Health Minister Terrence Deyalsingh yesterday took the media to task for its reporting of the Pan American Health Organisation (PAHO) report into the deaths of seven babies at the Neonatal Intensive Care Unit (NICU) of the Port of Spain General Hospital.
FELLOWSHIP AWARD: Commandant Col Patrick Taylor, left, Lions District Governor of District 60A, presents Health Minister Terrence Deyalsingh with the Lions International Foundation Melvin Jones Fellowship award at the NWRHA health fair at the Mt Hope/Mt Lambert Community Centre, Mt Hope, yesterday. —Photo ISHMAEL SALANDY
According to Deyalsingh, the report was misrepresented by the media. And, he told the media the PAHO team failed to interview key hospital personnel and that areas of concern will be raised with the organisation.
Deyalsingh, who spoke to members of the media during the North West Regional Health Authority (NWRHA) health fair and presentation of the Melvin Jones Fellowship Award from Lions Club to him at the Mt Hope/Mt Lambert Community Centre, said that as part of its investigations the PAHO team failed to interview both the head of the NICU and the Chief of Staff at the Port of Spain General Hospital.
The team comprised:
• Dr Nalini Singh MD, Professor Emeritus-in-residence, Professor of Pediatrics, Global Health and Epidemiology, George Washington University, Washington DC, USA.
• Dr Grisel Rodriguez MD, PH Clinical Microbiologist, head of Microbiology, Centro de Asistencia Medica Soriano, PAHO International Consultant based in Uraguay.
• Dr Gillian Borchwood MD, Newborn intensive care specialist and head of the Neonatal Care Intensive Unit at the QEH, Barbados.
Deyalsingh, who laid the PAHO report into the clinical events at the NICU at the Port of Spain General Hospital in Parliament on Friday, further stated there was no reason for any tendering of resignations coming out of the report.
The PAHO team, which conducted the investigation in April following the deaths of seven pre-term babies at the hospital’s NICU ward, found significant deficiencies in the operations at the NICU at the Port of Spain General Hospital, many of which relate to sanitation, and therefore gave the NICU a score of 29%.
Deyalsingh described media focus of the NICU’s score of 29% as misinformation.
“Unfortunately people are cherry-picking figures out of the report. And that is the problem with the way the report is being discussed by the media and the public. The data has not given the full picture because there were many other parameters that scored above 80%, 90%, and 100%, and unfortunately, we have to respond to that misinformation.
“The report anticipates the provision for more data and more information. Through the lawyers representing the North West Regional Health Authority… we will be responding to all the issues. Many if not all of the recommendations have been already a part of our standard operating procedures.
“When I laid the report, in my statement, I said there are areas of concern that we have to raise with PAHO and that they have to address,” Deyalsingh said.
He said many of PAHO’s recommendations have already been implemented, such as the early start to breast feeding is already being practised.
“Do you know that the head of the NICU was not interviewed, and do you know that the chief of staff at the Port of Spain General Hospital was not interviewed?
“As I said in my statement, many of the recommendations that they have made in the short, medium and long term are already and have already been a part of our standard operating procedures.
“Very early in the report, it said many of these babies were severely premature; in addition to being severely premature, they were severely underweight, and there were challenges posed by that,” Deyalsingh said.
He said a news conference will be scheduled this week to discuss various concerns.
“We will be hosting a press conference very early next week. We are going to be responding and telling the public what our concerns are which I said in the Parliament,” he said.
The findings
The PAHO team’s 35-page report found that breaches in personal protective equipment (PPE) protocols were observed in the NICU, “indicating a need for improved compliance monitoring and training”.
It recommended that compliance monitoring of donning and doffing (removal of PPE in a way that avoids self-contamination) procedures for PPE and contact precautions on NICU using the WHO tool should be done.
The PAHO team also found that skin irritation and adverse reactions were frequently noted in neonates following the use of chlorhexidine baths, “indicating a need for gentler, pH-neutral or mildly acidic cleaners”, and recommended that chlorhexidine baths be discontinued and pH neutral/mildly acidic gentle cleaners be used for neonates.
Inadequate skin preparation: The report said infections at surgical and procedural sites were linked to inconsistent or inadequate skin preparation practices, suggesting a need for standardised, pre-packaged 2% chlorhexidine solutions to ensure antisepsis, and recommended that 2% chlorhexidine skin preparation for pre-operative skin prep, NICU procedures and for Caesarean sections be used.
The report said in terms of the PoS General Hospital environment and sanitation, the use of alcohol-based hand rub from hands-free dispensers was not being done generally, and that appropriate bed spacing (that is, spacing of at least one metre between beds) was not present.
It placed the hospital environment and sanitation at 64%.
The PAHO team noted that there were not enough nursing professionals in relation to the number of patients (ie, pre-term babies), describing the professional nurse-to-patient ratio as consistently inadequate.
Others weaknesses the PAHO team identified at the NICU were:
1) early breast milk feeds were not being instituted;
2) NICU unit dose medications were not prepared in sterile conditions by the (hospital) pharmacy;
“Sterile unit dose preparation of all NICU medications by the pharmacy must be done,” the report recommended.
3) lack of implementation of timely contact precautions for patients affected by MDROs (Multiple Drug Resistant Organisms);
4) There are no policies or procedures for high-level disinfection for equipment such as laryngoscopes. In light of this, the report recommended policies and procedures for high-level disinfection—eg, laryngoscopes—must be developed;
5) Use of multi-dose saline vials was observed which could lead to an increased risk of infections among patients;
6) policies and procedures for use of multi-dose medications on NICU need to be developed.
The PAHO team said the hospital’s compliance with Infection Prevention Control (IPC) assessment varied from 29% to 80%.
In terms of organisation compliance, for which it gave the hospital a 66% score, the team noted that no personnel were responsible for IPC within the hospital.
In terms of organisation compliance, the hospital functioned at a level of 66%, the report said.
The performance of the hospital was poor in the area of microbiology (the study of the biology of microscopic organisms such as viruses, bacteria, algae, mould, etc), for which it was given a 40% score.
The PAHO team noted there were not enough nursing professionals in relation to the number of patients (ie, pre-term babies), describing the professional nurse-to-patient ratio as consistently inadequate.
