Report: Hospital ideal for infections

Two separate investigations into conditions at Mt Hope Women’s Hospital have revealed conditions at the hospital were responsible for enterobacter bacteria infecting babies at the neonatal unit of the hospital.

At a media briefing held at the Health Ministry’s head office to reveal the findings of the investigations, Health Minister John Rahael summed up the situation, saying a lack of infection control, shortage of staff, particularly Intensive Care Unit nurses, and equipment (ventilators/incubators) contributed to bacterial infection at the neonatal unit. While acknowledging that enterobacter lived in the hospital environment, Rahael blamed the deterioration of the physical environment, which he said should not have been allowed to happen. He said staff had to be trained to ensure protocols and procedures are established so when bacteria is discovered, they can respond quickly. Rahael also announced that $3.2 million has been earmarked to purchase equipment for the hospital. He hoped by the end of January all will be installed. If additional funding is required, the Minister said he would approach Cabinet.

While there is still insufficient information to state whether the two deaths publicised in the media were due to enterobacter, Dr Petronella Manning yesterday said “in general” the neonatal unit is poorly prepared for dealing with prevention of hospital-acquired infections. Dr Manning has been spearheading the most recent investigation into an outbreak of enterobacter (in October). She has been mandated to make recommendations after identifying the causes. Although her report is “preliminary,” Dr Manning said the Women’s Hospital had no infection control policies and systems have been put in place, so there is no policy to enforce or vigilance for infections. Dr Manning also noted the absence of an antibiotic policy. She said the facility did not have a dedicated area for mixing intravenous solutions or preparing IV medication. There was insufficient storage space and items were being stored on the floor of the unit which she described as a “no no in infection policy.” Dr Manning said there needs to be an overall revamping of policies and more definite infection control and antibiotic policy.

Commenting on the cleaning/sterilising exercise undertaken after the first outbreak last September, Dr Manning described the neonatal unit as very clean, but she said the North West Regional Health Authority may have overreacted by putting in repeat systems which may not be necessary. Dr Manning said someone should be appointed to spearhead the management of the neonatal unit at Mt Hope. She could not say how many deaths were due to enterobacter, because she did not have figures and was still examining “notes.” Questioned about whether the outbreaks were due to negligence, Dr Manning said the Women’s Hospital did not have a management system on wards. She said perhaps it took the Pan American Health Organisation’s (PAHO) report to be the “wake up” call.

Disclosing the contents of the report compiled by PAHO consultants, country representative Lilian Reneau-Vernon said they looked at the infrastructure of neonatal units at PoSGH, San Fernando, Sangre Grande and Mt Hope hospitals and found the facilities were not designed to be ICUs. PAHO has advised the Health Ministry to expedite the plan for refurbishing and extending nurseries. Reneau-Vernon said the assessment by the consultants was done in two parts: validating the perinatal, neonatal and infant mortality statistics and visiting units to look at the management systems, staffing and equipping of the neonatal units. Outlining the general recommendations, she said the Ministry must decide if to refurbish or close down the hospital. This decision must be based on proper technical analysis. PAHO has also recommended the NWRHA institute a preventive maintenance schedule for infrastructure and equipment; introduce internal auditing of neonatal nurseries and infection control systems.

PAHO was also asked to assess the waste water disposal system in place. Reneau-Vernon said drains at the hospital need to be excavated and repaired and filters installed at “appropriate areas” to ensure cleaner water supply. She said the hospital has been functioning without a supply of hot water since the hot water clarifier stopped working over a year ago, and only one of the three air-conditioners is working. Reneau-Vernon said appropriate solid waste management protocols are needed. She said the roof of the main building is leaking and as a result, several rooms in the neonatal unit cannot be used. PAHO has recommended the installation of a new roof since repairs to the existing one would be inadequate. Sterilisers are in a “sorry state” with only one small autoclave sterilising items for the hospital. “Very little if any preventive maintenance is done,” Reneau-Vernon said, adding that repairs only took place when breakdowns happened.