JDWNRH keep an eye on NICU

Bhutan Times - - Front Page - Staff Re­porter

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

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