Headline — 24 May 2013 — by Miriam Longsworth
KHMH Cloacae calamity !

Hospital CEO said he learned of the 12 infant deaths “through the media;” 7 deaths due to bacteria and 5 due to “premature-related issues”

When one mother loses her infant child in a hospital unnecessarily, it is a tragedy; when twelve mothers lose their babies, it is a catastrophe of mammoth proportions. The collective pain and heartbreak is beyond measure.

Within the first 20 days of this month, there have been 12 neonatal deaths at the Karl Heusner Memorial Hospital (KHMH) Neonatal Intensive Care Unit (NICU) in Belize City, and the hospital’s Chief Executive Officer Dr. Francis Gary Longsworth, said in a press conference yesterday, Wednesday, that he only became aware of the situation after parents of one of the deceased babies went to the media with their concerns.

At the press conference, Longsworth, Chairlady of the Board of Governors Chandra Nisbet Cansino, and Chief of Medical Staff Dr. Adrian Coye addressed the situation – 7 deaths by bacterial infection, and 5 from prematurity-related issues.

We were told that internal investigations into the matter started immediately after the deaths in the NICU began.

“One of the parents went to the media, I believe” Longsworth said, adding “That actually prompted the investigation because up to that point, we were not aware that the situation was developing.”

Investigations are ongoing and the hospital has acquired assistance from outside sources, including the Pan-American Health Organization (PAHO) in Washington.

Coye told us their preliminary investigations have determined that of the 12 deaths, only seven were caused by an outbreak of a particular organism — Enterobacter cloacae, at the hospital.

He said that the organism affects babies all over the world, and that the outbreak has rung alarm bells and adjustments are being made clinically and within the unit.

The organism is not a super bug, and although the hospital has the treatment to counteract it, it is difficult to assess, Coye added.

“The profile of the resistance pattern within the organism we have found is sensitive to antibiotics we do have in the hospital and made available through the Ministry of Health, so it’s not a super bug,” Coye said. “But the problem with this kind of organism,” he went on to say, “is that it is very fastidious, very difficult to care [against], and there is transmission by direct contact and also by indirect contact.”

Cansino said that the hospital was looking into the deaths, but while testing was being conducted, they were still losing more babies.

“While you’re waiting five days for a blood culture, babies were passing away,” she said. “That little cluster of time was where we lost some of the babies without knowing it was because of this particular bacteria,” she said.

Cansino said that one of their main goals is to find out where or who was the source of the infection.

“We still have not gotten a lot of reports to determine if anybody is culpable,” she said, adding that, “We have not established that at this time and that is a process that is still under investigation.”

Coye said that the bacteria can be carried on anyone or on any surface, anywhere in the hospital. He went on to explain that in outbreak cases, it is necessary to look for an index case, and they believe that the case in this matter dates back to February of this year.

In February, an infant was treated for the infection and was sent home. The doctor said that that might have been where the infection originated and colonization began. But that’s only a speculation. Nevertheless, it has been declared that the infection is currently under control.

The 16-year-old NICU is a 10 to 11-bed unit and is the only public facility in Belize that offers that level of nursery care. The hospital has closed operations in the NICU until they find out whether the cause of the deaths was a hospital-based infection or infection from another source.

The Ministry of Health issued a press release on Tuesday, May 21, stating that KHMH has its full support in carrying out investigations into the matter. On Wednesday, May 22, the Office of the Special Envoy for Women and Children announced that they are spearheading the construction of a suitable pediatric and neonatal intensive care unit in a new wing at the KHMH.

We spoke to a couple of the parents who have lost their babies during the bacterial outbreak. Harrison Sutherland, 18, lost his daughter, Imari. She was born on May 10 (Mother’s Day) and died on May 18 — just eight days after being born premature, seven months into her mother’s pregnancy.

He told us that after he found out about the other babies who had died from an infection, he became concerned about his child. He added that his daughter was doing just fine until he was suddenly told that she needed blood. Less than a day later, his daughter died.

“The baby was eating and everything because my girl would take breast milk for her. The baby was playing with my fingers; her eyes were opened, everything,” he said. “Every day I go there I play with my baby, my baby looked okay,” he wistfully stated.

Sutherland said that he blames the hospital for the babies’ deaths.

“I blame the ICU because they should have known that the ICU had an infection so they could have moved the babies from there a long time; they waited until all the babies died,” he said. He then noted, “I thought this place was better than that. All young babies — they were supposed to have that place well-secured, wash your hands properly. Sometimes I see people from the morgue go inside the ICU with their clothes – they come straight out the morgue and go in there to take gowns to the ICU. That’s not right because that’s infections they’re taking into the babies’ spot.”

He told us that his baby’s death certificate listed the cause of death as prematurity.

A 16-year-old’s baby was the twelfth baby to have succumbed in the NICU. Her baby boy, who was to be named Jordan, was born at 34 weeks on May 4, 2013, and died May 20.

She said she was told that the baby was being kept in the ICU because his lungs weren’t fully developed, but she was told that her son was responding well to treatment. The baby’s health suddenly began to deteriorate and he died.

The mother said before her son died, she heard from other parents that there was a bacteria going around and it was killing other babies in the unit.

“So I asked one of the nurses, if they knew that there was a bacteria, then why didn’t you move the babies first before all these deaths had to happen, because this wasn’t necessary,” she said.

She went on to say that she was praying that her baby was going to make it, but after being told that her baby had to go back on a ventilator, she prepared for the worst.

Like Sutherland, this mother blames the hospital for her baby’s death. She believes that her baby would have lived if he had not become infected.

She said her son’s death certificate stated the cause of death as neonatal sepsis, which is a blood infection that occurs in 90-day-old babies.

Amandala has learned that Enterobacter cloacae is in the human intestinal system and is normal, but if it gets into the blood it can cause sepsis and urinary blood infections. The organism has been proven to be hospital-acquired bacteria, believed to be caused through contamination.

We have been told that a group of the parents who have lost their babies through the spread of this bacteria will consider taking legal action against KHMH.

Rafael Martinez, police press officer, told Amandala today that the infants’ deaths are an internal matter for the hospital, and they, the police, would not become involved unless it was believed that a crime had been committed.

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