Last night, 7News told you about the now-ready report from the Pan-American Health Organization, which shows that there were a number of irregularities at the KHMH which could have contributed to the deaths of the 12 neonatal patients in May.
And even if they don't, it shows that the hospital is not up to international standards in trying to insulate its patients from contamination as best as possible.
Well this afternoon, the hospital's Administration and the Minister of Health hosted a press conference to address the concerns raised by the PAHO investigators.
The media was there in full force, and the head table was grilled on this report. We'll get to that, but first… 2 members of the head table accused the media of twisting the facts to further their own sinister agenda. So for transparency, we'll start with start with a few parts of the report which KHMH CEO chose to address.
The first was that the report points to the fact that hospital has an Infection Control Committee ICC, and this committee advises the hospital on its Infection Prevention and Control program, ICP. As we've reported, the PAHO investigators found that this program was not functioning as well as it should, or the bacterial outbreak which caused the death of the neonates would not have been as catastrophic.
Here's how the CEO interpreted it to the nation:
Dr. Francis Gary Longsworth - CEO, KHMH
"The outcome that PAHO allied is that this program and this committee are not working on a regular basis and that although we have trained personnel on staff in the committee, our methods of surveillance in the past leading up to the outbreak have been fearful non-specific and not targeted at any particular types of illnesses and diseases. The other set of findings related to the laboratory, in order to investigate outbreak and any disease for that matter, you need micro-biologist support from the laboratory and some deficiencies were documented by the team. They have made recommendations regarding improving the space, the training of the individuals who work in the micro-biology department and that there are quality control measures that need to be implemented urgently in order to improve the functions for micro-biology laboratory."
As we told you, that is a major failure in oversight, so at the press conference, the CEO announced that he will now be a part of the committee, and he will have direct influence on it.
Dr. Francis Gary Longsworth
"I have volunteered to become a member of the infection control committee at the hospital because of the importance that I give to this area of work. So I will become a regular member to the infection control committee and will be attending all the meetings. We have also, in terms of surveillance, the surveillance needs to be better targeted and the team since the outbreak and investigating team and the quality assurance group at the hospital, including Ms. Michelle Hoare from the Ministry of Health - have been working on a draft policy for surveillance and a strategic plan to go forward for the next year and beyond."
And another important point mentioned in the PAHO report is that the most likely method which the premature babies were infected was through Intravenous therapy. The CEO said today that they take that observation seriously, and they have taken corrective steps:
Dr. Francis Gary Longsworth
"One other area that was sited is IV therapy and the methods by which this therapy is delivered - we are fortunate to have two experts from Mexico City who have been doing this kind of work over a period of ten years in response to outbreaks in Mexico at various hospitals. So they have come with a wealth of knowledge and experience in this particular area - they have assisted us in certain stages of the investigation and they have now come back, thanks to sponsorship through the Ministry of Health and the CBC and they have come back to provide training to approximately 25-30 of our nurses in the hospital in improved methods of intra venous therapy administration. This training will be put into effect immediately in the critical areas of the hospital and other service areas for in-patients and out."
While the report does not say directly that the bacteria outbreak was spread by the hospital's IV procedures, it does paint a clear picture of what possibly happened in the Neonatal Intensive Care Unit.
The report says quote,
"Since this bacteria was isolated in blood samples and its transmission is via the oral-fecal route, the most plausible explanation for this infection is through contamination of any device for intravenous puncture or intravenous medication used in these patients."
It adds,
"Their prematurity implies management with intravenous therapies permanently, since their admission. The regular practice of using multi-dose syringes shared for many patients and kept in use for at least 48 hours confers a high risk of contamination by any handler."
The reports notes that medical specialists observed this practice in an assessment in 2011, where they recommended that it be discarded, but the hospital, instead of doing so, decreased usage time from 7 days to 48 hours.
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