New York Times
July 31, 2004

Westchester Hospital Seeks Source of Baby Deaths
By KIRK SEMPLE
 
VALHALLA, N.Y., July 30 - Doctors at Westchester Medical Center are trying to identify the source of a bacterial outbreak in the neonatal intensive care unit, where seven infants have tested positive and four of them have died, hospital officials said Friday.

The officials said that three surviving infants are being treated with antibiotics and that the outbreak has been contained and poses no risk to other patients. It was still unclear, they said, whether the bacteria, first discovered at the unit about two weeks ago, had contributed to the four babies' deaths.

The hospital's neonatal intensive care unit treats some of the sickest premature infants from the Hudson Valley region, New Jersey and Connecticut. Dr. Michael Gewitz, the center's director of pediatrics, emphasized on Friday that the babies in the unit were critically ill and therefore more vulnerable to the bacteria, acinetobacter.

"It's impossible to say that this was a cause or the cause" of the deaths, he said.

The germ was discovered during a post-mortem analysis of one of the babies, Dr. Gewitz said. Six other babies - among a total of about 30 who had been exposed to the germ, officials said - tested positive and were swiftly isolated. Further testing of the exposed population has indicated no further spread of the bacteria, officials added. "We believe at this time that everything has been contained,'' said Danny Loughran, a medical center spokesman. "At this point in time we don't feel that our patients should have any concerns regarding this issue.''

Dr. Gewitz and another doctor who spoke with reporters said they did not know exactly when the four deaths occurred.

Acinetobacter (pronounced AH-sin-knee-to-back-ter) is a commonly occurring and particularly hardy group of bacteria found in many different environments, including soil and water, homes and hospitals.

 "It's not a common infection among people who are healthy, but it can cause opportunistic infections among people who are debilitated" such as babies, the elderly and the sick, explained Dr. Alex McAdam, medical director of the infectious diseases diagnostic division at Children's Hospital Boston.

Dr. David Lewis, an immunologist and infectious disease physician at Stanford University School of Medicine, said that acinetobacter infections most commonly occur among older hospital patients. While infections among neonatal populations are not common, he said, other cases have occurred elsewhere in the United States. and in several countries around the world.

He said occurrences are rarely fatal in the neonatal population. "This is bad," Dr. Lewis said of the Westchester outbreak. "I hope they figure this out."

Dr. Gewitz said the medical center suspects that one of the babies imported the bacteria when it was transferred from another hospital, though he did not give the name of the other facility or explain how it might have been transmitted to the other babies once it was inside Westchester Medical Center. An investigation into the causes of the outbreak, which was first reported by The Journal News on Friday, was still ongoing, he said.

Several experts in infectious diseases and pediatrics said Friday that acinetobacter can be transmitted within medical facilities by various routes, including in medical solutions or by health care professionals who do not strictly follow common rules of hygiene, such as washing their hands between handling patients.

According to Dr. Don Goldmann, a professor of pediatrics at Harvard Medical School and hospital epidemiologist at Children's Hospital Boston, in most outbreaks "it's concluded that the organism was transmitted from baby to baby or patient to patient because the hand hygiene was not perfect."

Dr. Gewitz said that compared with other medical facilities around the country, Westchester Medical Center has a very low death rate - 40 percent - among the most severely infirmed premature babies - those weighing below or around 1 pound.

The medical center reported the outbreak to the New York State Department of Health within the past two weeks, officials said, and a department spokesman confirmed on Friday that the state was investigating the outbreak at the Westchester Medical Center but declined to comment further.

The outbreak is another setback to the medical center, which has been suffering a financial crisis that threatens its long-term solvency. Earlier this week, the Westchester County executive, Andrew J. Spano, and a county legislator called on the state comptroller to conduct a thorough audit of the center. The hospital, Hudson Valley's premier health-care provider, recently announced that it lost $83 million last year and has projected a loss of $31.6 million this year.

The medical center spun off from the county in 1997 and became a public benefit corporation, though the county still guarantees a large amount of the hospital's debt.

The hospital has been the subject of several recent wrongful death charges. In 2000, a 6-year-old boy died after being hit in the head by an airborne metal oxygen tank during a magnetic resonance imaging test. The hospital quickly admitted its error and was fined by the state.

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