Friday, July 11, 2008 Probers find lapses in Osmak's infection control
THE outbreak of neo-sepsis at the Ospital ng Makati (Osmak) last May that led to the death of more than two dozens infants could have been averted had proper measures been undertaken at the onset of the case.
Former health secretary Jaime Galvez-Tan, who leads the fact-finding team tasked by Makati Mayor Jejomar Binay to investigate the case, said there was an "absence of consistent infection practices" at the City Government-owned hospital.
"It appears that such a high number of deaths could have been prevented or at least minimized had there been measures taken at the onset to respond to the situation," he said.
The presence of multiple levels of pathogens found at the hospital's Neonatal Intensive Care Unit (Nicu) indicates breakdown in infection control, owing largely to the absence of consistent infection control practices," Galvez-Tan added.
Aside from Galvez-Tan, other members of the fact-finding body were Dr. Anthony San Juan and Sally Espeleta of Department of Health-National Capital Region (DOH-NCR), Dr. Jacinto Mantaring of University of the Philippines-Philippine General Hospital (UP-PGH), Dr. Ernesto Santos of Makati Medical Center, and Dr. Lourdes Salud of the Makati City Health Office.
Galvez-Tan said the situation was exacerbated by overcrowding at the hospital particularly at the neonatal care unit.
But he said the hospital management should not be totally faulted for accommodating as many patients at it can, even to the point of taxing the hospital's facilities.
"Given the fact that Osmak is oriented towards service, its management and staffs have been inclined to accommodate as many patients as possible. Without realizing it, however, their good intentions somehow compromised the hospital's efficiency because its capacity was often stretched beyond tolerable limits," he added.
Records of the DOH National Epidemiology Center showed that 23 infants or "neonates" died of neo-sepsis in May out of the 34 cases.
A total of 55 deaths were recorded from January to June this year, with the last death recorded last month.
Only one case was reported last month, DOH-NEC Chief Eric Tayag said.
The unusually high number of infant deaths led to the closure of the neonatal intensive care unit while the DOH and the local government conducted an investigation and determine the best course of action to take.
Authorities later re-opened the unit.
Neonatal sepsis, also called "sepsis neonatorum" or "neonatal septicemia", is a blood infection that occurs on infants younger than 90 days.
A number of different bacteria, including E.coli, Listeria, and certain strains of Streptococcus, may cause neonatal sepsis, which could be worsened by contaminated hospital equipment and exposure to medicines that lead to antibiotic resistance.
Health authorities said the neo-sepsis has a fatality rate of 60 to 70 percent.
A separate investigation was conducted by a DOH panel headed by Tayag also said they have similar findings.
"We shared the same findings and recommendation with the fact-finding team created by the Makati City Government," Tayag added.
Osmak officer-in-charge Dr. Perry Peralta said they have already instituted preventive measures to ensure that there will be no repeat of the incident including the upgrading of the hospital's infection control program.
But he admitted that there were lapses in infection control that led to the outbreak adding that they have recognized the problem and put in place measures recommended by the body.
"There were lapses in infection control due to our desire to admit as many patients as possible but were not remiss in our duties," Peralta said.
He added that Osmak has already re-organized the infection control program composed of seven infectious disease experts and strengthened the alarm system as well as the inter-phase with health authorities.
The fact-finding team recommended an immediate review of the current hospital infection practices with the Hospital's Infection Control Committee, and to ensure that all the necessary mechanisms are in place for an effective and efficient infection control system, including a functional infection surveillance system.
Second, it recommended that Osmak should limit overcrowding by admitting to its Obstetrics Department only those who are classified as "high-risk and emergency cases."
"At any rate that either the hospital's OB delivery room or its neonatal intensive care unit is filled to capacity, incoming patients will be automatically referred to other hospitals," the report said.
Galvez-Tan said all normal deliveries will be referred to the city's three lying-in clinics or to another hospital.
On the other hand, Tayag reminded pregnant women to maintain a healthy lifestyle and adhere to pre-natal care adding that safety starts not only when they are in the hospital but even before.
"Mothers should adhere to basic pre-natal care like going to regular check-ups. They should also breast-feed their infants," he said.
He also said that pregnant women should take a bath before giving birth adding that information they received in the course of the investigation showed that most of them skipped bathing before giving birth.
"If mother's hygiene were the cause of the infection, then no matter how clean the hospital is there will be cases of sepsis deaths," he said.
To provide assistance to mothers whose infants died, Binay said a counseling task force has been convened to provide professional care that would enable them to cope with their loss emotionally and psychologically.
A team of social workers trained in provide counseling to people in distress have been tapped augmented by clinical psychological experts from the Makati Medical Center to help mothers recovered from their loss.
As to the liability of Osmak officials, Galvez-Tan said the city legal officer has already issued a memorandum to five high-ranking officials to answer their questions as to why the outbreak has taken place.
"We are still waiting for their reply to our memorandum. We are following procedures of the Civil Service Commission in the investigation," he said adding that based on the reply, the city legal officer will study if legal charges is warranted for filing.
"We will give them due process," Tayag said as he refused to identify the hospital officials based on Binay's order. (AH/Sunnex)
