installation of 3 stage ultraviolet water filter in NICU, strengthened monitoring and supervision on compliance of infection prevention and control practices among staff and attendants, frequent meetings of the stakeholders to update the outbreak situation and implementation status of the recommendations, environmental surveillance with help of RCDC, restrictions of visitors by deployment of one security guard at the entrances of all Intensive Care Units (ICUs), antibiotics stewardship, and liaising with other stakeholders to prevent future outbreak.
According to the press release, the interim government short term recommendations for immediate actions were discussed and endorsed by the JDWNRH. The actions were urgent need of infection control unit in JDWNRH. The hospital management waits for approval from Royal Civil Service Comission (RCSC) in setting up the unit and the required staff strength untill 12th Five Year Plan HR standard is in place. JDWNRH has a Standard Operating Procedure ( SOP) for cleaning in the hospital and the ward. The unit In- charges will strengthen the monitoring of the cleaning and compliance of the SoPs in cleaning.
In addition, the incharges of the concerned unit and maintenance division would work collaboratively to ensure that water stagnations and blockages of drainages are cleared imme- diately.
The press release of JWDNRH states that with the current infrastructure design, hospital faces difficulty in relocating the hand washing basin as recommended because of the lack of space in the critical unit. Further, installing hand washing basin inside the unit requires closing of the unit for at least 7 to 10 days which may cause huge inconvenience to the babies requiring admission both within Thimphu and from the districts. However, the maintenance division plans to revisit the space and explore ways.
The maintenance division ensures that daily water chlorination in the reservoir tank and water quality testing carried out without fail. And also, maintenance division will develop SOP on maintaining safe drinking water in coordination.
To accelerate procurement of infection control material and provide consistent and adequate supply, regarding the inconsistent supply of bleaching powder, that had occurred due to some packaging problem. The procurement division places the purchase order based on the annual requisition put up by the Unit and ward In-charges with certain percentage added to that in order to last for the whole year. The press release also states that quantity purchased of hand sanitizer is inadequate for the whole year. Hence, problem occurs when the additional quantity is being ordered as the procurement cycle has to be followed as per procurement rules.
JDWNRH also implementation of strict crowd control measures with additional security guards, outsourced to Jachung Security Service. The security guards are being deployed in different designated areas starting from the Emergency Department to all the levels of the buildings and critical areas in three shifts basis. Besides the security service, biometric doors and CCTV cameras have been installed in 2017 in all the buildings and units as a crowd control and surveillance measure.
According to JDWNRH, despite these measures, there is still difficulty in controlling the access of people to the ICUs ,Wards and Cabins.
From now onwards there will be strict crowd control measures with additional security guards at the national referral hospital in Thimphu