Editorial: Hold hospital management to account
There is a saying in Jamaica that “bad luck worse than obeah”. Fenton Ferguson seems to have a double dose of both. There was the national outbreak of chikungunya. Then foot and mouth disease in schools.
Now, 18, mostly prematurely born babies, have died in two Jamaican hospitals from the klebsiella and serratia bacteria. Dr Ferguson, in part, no doubt because of his clunkingly pompous style, cops the blame. As the health minister, he is, of course, ultimately responsible. But in the current case, hospital administrators, too, have serious questions to answer.
For, ultimately, what has occurred at the University Hospital of the West Indies and Cornwall Regional Hospital is not an outcome of policy, but more the result of operational management. At the same time, this issue has to be placed in an appropriate context and lesson drawn for the broader management of health care in Jamaica.
First, welcome what the permanent secretary in the health ministry indicated in this week’s revelation: new transparency with regard to problems in the health system. We, however, would have welcomed comparative data of previous outbreaks of bacterial infections in health-care institutions. That would help the public to arrive at informed conclusions about these facilities and how they stack up against their counterparts.
On the issue of context, Dr Harvey is right that outbreaks of this kind at the University and Cornwall Regional hospitals are not particularly unusual in neonatal facilities – or for that matter, at health-care facilities more broadly, especially, according to the US Centers for Disease Control and Prevention, among patients being treated for other conditions, immune systems are weak and may require invasive treatment.
So, where the use among such patients of intravenous catheters, the dangers of bacteria of the likes of klebsiella and serratia are likely.
That usually means hospitals and nursing homes – which often means the very young and the elderly and/or patients in intensive care units (ICU) – like the environment in which premature babies are kept. Indeed, one study, referenced by the online publication Antimicrobe noted that serratia accounted for nearly seven per cent of the infections caused by these types of gastrointestinal tract bacteria in ICUs in the United States and Europe.
The fact is that nosocomial infections are not a feature only of Jamaican institutions, and are on the rise as viruses and bacteria are growing increasingly resistant to antibiotics, in part because of their overuse – as is the case with klebsiella and serratia.
In the circumstance, the issue is of the management of such diseases and how they were able to spread and cause 18 deaths in Jamaican hospitals.
These are bacteria of the gut that are mostly opportunistic pathogens. They are passed along by people in a circumstance of a failure of hygiene and vulnerable potential victims, such as old people and babies and others with weak immune systems.
The best prevention against outbreaks in health facilities is the washing of hands, wearing gloves and gowns and other protective clothing, especially when coming into contact with patients. In other words, following basic rules.
Somehow, that broke down at the two hospitals.
People didn’t do the right thing, Management was lax.
Fixing the problem is largely education – for staff and the wider public. Hospital managers and team leaders should also be held to account.