Hospital manager fears new bacteria outbreak

Head of the Neonatal Intensive Care Unit (NICU) at Mt Hope Women’s Hospital yesterday told the Commission of Inquiry into the Operation and Delivery of Public Health Care Services in TT that he was fearful of another enterobacter outbreak, since all of the factors which contributed to it still exist. During a meeting with commissioners at the lecture room of the hospital, Dr Gary Yuille said  the NICU has been able to bring down infection rates, but many of the problems which contributed to the enterobacter crisis still exist. He highlighted overcrowding in the NICU, staff shortages, inadequate equipment, poor water supply and erratic drug supply among the problems which continue to plague the NICU.

In August through November 2003, the hospital had an upsurge in enterobacter cases which resulted in the deaths of several babies.  Yuille said, “I fear that if we don’t do something as a matter of urgency, we can have the proportions we experienced in 2003.” He told the commissioners that the NICU was charged with caring for sick newborns with many medical needs. Approximately ten percent of all the babies born at Mt Hope would require intensive care treatment.

Yuille said 24 babies could be accommodated in four patient care rooms each 230 sq ft. The space between each baby is less than 40 sq ft although international recommendation is that the space should be between 120-180 sq ft. “Due to our extreme overcrowding it leads to infections and other problems.” He said the NICU did not have space for an isolation room for babies with infections. He said the hospital was not ordinally designed for an ICU, so there were many “intrinsic problems.” Yuille said there were insufficient electrical outlets for equipment so there was a mass of cords which staff often tripped over.

Due to the absence of an air-conditioning unit, windows were left open, and the area open to infection. “Recently they were working on the roof outside the unit. We had just finished cleaning our entire unit, and the breeze blew all the dirt right back into the unit.” Yuille said most of the equipment in service was obsolete. There are ventilators in use for more than 20 years. Despite receiving equipment in the aftermath of the enterobacter outbreak, Yuille said the supply was so inadequate they could not substantially alleviate the problems experienced.

He said maintenance was a problem and equipment was being used until it broke down. The inconsistent supply of “consumable” items caused some equipment intended for one-time use, to prevent cross infection, to be reused. Yuille said staff was forced to clean oxygen saturation probes to be reused because supply ran out for four months starting in January. One nurse assigned to care for one baby has not been possible. Yuille said last weekend there were two nurses and one nursing assistant for 20 babies.

He said one nurse will be scampering from one baby to the next and this compromised the babies’ care and contributed to infection rates. Yuille said, “There is no time to sanitise your hands, running back and forth all night, all day.” At night the situation is worse. He said there should be ten-14 nurses on every shift. Transportation of babies and lab specimens to the nearby complex is also problematic, since the hospital does not have its own transport or dedicated ambulance. “Quite often our babies miss appointments. We don’t get lab tests back in a timely fashion.”