A recent bacterial infection outbreak at the Neonatal Intensive Care Unit (NICU) of the National Referral Hospital (JDWNRH) in Thimphu resulted in the death of 11 newborns.

Since the infection was reported on July 22, about 11 babies, mostly preterm died of Klebsiella pneumonia at the NICU. The last case was reported on August 9.

Klebsiella is a superbug that causes a range of diseases depending on which part of the body it infects.

Klebsiella pneumonia causes severe lung and bloodstream infections that are difficult to treat due to multidrug resistance.

Such infections are hospital-acquired infection, which means they originate in a hospital that has evolved resistance to antibiotics.

A parent said his daughter was born prematurely at seven months and weighed just 1.9 kilograms at birth. “Although she was very tiny, we had big dreams for her,” he said choking.

His daughter was admitted at the NICU for more than a month. “Because of the infection, the baby’s platelet count dropped to as low as 4,000.”

The actual requirement of platelet count is between 150,000 to 450,000, he said. “She was treated and her platelet count increased to 150,000 but she couldn’t survive.”

He claimed that during his stay in the NICU, he saw about six babies die. “There was nothing that we could do.”

Medical superintendent with JDWNRH, Dr Gosar Pemba said the outbreak is now under control.

“We have two epidemiologists who gather all the information and study the positive factors that could have caused the infection in the NICU. They are analysing the data.”

While the hospital is yet to find out how the infection spread in the unit, Dr Gosar Pemba said they have found that the water supply to the hospital was contaminated.

Babies, especially those born prematurely, are more vulnerable to infection, as their immune systems haven’t developed properly, he said. “Moreover, most of the preterm babies are admitted to the NICU so that is why most of the infected babies are of preterm births.”

Klebsiella pneumoniae is a bacterium that lives inside human intestines. It is spread through direct person-to-person contact. People on ventilators can contract Klebsiella pneumonia if breathing tubes are contaminated with bacteria.

Dr Gosar Pemba said the hospital suspected the outbreak of the infection on July 22 after more babies died in the NICU and the staff informed the hospital management.

While the investigation was on, the hospital started with basic infection control, which is hand washing because hand hygiene and environmental sanitation are essential to prevent the spread of the bacteria.

Dr Gosar Pemba said the hospital immediately cleaned the entire NICU using detergents and disinfectants. All staff including doctors handling the babies was asked to wash their hands. Parents and attendants were asked to do the same before handling the babies.

“We put a swab in places at the NICU to see if there is any growth of the bacteria and it was found that there was bacteria growth at the NICU’s sink. That is when we suspected that the water might be contaminated,” he said.

The hospital asked the Royal Centre for Disease Control to test the water. “We chlorinated all the hospital tanks and we are still doing it.” Royal Centre for Disease Control confirmed that the water supply to the hospital was contaminated.

Dr Gosar Pemba said while the water was being treated, the hospital provided the NICU patients and attendants mineral waters for drinking and making baby milk and had provided a water filter. Single-use paper towels were also provided for the attendants and staff at the NICU to prevent further spreading of the infection.

“We even tested our medicines to see if they are infected and also the operation theatres because many babies who were infected are those there were delivered through caesarian,” he said. “We swab all health workers’ hands to see if they were transmitting the infection. We tried to reduce the number of visitors to the hospital which is one of the most difficult things to do,” he said.

Normally, for the preterm babies, milk is expressed in a cup and a syringe and a plastic feeding tube used to feed the babies.

Dr Gosar Pemba said the hospital provides new syringes but it is not possible to provide a new cup every day and parents are expected to wash it. “Even if they have washed the utensils properly, because of the contaminated water, there could be the risk of babies getting the infection.”

Another parent said his son who was also born preterm was infected twice. “I found my son healthy but he was taken to the NICU after birth. Maybe he had a problem but the hospital staff did not say why my son was taken to the NICU.”

He said his son got infected three days after he was taken to the NICU and his health deteriorated. “He was treated and shifted to another room next to NICU. He was again shifted to NICU after he got infected for the second time. But, this time they couldn’t save him,” he said.

The parent claimed that he repeatedly asked the health staff including the doctors at the NICU to separate the infected babies from those who are not instead of giving antibiotics to the infected babies.

“I was told that the infection was from the mother’s milk, some said it is from the water. I feel that the infection was within the room only,” he said. “If it is from mother’s milk then my son was not fed breastmilk once and if it is from the water, then everyone was using the same water. So why did only some babies get infected?”

He claimed that they have maintained hygiene and always washed hands before handling the baby. “It is my first experience in the NICU and the staff were very rude. I even talked with the nurse in charge to ask them to talk nicely as most of the attendants are mothers who are recovering from childbirth,” he said. “I pray and hope that no parents get to experience what some of us went through.”

Dr Gosar Pemba claimed that the babies who had infection were kept in a separate room. “We even tried to look for some empty space to shift the babies but shifting the whole equipment was a problem.”

He acknowledged the parents’ grievances and said that despite whatever the hospital does to avoid such incidents, instances like this happen because of many factors. “We are doing whatever we can to avoid such incidents from happening again.”

Preterm babies from across the country, he said, are brought to the hospital and admitted at the hospital, which increases the risk of spreading the infection. In other countries, Dr Gosar Pemba said when a hospital has such issues, they stop accepting patients to stop further spread of the infection and ask patients to be taken to other hospitals.

“In JDWNRH, we cannot do that. There is no other hospital in the country that could provide NICU facilities to the babies who are ill.”

Dechen Tshomo