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As we've described it, there are major signs of sub-standard conditions within the hospital, and so Daniel Ortiz took an in-depth look at what the PAHO investigators found. Here's his report:

Daniel Ortiz reporting
The PAHO report has gone into extensive detail with some of the problems discovered at the KHMH, and the Ministry of Health is taking the findings as matters of urgent national interest.

Hon. Pablo Marin - Minister of Health
"Clearly, the report is critical of many areas and makes strong recommendations. The Ministry of Health and the KHMH will remain dedicated in accepting these recommendations and implementing all necessary actions at the earliest possible time. Many of these have already been implemented while the remainder will be implemented as soon as possible."

Dr. Francis Gary Longsworth - CEO, KHMH
"We have pledged, as I said in the earlier part of my address to continue to keep the public and the parents of these neonates informed as to developments and imporvements that we will be making in the systems at the hospital and we would like to assure the public that depsite this setback - we are on the road to continue imporvement and excellent service at the hospital. This is not only in the areaof pediatrics and neonatal care, but in every service area of the hospital."

But, just from a cursory look, which was prompted by the deaths of the neonates, the PAHO investigators have made discoveries, and they use strong language with suggest that KHMH is in a sub-optimal state.

The report says, quote,

Page 24: Findings

"The hospital does not provide a safe and appropriate environment for the compliance of Standard Precautions and practices such as: not enough hand washing sinks or hand hygiene solution dispensers.

Many patient care areas have cracked benches (which) cannot be properly disinfected. Construction and renovation activities were taking place in critical care patient areas such as PICU and near the new NICU area without appropriate barriers to prevent the spread of dust.

Many areas of the hospital (were) found with walls and ceiling tiles with sign of exposure to water leaks and mold growth. (There were) Rusty furniture and porous surfaces such as wood furniture in critical care areas."

As the Minister Indicated, KHMH has effected immediate remedies to comply their recommendations.

Dr. Francis Gary Longsworth
"We have also dispensed approximately a hundred hand sanitizers throughout the hospital by area of priority and we have another 100 of those dispenser to be deployed over the next week or two. We have been encouraging by use of our PA system and by the use of signs and assistance from our staff - we have been encouraging the public to utlize hand sanitation at every entry point in the different areas of the hospital."

But, the hospital has been employing disinfection practices which, according to PAHO are not up to international standards.

They say, quote:

Page 11.

"The National Guidelines describes, products to be used for cleaning and disinfection. In clinical settings there is regular use of acetic acid 1%, and acriflavin in spirit 0.4% which are not included in the guidelines."

But, the CEO says that these standards can change:

Dr. Francis Gary Longsworth
"My response and in keeping with the report as well is that standards change and the standards that we have employed over many years have changed and we have (pre-dating the outbreak) madechanges to some of the substances that we use for disinfection, sterilization and sanitation."

Reporter
"Why has it changed?"

Dr. Francis Gary Longsworth
"Because the world of microbes changes and the germs that we have today, the bacteria that we have today are not the bacteria that we had ten years ago."

So, that leads us the most urgent issue. What caused the deaths of the neonates?

Quoting from the PAHO report, they say,

Page 7.

"During the month of May 2013, 8 patients in the NICU where confirmed with clinical signs and symptoms of sepsis, having E. cloacae as the common pathogen in all cases, between 5th and 17th of this month."

And while in their investigation, the PAHO specialists inspected the area. They said,

Page 9

"The formal NICU was visited after it was closed for all clinical purposes. The space once assigned to hospitalized patients is restricted, and favors overcrowding of patients and personnel, according to the demand for hospitalization being the reference NICU for the country."

No surprises there, the Hospital has admitted that this is an issue, and since this catastrophe, the Government of Belize has committed funding to upgrade the unit, something which has been somewhat over-emphasized, but it shows a great importance attached to this observation.

Hon. Pablo Marin
"The government, through my ministry, is immediately investing over $80,000 in training for nurses in safe intro venous therapy and access to sexual and reproductive health services. We have further identify an additional $500,000 to support our on going construction of the new Pediatric of Neonatal Intensive care unit."

So, who is to blame for this uncontrolled outbreak? The report says

Page 8.

"The personnel responsible for Infection Control Program (ICP) in the hospital fall under the Quality Assurance Coordinator who reports to the CEO. This program includes an Infection Control Committee (ICC) with specific duties in surveillance, product review, policies, procedures, and administration of the program."

It continues:

"The ICC has a physician assigned to it with no specific references as to weekly hours specially dedicated to ICP. In the time visiting the Hospital, there was neither permanent nor partial participation of this professional with the external team from PAHO. There is an Infection Control Unit staffed with two infection control nurses, one of them with specific training. No written annual goals for ICP are known for the hospital."

And tomorrow, we'll have part 2 of that drill-down, which shows that the infection outbreak protocols at the hospital were not functioning the way it should.