The Department of Health has confirmed that out of the 17 cases of antibiotic-resistant CRE (Carbapenem-resistant Enterobacteriaceae) reported between 1 November and 31 December 2019, 10 babies have died.
“It was suspected that the organism responsible for this outbreak was Klebsiella pneumoniae,” said the department’s spokesperson, Kwara Kekana.
While it is still unclear at this point how exactly the babies contracted the deadly Klebsiella pneumoniae pathogen said to be responsible for the outbreak, overcrowding of maternity wards, understaffing and poor hygiene were cited as the key reasons for how this bacteria thrives in the first place.
“Overcrowding and poor hygiene measures are a major problem in neonatal units in Gauteng hospitals. This led to the deaths of six babies from Klebsiella at the Thelle Mogoerane Hospital in 2018, but there has been no proper accountability for these deaths,” said DA Gauteng Shadow Health MEC Jack Bloom.
“This hospital is notoriously overcrowded and the 44-bed neonatal unit often admits more than double that number of babies. We need to know why the public was not informed earlier and what accountability there will be for these deaths,” he said
Tembisa Hospital, like many other health facilities in the province, is faced with the challenge of ever-increasing demands for services. The 44-bed neonatal unit often admits close to 90 patients.
CRE is a family of germs that are difficult to treat because they have high levels of resistance to antibiotics. They can cause deadly infections in the bloodstream, lungs and urinary tract, including pneumonia and meningitis.
Last year, the Thelle Mogoerane Regional Hospital recorded an in-facility maternal mortality rate (MMR) for the period 1 January to 30 September 2019 at 211.8 per 100,000, with the neonatal mortality rate (NMR) at an average of 19.2 per 1,000. The hospital had 6,198 deliveries in the same period, with 118 of those resulting in neonatal deaths.
The causes were related to prematurity, asphyxia, congenital abnormality and sepsis – which resulted in the highest number of deaths.
The high mortality rates were attributed to a high burden of disease in pregnant patients, a high number of referrals of high-risk patients from surrounding clinics and district hospitals, and inadequate infrastructure to accommodate all neonates resulting in overcrowding of the neonatal ward, thereby increasing the risk of sepsis.
Furthermore, staff shortages impact negatively on health outcomes – premature babies require higher-skilled dedicated nurses.
According to the department, a stakeholders meeting, which consisted of the hospital services directorate, Tshwane district microbiology team and the National Institute of Communicable Diseases (NICD) was convened on 6 January 2020 to discuss challenges of overcrowding in the ward, staff shortages, infrastructure, inappropriate equipment storage, and difficulty in isolating infected infants.
The department said the following measures have been taken to prevent further infections in the neonatal unit:
A quality improvement plan has been created and implemented with immediate effect;
Additional professional nurses have been deployed to assist at the neonatal unit;
Approval to divert new admissions to the Kalafong Hospital and Steve Biko Academic Hospital has been granted in principle;
- The external Infection Prevention and Control Audit is to be conducted on the date to be provided by the Provincial Quality Assurance Directorate;
The National Health Laboratory Services Infection Control Service is to provide technical support assistance to audit the Gauteng Department of Health Neonatal Units; and
The NICD is to allocate resources to develop a dashboard to monitor laboratory-confirmed neonatal infections at the facility level.
Bongani Mazibuko of the Democratic Nursing Organisation of South Africa (Denosa) said they are still waiting for the department of health to complete investigations before they make a conclusive statement on the matter.
Bloom said: “How many more babies will die before effective measures are taken at all hospitals? It is no use waking up after the tragedy, when babies have already died.”
While the department is looking at improving the hospital infrastructure, it is doing its utmost to serve patients with respect and dignity, said Kekana. DM