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It was located on the sink faucet that NICU staff used to get water to give to babies along with the terrible Citrobacter milk. This is the bacteria that in two years killed four children hospitalized in the internal ward of the Hospital de la Mujer y el Niño de Borgo Trento (Leonardo at the end of 2018, Nina in November 2019, Tommaso in March this year and Alice on August 16 last.), leaving nine with brain damage and reaching 96 in total. This is what emerges from the report delivered in the Region by Professor Vincenzo Baldo, Professor of Hygiene and Public Health at the University of Padua and coordinator of the verification commission appointed on June 17 by the CEO of Veneto Healthcare, Domenico Mantoan, to clarify the matter. The inspection body, also made up of Professors Elio Castagnola, Head of Infectious Diseases at the Gaslini Pediatric Hospital in Genoa, Gian Maria Rossolini, Professor of Microbiology at the University of Florence, and Pierlugi Viale, Professor of Infectious Diseases in Bologna, by the director of Pediatrics and Neonatology of Usl Berica, Massimo Bellettante, and by the managers of Azienda Zero Mario Saia and Elena Narne, found that the sink faucet inside the room, also under investigation by the Verona Prosecutor, was literally colonized by killer bacteria. But also from other bacteria. In short, a dangerous outbreak.
Non-compliance or partial compliance with hygiene measures.
Citrobacter, in particular, got there from the outside, probably due to the non-compliance or partial compliance with the strict hygiene measures imposed on personnel in high-risk departments, such as frequent hand washing, changing gloves at each patient or function change, wearing galoshes, galoshes, overboots and masks. All of this arose from the control of medical records and procedures, protocols, equipment, environments and systems, from the hearings of doctors, nurses, social and health workers and from Nina’s mother, Francesca Frezza, the first to report the incident and trigger the case. He was also heard by the investigators, because now it will be the Prosecutor’s Office (at the moment there are no suspects), which relies on the Nas, to identify responsibilities, but Another mistake may have been to use tap water and not sterile water..
Checks in january
The first controls by the top management of the university hospital began in January of this year, only to be interrupted by the coronavirus emergency. June 12 general manager Francesco Cobello closed the birth point, Neonatal Intensive Care and Pediatric Intensive Care and the following day a commission of experts was appointed, which was later canceled because two of the members, Narne and Belletta, went to the regional inspection body. Then the manager appointed another, also from outside, to verify the reopening procedures of the departments, which produced reports, technical indications and inspections. But above all, the summer served to carry out a global sanitation of the premises, working the air, water and the environment. The air filters, the conditioning and disinfection systems were recovered, the water network was hyperchlorinated, that is, chlorine was introduced into the system, monitoring the bacterial load and the chlorine load in the water. To achieve absolute prevention, chlorine dioxide was used in hot and cold water through two machines. Instead, the facilities were disinfected with hydrogen peroxide..
The reopening of the Maternity Center
Today, September 1, Maternity Center reopens for deliveries from week 34, that is, without risk. Between September 30 and the first days of October, the neonatal and pediatric intensive care units will be reopened, with the original 36 beds and new technologies. The two departments are now temporarily transferred, with a total of 12 beds, to the Confortini center and in case of need we have the Pediatricians of Padua and Vicenza. The sanitation had to be done two summers ago, when the first cases of Citrobacter had already emerged – said Nina’s mother – if I had not waited so long, now my baby and the other three children would still be alive.
September 1, 2020 (change September 1, 2020 | 10:14)
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