Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.
South African Press Association - March 16, 2004
"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 others.
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 monitored."
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 incident.
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 diagnosed.
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 needles.
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.
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