Improperly sterilized medical instrument is found to be likely cause of infectious outbreak at a Boyle Heights hospital.
By Charles Ornstein and Francisco Vara-Orta
Los Angeles Times
Copyright 2006 Los Angeles Times
All Rights Reserved
A premature baby infected by a virulent bacterium at White Memorial Medical Center died Monday morning, the second death believed to be related to an outbreak that forced the Boyle Heights hospital to close its neonatal intensive care unit to new admissions, hospital officials said.
“What started out as the happiest day of my life a month ago has become the worst nightmare,” the baby’s father, David Marin, 45, said in an interview in Spanish. “We are heartbroken.”
Also Monday, the hospital reopened its pediatric intensive care unit after determining that two children infected with Pseudomonas aeruginosa were not related to a neonatal outbreak of the same bacterium, which sickened five. The pediatric unit was closed Friday when infections there were discovered.
White Memorial closed its neonatal unit Dec. 4 after consulting with county health officials. It remains closed to new admissions but continues to care for 12 infants. Dr. Rosalio Lopez, the hospital’s chief medical officer, said he could not predict when the unit would reopen. All other areas of the hospital remain open.
Lopez said testing results shared with the hospital Monday confirmed that an improperly sterilized medical instrument was the probable cause of the neonatal outbreak. Four of the five infected newborns have died, but doctors believe that two of those babies succumbed to underlying medical problems and not the P. aeruginosa infections.
The medical records on the four deaths, along with those on two other deaths in the neonatal unit since Nov. 30, have been sent out for expert review. Results are not expected for several weeks.
The hospital confirmed Friday that 10 other newborns have been found to have colonies of the P. aeruginosa bacteria in their noses or rectums, but they did not develop infections, Lopez said.
P. aeruginosa is a common bacterium found in water and soil, and can be spread through body contact, fluids and water. In most people, it is not deadly or even dangerous because the immune system can ward off infection. But that is not the case in patients with weakened immune systems, such as premature babies, patients with cancer or AIDS and those on breathing machines.
David Marin’s son, who died Monday, was born prematurely Nov. 17 at 26 weeks gestation, the Los Angeles County coroner’s office said. The coroner’s office will perform an autopsy. Marin declined to provide his son’s name, and the coroner’s office has him listed simply as “Baby Boy.”
Marin said he and his wife, Lucina, had been trying for a child throughout their eight-year marriage. The baby, though premature, seemed healthy, he said.
“You should have seen my baby,” Marin said, his voice quivering. “My child was absolutely healthy. It wasn’t until the infection that it all went downhill.”
Marin, a native of Veracruz, Mexico, and his wife, a native of Guadalajara, have talked with the parents of other children still in the neonatal unit about pursuing legal action against White Memorial. He said he and other parents will hold a news conference today outside the hospital to discus their plans.
“Many of us are not English-speakers. [We are] immigrants and Latinos and need to unite to make sure this never happens again to the East Los Angeles community,” he said. “I don’t want this to ever happen to anyone else.”
About 90% of White Memorial’s patients are Latino, hospital officials said.
Lopez said Monday that he could not comment on individual patients. But overall, he said, the hospital has reeducated its staff on infection control procedures and is treating all babies with antibiotics.
Babies in the neonatal unit are especially at risk for infections because they often are connected to ventilators, tubes, monitors and other equipment that give bacteria an easy pathway into the body.
The testing conducted by Los Angeles County has answered some questions and raised new ones. Five of the 10 samples taken from newborn patients showed strains of the P. aeruginosa bacterium that were found on a laryngoscope blade, used to place breathing tubes in the newborns. The other five, however, had different strains.
Hospital officials say they want to explore the other cases more before reopening the neonatal unit.
Dr. Laurene Mascola, chief of the county’s acute communicable disease control unit, said she believed that some of the P. aeruginosa cases were discovered in the neonatal unit simply because doctors were looking at every infant. Because the bacterium is common, some infants are exposed to it naturally and do not become ill.
“If they want to take the time to continue to understand how they became positive, that’s OK,” Mascola said.
She said the county is waiting for an explanation from White Memorial on how the laryngoscope blade may have become infected. She said the procedure for disinfecting the instrument changed in March, but she did not have additional information.
“Whatever it was, it didn’t work well enough to prevent pseudomonas from growing in them,” Mascola said.