Hospital-Acquired Infections in Babies in South Africa

Hospital-acquired infections (HAIs) are a risk for patients of all ages in South African hospitals.

However, growing numbers of infection outbreaks across the country’s neonatal wards are especially troubling.

Here, we outline the issues and offer advice on medical malpractice claims for hospital-acquired infections in babies.

Increase in hospital-acquired infections in babies in South Africa

There has been a significant increase in the rate of neonatal hospital-acquired infections over the past two decades. This includes both the number of infections and the degree of severity.

Infections have more than doubled. The emergence of antimicrobial-resistant organisms is contributing to an increase in the spread and severity of HAIs. However, limited statistics, and a lack of HAI surveillance and reporting, suggest the real statistics are considerably higher.

HAIs include urinary-tract, surgical site, respiratory, gastro-intestinal and bloodstream infections (BSIs).

Major infection outbreaks in South African neonatal wards

In the past few years, 34 neonatal infection outbreaks were reported to the National Institute for Communicable Diseases (NICD) from public and private hospitals in South Africa. More than half were in Gauteng.

This is believed to be “just the tip of the iceberg”. Most outbreaks go unreported. The outbreaks that are reported are the ones that usually require expert input.

Recently, the NCID confirmed outbreaks of carbapenem-resistant Klebsiella infections in babies at Tembisa Hospital (2020) and Thelle Mogoerane Regional Hospital (2018) in Gauteng, and Mahatma Gandhi Memorial Hospital in KwaZulu-Natal (2016).

Most of the outbreaks – 97% – reported to the NICD have involved bloodstream infections (BSIs) that have been caused by drug-resistant pathogens.

Frightening mortality rates for hospital-acquired infections

Babies, especially those born prematurely, are particularly vulnerable to HAIs.

According to Professor Nelesh Govender, head of the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at the NICD, it’s estimated that 10% of people with HAIs will die.

However, babies – particularly premature neonates – have a considerably higher risk of death. The mortality rate of HAIs with a group of bacterial infections called gram-negative organisms can exceed 50%.

A post-mortem study of babies who died in a large neonatal unit found that infections were responsible for 58% of all deaths and 70% of all deaths for neonates born prematurely.

When infection may be due to medical malpractice
It’s not inevitable that babies will get infections in hospital. Infection prevention is limited in SA hospitals and many babies contract HAIs as a result of medical negligence. Many hospitals do not implement infection prevention measures at individual level and institution wide.

Acts of medical negligence – including negligence through omission or a failure to act – that could cause HAIs and may be grounds for a medical negligence claim include:

• failure to meet hygiene standards
• insufficient hand washing
• failure to monitor air, water and surfaces
• failure to sanitise medical equipment
• improper aftercare following a procedure
• inadequate wound dressing
• failure to isolate patients with infections
• failure to prevent the spread of infection between patients.

Claims for hospital-acquired infections in babies

If your baby suffered harm, or died, as a result of contracting a hospital-acquired infection, you may have grounds for a successful medical negligence claim.

Who can be held liable?

A medical negligence claim can be brought against a hospital, medical professionals from nurses to individual doctors, a state health department and/or private hospital group.

What’s needed to support a claim?

In any medical negligence claim, the burden of proof lies with the claimant.

This means that the claimant’s legal team must use evidence and expert medical opinion to prove that medical negligence occurred, or breach of duty of care, and this led directly to your baby contracting a hospital-acquired infection.

What compensation can be claimed?

There are five areas, or heads of damage, in which a victim of medical negligence can claim. Not all will apply to a baby. These are:

• past hospital and medical expenses
• past loss of earnings
• future hospital, medical and supplementary expenses
• future loss of earnings and interference with earning capacity
• general damages, loss of amenities of life and disfigurement.