Why children died still unclear
The Department of Health has apologized for the deaths last week of six babies at Charlotte Maxeke Johannesburg Academic Hospital and 10 at Natalspruit Hospital on the East Rand. The Department says it’s investigating several factors to determine the cause of deaths.
‘The past week has been a very traumatic one. Nobody wishes to see babies dying. Our hearts are with the families of those children whom we have lost. And I want to take this opportunity on behalf of the hospital and on behalf of the Department of the Health and on behalf of the government to apologise publicly to the families, to the country as a whole, about this tragedy because I believe we should have done better’, said Health Minister Dr Aaron Motsoaledi at a media briefing following the deaths of six premature babies at Charlotte Maxeke Johannesburg Academic Hospital and 10 at Natalspruit Hospital, east of Johannesburg.
The Health Minister said various factors could have caused the Charlotte Maxeke baby deaths, but he was unequivocal that poor infection control at the hospital was the root cause. Last year, the Health Department identified infection control as one of six key areas that needed improvement in the public health sector.
‘We want to accept up-front that there was definitely a lapse in infection control. Many of you who have been following us in the Department will remember (that) in November I called all the CEOs of hospitals to tell them about the six immediate standards which we would like to see in the country. We spoke about infection control, which is the subject of why we are here. The lapse of infection control measures is a very good lesson and we are hoping that other hospitals have learned this lesson from a distance that when I spoke to them in November that we are worried about infection control, the consequences of not following that, is exactly what has happened here’, he said.
Because of poor infection control measures, there occurred an outbreak of a viral infection known as the norovirus in the paediatric ward. The virus causes gastro-intestinal infections such as diarrhoea. The norovirus was further complicated by a bacterial infection, Klebsiella, which tends to attack weakened immune systems, in this case the premature babies at Charlotte Maxeke Johannesburg Academic Hospital. Klebsiella is very often contracted in hospitals. Professor Adriano Duse of the Paediatric Unit at Charlotte Maxeke Hospital explained that these and various other factors are being investigated as the cause of the babies’ deaths.
‘It’s very likely that norovirus was introduced from the community into the hospital, where as a consequence of possible infection control lapses, overcrowding, and so on, the virus may have actually been spread to other infants in the ward.
Once norovirus, which was detected in 15 out of the 17 cases that initially were part of the outbreak on Sunday, is present it can cause damage to the gut. When the gut wall is damaged, bugs from the gut (these are bacteria, not viruses) can move into the blood-stream and cause further complications – septicaemia, severe sepsis. And, usually, it is these further complications that are the ones that result in bad outcomes such as deaths of babies’, Professor Duse said.
‘It so happens that we found and confirmed norovirus by doing certain specialised virology tests on stools of the babies. We also found Klebsiella Pneumonia in the bloodstream of some of the babies and that would suggest that there has been a more serious insult to the babies caused by bacteria. We also just need to stress that although we did find Klebsiellas in 13 out of 19 milk bottles. They were not in use. They were empty and they were in the ward for some period of time. We are not a 100% clear what the relative contribution of each of these factors are and it’s by addressing all of these things that we will be able to, hopefully, get on top of the outbreak and come right’, he continued.
But could the infections and the deaths have been avoided?
‘There is not a country in the world that can really claim to have zero outbreak rates. We talk about hospital infections as reaching an irreducible minimum, which means that no matter how hard we try, worldwide outbreaks occur and, obviously, they cause all the devastation that comes along. Hospitals are always a high-risk place for anybody to go into. Hospitalisation carries intrinsic risk. Of course, if we had had increased infection prevention and control personnel and if we had better staffing situations, if we didn’t have over-crowding and our programmes had been more robust we may have actually, in some way, mitigated against this tragedy to a degree’, said Professor Duse.
‘Infection control cannot easily happen in over-crowded conditions. While I say there was a lapse in infection control, overcrowding contributed a lot. These babies need to be taken care of almost every single second’¦ you can’t get your eyes off’¦ because neonates change dramatically within a very short space of time. So, you need one nurse to take care of two babies. Unfortunately, this was not necessarily the case because of over-crowding’, Health Minister, Dr Aaron Motsoaledi conceded.
Investigations into the babies’ deaths are still continuing. Meanwhile, the Health Minister reported that of the 10 babies who died at Natalspruit Hospital on the East Rand two were macerated still-births, which means they had died a while before in their mothers’ wombs and another two were freshly still-born, while the rest died of various undisclosed causes.