Unexplained HIV' in SA's hospitals
16 March 2004 11:53
The poor infection control practices in some of South Africa's top
academic hospitals raise the spectre of "unexplained" HIV/Aids
transmission, an article in the SA Medical Journal (SAMJ) says.
"There is an urgent need to re-evaluate and improve infection control
practices in health care settings," the article concludes. It was
written by doctors attached to the Department of Paediatrics and
Child Health, the Tygerberg Children's Hospital, the School of
Adolescent and Child Health and Red Cross Children's Hospital among
They recommended that procedures for the safe administration of
expressed breast-milk be widely disseminated.
"Infection control should receive high priority for adequate funding
so that personnel are continuously trained and procedures regularly
Last week, in an incident unrelated to anything mentioned in the
article, six premature babies died in Bloemfontein's Pelomoni
Hospital, apparently after being were fed contaminated feed. A
seventh is still fighting for her life.
The Department of Health has ordered an investigation into the
The SAMJ paper is titled, Unexplained HIV-1 infection in children --
documenting cases and assessing possible risk factors.
Sketching the background to the article, the authors say that, in
2000, a possible case of "horizontal" (or unexplained) transmission
of HIV-1 infection was reported between two siblings, where sexual
abuse and surrogate breast-feeding were ruled out.
The children had had overlapping hospitalisation in a regional
hospital, and since 2000, several cases of unexplained HIV infection
in children were reported, leading to the establishment of a registry
for unexplained transmission at Tygerberg Hospital.
During a retrospective study, fourteen children were identified, 12
from the Western Cape and one each from the Eastern Cape and KwaZulu-
Natal, in which horizontal HIV transmission was identified.
Thirteen (or 92%) had been hospitalised previously, and in the
Western Cape, children had been hospitalised in eight hospitals. Ten
of 13 (or 77%) were admitted as neonates and nine of out 13 (69%) had
two or more admissions.
Intravascular cannulation (of IV lines) and intravenous drug
administration occurred in all but two children before HIV was
The article noted that any study documenting cases where unusual HIV
transmission occurred, faced the "serious" difficulty of establishing
events which occurred a long time before HIV was diagnosed,
especially in a health facility.
"This study is an attempt to make sense of these incomplete data, to
encourage further research and to make suggestions to decrease the
risks to children admitted to hospital," said the authors.
In sketching possible ways of becoming infected, they said that in
the majority of the children presented in the case studies, it was
felt that hospital transmission was a possibility.
They said that to the best of their knowledge, needles and syringes
were not re-used in South Africa, but added that they had witnessed
the re-use of razor blades after brief immersion in chlorhexidine
solution for shaving infants' scalps before inserting intravenous
When medication was administered intravenously to more than one
patient, a single syringe might be used, especially in the setting of
a heavy workload and budgetary constraints.
This meant that health care workers could re-use syringes after
attaching a new sterile needle when withdrawing saline, potentially
contaminating the multi-use vial.
Other possible scenarios for unusual HIV transmission in hospitals
included clinical notes becoming bloodstained and patient linen being
bloodstained; as well as the unlikely possibility of transmission by
endoscopes (a device used to look inside the human body) being re-
used after incomplete sterilisation. - Sapa