7 July 2005
I would like to welcome you all to this press conference where we are officially releasing the report of the investigation into the outbreak of Klebsiella bacteria in the neonatal nursery at Mahatma Ghandi Hospital .
The report highlights a number of factors that might have contributed to this outbreak. They range from structural design of the facility, human behaviour and the workload that the hospital is faced with.
Structural design
The main entrance of the nursery is in close proximity of the obstetric wards. It is recommended that we construct a wall with a door in the passage to create an air-lock room with a hand wash basin. Anyone entering the nursery should put on a clean gown that should be used for this area only. Ideally, the air-lock room should have an air pressure that is higher than the corridor but lower than the nursery to control airflow and possibly, the movement of various species of bacteria.
The current kangaroo nursing area needs to be walled off from the obstetric wards and an air-lock room be built between the kangaroo nursing area and the nursery.
The four areas for different levels of care at the nursery should be partitioned and should have different levels of air pressure. We also have to get extra and larger hand-wash basins for the nursery and isolation cubicles. These basins should be equipped with elbow operated taps and wall-mounted soap and paper-towel dispensers. We also have to establish separate disinfection and sluice rooms.
Work processes and Human Behaviour
Infection control measures have been stepped up to deal with several flaws identified with regard to behavioural aspect of infection prevention. Before these interventions were made, Klebsiella pneumoniae was found on the hands of 10% of the staff. It is now recommended that long sleeved clothes should not be worn. Wrist-watches and rings should not be allowed and hands should be washed up to elbow level.
There should also be a continuous education and training on infection control and more authority should be delegated to an infection control officer to allow for appropriate intervention to be made immediately to prevent infection and deal effectively with identified cases.
Klebsiella pneumoniae was found in bottles of one of the intravenous preparations (Vamin-Glucose). This requires that extra precautionary measures be taken in preparing these solutions as contamination at the production level has been ruled out. Multiple use of intravenous medication should be stopped.
Workload
The team also raised concerns about overcrowding of the section under investigation which leads to high patient/health worker ratio.
Conclusion
The report does not hold any single individual or particular section of the hospital community responsible for the outbreak. This therefore requires that we focus on corrective and preventative measures to prevent such incidents in the future.
Some interventions have already been made to address these challenges and ensure that the outbreak is effectively contained. The neonatal intensive care unit was closed and alternative one identified. High-risk pregnancies are identified and referred to other facilities and the policy on infection control has been reviewed and strengthened.
The provincial Department will work with the hospital management in effecting the required structural changes to the facility. An early warning system and a rapid response team will be established to allow for early identification of risk and immediate reaction to cases of this nature.
We have also agreed that the Medical Research Council will soon initiate a study on the effective measures to prevent various hospital-acquired infections. While the study is underway, we will be implementing a nationwide education and training campaign addressing all major areas of infection prevention.
This has been a difficult moment for all of us in the health sector and the affected families. I would like to thank the team from the Nelson Mandela School of Medicine for responding urgently to our call to have this unfortunate incident investigated.
I would also like to thank the affected families, the management and staff at Mahatma Ghandi Hospital for your cooperation in ensuring that this investigation is finalised as quickly as possible. Without your continued support, we could not get to the bottom of what happened and more importantly, how we will prevent similar incidents in the future.
Dr Manto Tshabalala-Msimang
Minister of Health