Health on the klebsiella outbreak
28 November 2007
It is unfortunate that we have had to face this challenge of klebsiella once
again in this province after we responded to a similar challenge at Mahatma
Gandhi Hospital in 2005.
Prince Mshiyeni Memorial hospital is a district and regional hospital with a
huge catchment population of 1,6 million people. It conducts about 1 200
deliveries per month.
We have received a presentation on what has happened and engaged the
management and staff on a number of issues relating to the cases of klebsiella
reported here.
We can confirm that there have been seven confirmed cases and two
unconfirmed cases of klebsiella at this hospital. The results on the two cases
are expected tomorrow. It is important to state that the two cases are babies
that were in the ward at the time when the seven cases were detected. One of
these two babies was born at home with birth weight of 1,1 kg to a teenage
mother who never attended antenatal care.
Five of the babies affected unfortunately passed away as reported by the
provincial Department yesterday. Efforts are being made to communicate and
support the mothers and the families of these babies as much as possible.
All babies had low birth weight ranging from 1,15 kg to 2 kg. All presented
with respiratory distress syndrome and one with intra-uterine growth
retardation.
The presentation made indicates that the hospital management has taken
reasonable measures to contain and prevent further outbreak of klebsiella
here.
A microbiologist at this hospital reported of the possible outbreak of
klebsiella at the hospital nursery on the 20th of November. Seven babies were
diagnosed with klebsiella septicaemia with positive cultures from positive
blood culture. A team was formed to respond to the challenge immediately. Swabs
were taken and district and provincial offices informed. A team from Nelson
Mandela School of Medicine was brought in to assist in containing the
situation.
Interventions
Significant measures have been taken to ensure that no new cases emerge.
These measures appear to be having effect as no new cases have been
reported.
All currently in-use vials of medication and infusion fluids were discarded
and replaced by new ones. No multi-dose vials are used anymore and efforts are
underway to procure low dose vials of antibiotics or get pharmacists to produce
smaller doses in the controlled environment.
A 24 hour laboratory emergency microbiology service was instituted to
monitor the situation and remains in place.
The nursery is going to be restructured to increase space to avoid cross
infections. More basins are to be added and elbow controlled taps to be
procured immediately.
26 beds and theatres have been identified at Wentworth to reduce the load
from Prince Mshiyeni.
Process is underway to improve the capacity of the cleaning services and the
suggestion is to outsource this service.
All staff's use of disposable aprons is now standard and there is close
monitoring of infection prevention practice in the nursery. Use of cellphones
in the nursery is discouraged.
Entry to the nursery is restricted â one entrance, mothers and nursery staff
only. Mothers are taught about infection control and given protective clothing.
There is security controlling access.
We believe that reasonable measures have been taken to contain the
situation. However there is a need for further investigation of the actual
cause of the outbreak.
Issued by: Department of Health, KwaZulu-Natal Provincial Government
28 November 2007
Source: KwaZulu-Natal Provincial Government (http://www.kwazulunatal.gov.za/)