The death of 38 new-borns from a hospital-acquired infection at the Sree Avittom Tirunal (SAT) Hospital in Thiruvananthapuram over the past four months has shocked Kerala. All the deaths were in the neonatology unit of the hospital where 60 deliveries on an average take place daily. The incident has set the alarm bells ringing as it has happened in Kerala, which boasts of the lowest infant mortality rate in the country with only 15 deaths per thousand where as the national average is 58.

The first three infection-caused deaths were reported in January. The count went up steadily with five in February, 14 in March and 16 in April. It was only then that the media zoomed in and the hullabaloo broke out. The hospital superintendent Dr K Rajmohan was placed under suspension for not reporting the deaths and the cause to the higher authorities. Politicians of all hues made a beeline to the hospital and the opposition demanded that Rs.10 lakhs be paid to the parents of each baby that died.


In what appeared to be a case of publicity-seeking, V Vikraman, a BJP activist filed a complaint against the health minister P K Sreemathy and hospital staff. An enthusiastic magistrate of a local court, S Gopalakrishnan, asked the police to register a case against Sreemathy on the charge of culpable homicide not amounting to murder.

"It's a system failure, a classic case of negligence and wrong health policies," says Dr Ramesh, Secretary of the Kerala branch of the Indian Medical Association.

The government set up a five member expert committee to investigate the deaths. Dr V Rajasekharan Nair was the Chairman and Dr Sudhayakumar, Director of Medical Education, was the convener. The committee confirmed in its interim report that there was an outbreak of sepsis in the in-born nursery (IBN) at the hospital which led to an increased proportion of babies dying due to infection. However, there was no apparent increase in the total mortality rate of the babies admitted to the SAT Hospital's IBN, the report said. The hospital authorities were aware of an increased rate of infection in its IBN and had adopted measures to contain the infection. The report found that the labour room and theatre cots at SAT are cleaned and wiped with anti septic solutions after each case.

But these efforts proved to be ineffective. There is no time for air drying as the next patient is ready to occupy the cot. Lack of staff has resulted in the same person doing multiple jobs, including handling of babies. Also, the concerned sites of infection could not be closed down and the babies shifted to an alternate nursery, the report said. It added that the principles of 'barrier nursing' should have been implemented. It recommended that further admission to the present IBN be stopped and that once all babies are discharged, it should be properly disinfected and fumigated. Babies not requiring critical care should be kept with the mothers, said the report.

Despite this, the interim report surprisingly attempted to explain away the deaths. According to the committee, the deaths of new-borns in March and April were proportionate to the rise in number of admissions during these months. The report reeled out statistics to prove that the number of deaths were not all that alarming. However, even if we take the report at face value, the tragedy throws up many serious questions.

Why is it that this 'women and children' hospital with 1035 beds is overcrowded round the year, with the average number of inpatients being 1200? And why almost double its capacity during March and April? Why only two nurses per shift in the IBN when there are 60 new-borns to take care for? Why is it that the hospital which had spent one crore rupees for modernisation in 2006 doesn't have space or facilities for an alternate IBN when more than 20,000 deliveries take place a year in the hospital?

There has not been any concerted effort or perhaps even a desire to reduce it further to the level of the developed countries like Germany and the USA where the rate is only four per thousand.

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