The deaths of 10 babies at an Ekurhuleni hospital due to drug- resistant infections has provoked an outcry.
The deaths are believed to be the result of klebsiella, which causes pneumonia and meningitis.
Medical records show it has a death rate of about 50%, even with antimicrobial therapy.
The DA and a nursing union said measures put in place at Tembisa Hospital by the Gauteng Health Department to prevent further infections in its neoanatal unit – where the 10 babies died after the outbreak of bacterial infection – are still not adequate because the hospital remains “dangerously understaffed and overcrowded”.
In a statement, the Young Nurses Indaba Trade Union said the deaths of the newborns at the hospital were due to overcrowding, and it placed the blame for this on the provincial government for failing to build new hospitals and upgrade existing ones.
“It is well expected that a hospital that caters for a densely populated area such as Tembisa and still must cater for an area such as Diepsloot, housing 350 000 citizens who are without a hospital within their proximity, would encounter such a problem.
“The truth of the matter is that our government doesn’t care about the health-care system in our country. The infrastructure in that hospital is the old apartheid-era product that was never built to cater for the consequences of our porous borders, exponentially increased population and the disease burden that is exploding and putting pressure on the already ailing healthcare system,” the union said.
DA Gauteng spokesperson on health Jack Bloom, asked if he thought measures put in place by the department since the outbreak two months ago were adequate, responded: “The hospital is still dangerously understaffed and overcrowded; unless that is rectified very soon, there is still a high risk of avoidable baby deaths.”
Bloom said overcrowding and poor hygiene were a major problem at neonatal units in Gauteng hospitals.
“This hospital (Tembisa) is notoriously overcrowded and the 44-bed neonatal unit often admits more than double that number of babies.
“The department needs to ensure that all neonatal units have enough staff and beds, with strict hygiene to prevent more klebsiella deaths.”
Professor Nelesh Govender of the National Institute for Communicable Diseases said it was informed last month of a suspected outbreak of bloodstream infections in the neonatal unit at Tembisa Hospital.
“The suspected organism was identified as Klebsiella pneumoniae, a bacterial pathogen. We define an outbreak as an increase in the rate of K. pneumoniae above the baseline rate and we noted an increase above the expected threshold in the number of observed cases of (such) bloodstream infections.
“Based on the latest information we have, from November 1, 2019, through to January 16 [this year], 22 babies were diagnosed with a K. pneumoniae bloodstream infection, and 21 babies were infected with a carbapenem-resistant K. pneumoniae strain. Ten deaths have been reported.
“There have been three new cases in January to date and no new deaths.”
Govender said carbapenem-resistant Klebsiella pneumoniae belonged to a group of bacteria called the enterobacterales and can cause serious infections in newborn babies. Some strains of K. pneumoniae are resistant to the broad-spectrum carbapenem group of antibiotics.
He said infections caused by such strains could be difficult to treat.
“Strict adherence to contact precautions that includes isolation of cases in separate cubicles is recommended for babies with such infections,” said Govender.
The Gauteng Health Department said following the deadly outbreak, a stakeholders meeting was convened to discuss the challenges of overcrowding in the ward, as well as a staff shortage, infrastructure, inappropriate equipment storage and difficulties in isolating infected infants.
It said measures had been taken to prevent further infections in the neonatal unit.
“A quality improvement plan has been created and implemented with immediate effect, additional professional nurses have been deployed to assist at the Neonatal Unit, (and) approval to divert new admissions to the Kalafong Hospital and Steve Biko Academic Hospital has been granted in principle.
“Furthermore, the external infection prevention and control audit to be conducted on the date to be provided by the Provincial Quality Assurance Directorate, National Health Laboratory Services Infection Control Service to provide technical support assistance to audit Gauteng Department of Health Neonatal Units and NICD to allocate resources to develop a dashboard to monitor laboratory confirmed neonatal infections at facility level,” read the report.
In 2018, six babies died at Thelle Mogoerane Hospital in Vosloorus, Ekurhuleni, while nine died in the same year at the Rahima Moosa Mother and Child Hospital following an outbreak of necrotising enterocolitis.
When asked what lessons had been learnt from similar outbreaks, health spokesperson Philani Mhlungu promised to reply, but had not done so by the time of publication.
Last November, following the klebsiella outbreak at Thelle Mogoerane Hospital, Gauteng Health MEC Bandile Masuku – in a written reply to a question from Bloom in the Gauteng Legislature – said an investigation had found that there were “a number of systemic challenges faced by the health system” in Gauteng.
These included “overcrowding, (and a) shortage of equipment and disposable medical stock due to high turnover of babies that needed critical care.
“The investigation further noted that no appropriate isolation facilities for infectious neonates and a shortage of staff. (It) also noted the lack of IPC (infection and prevention control) oversight.”
When the Sunday Independent visited Ward 4 at Tembisa Hospital last week there was a security guard at the door who said no visitors were allowed inside the ward.
Mothers of babies still in the ward were required to wash their hands before entering and exiting the neonatal unit.