Fighting sepsis in newborns

ER24’s Critical Care Retrieval Services (CCRS) teams transport critically ill patients. Around 70% of calls involve neonatal (newborn) and paediatric patients.

Why newborns are especially at risk from sepsis

Sepsis is a blood-borne infection with many causes. Newborns and neonates (babies younger than 28 days) are most susceptible to sepsis because of their poorly developed immune systems. Sepsis is a killer that is often missed because the signs and symptoms are so subtle – from sleeping too much, to not feeding properly to high or low temperatures. In South Africa, infants in low-income households without ready access to clean water and a hygienic environment are particularly at risk.

Preventing sepsis in babies

“The first step in preventing sepsis in babies is to look after the mom,” says Maxine Dickson-Hall, a paramedic for ER24's Critical Care Retrieval Services (CCRS) in Cape Town. “It’s important for expectant mothers to be up to date with their immunisations, go for antenatal check-ups and have blood tests done to check they’re not carrying any diseases themselves. Mothers also need to be well nourished and have access to sanitation facilities. In addition, not drinking, smoking, or using drugs are crucial for mothers and mothers-to-be.”

Without these precautions, babies who are delivered in unhygienic environments are more likely to become infected with dangerous bacteria such as Escherichia coli (E. coli) or group B Streptococcus (GBS) bacteria.

“By encouraging expectant mothers to go for antenatal check-ups, there is more chance that their babies go to term and are not delivered spontaneously prematurely,” says Dickson-Hall. If the mother has diabetes, hypertension or HIV, which are extremely common in South Africa, she needs special care during the pregnancy to prevent negative impact on the baby.

Babies are best born in a clean facility where there is expert knowledge and assistance. Premature babies are even more susceptible to infections directly from their mother, from dirty clothes or bottles, as well as from unclean breasts, says Dickson-Hall. Even before the actual birth, ruptured membranes from a woman’s water breaking can be a direct route for sepsis if she is not seen by a doctor, nurse or midwife within 24 hours.

“Staphylococcus epidermis (skin bacteria) is a leading cause of neonatal sepsis cases,” Dickson-Hall says. “We need to take care of these infants in a clean environment and look after them holistically.”

How CCRS prevents contamination

ER24’s CCRS, based in Cape Town and Johannesburg, is a dedicated service for transporting anyone who is in a critical state to a medical facility for further treatment, including newborns and babies born prematurely.

“At CCRS, we aim to emulate the intensive care unit (ICU) environment in the back of an ambulance,” explains Dickson-Hall. The Cape Town branch was the first service in the Western Cape when it was launched 11 years ago, and it subsequently expanded to Gauteng.

“We are very aware of what a clean environment is,” says Dickson-Hall. “As paramedics, we are in and out of many hospitals, so our potential to transmit bugs from one area to the next is very high.” She adds that research conducted in 2017 with University of Cape Town microbiology students highlighted areas in the CCRS ambulances that pose a risk for contamination and need routine sanitisation. These including steering wheels, the sides of stretchers and the ventilator’s exhaust valves.

To avoid problems and keep track of any issues, CCRS team members use a very thorough reporting system when transporting babies:

• What infections the baby is found to have, if any.
• What the team has done to mitigate any contamination, such as what was cleaned and how, the barrier devices worn by the team members, and what equipment they used on each infant.
• Staff keep their nails short and don’t wear jewellery, watches or zips, which could injure delicate skin. Sleeves are kept above the elbows.

“In the vehicles in which babies are transported, we have back-ups for absolutely everything,” says Dickson-Hall. “This includes two incubators, two ventilators and two suctions. We have a cleaning register on our incubators, which shows they’ve been washed with soap and water and disinfected in between each use and are plugged in in an equipment room inside the hospital, and nowhere else, to maintain a sterile environment.”

All babies transported by CCRS are placed on a jelly mattress, in a nest, with at least two safety belts with soft, padded elastic straps to maintain skin integrity. Micro premature babies are transported in incubators in special bags to preserve the heat and moisture.

“We’re also fanatical about what is known as ‘scrubbing the hub’, which means that after a drip is used, we clean the hub with alcohol wipes for at least 15 seconds and allow it to dry before reattaching,” Dickson-Hall explains.

Saving precious lives

“For us at CCRS, it’s about maintaining integrity and knowing precious lives are at stake,” she adds. “We’re really dedicated to our cause. We’re fortunate that ER24 has supported the establishment of these units since 2010 and has provided us with the best equipment. For us, it’s always the ‘nick of time’ and every baby counts and has a unique story. These are precious bundles that need vigilant care.”

Fellow CCRS paramedic Sheldon Poisson adds that parents often approach team members to thank them for having transported their baby or child safely at what would have been a traumatic time. “What stands out for me is how often this happens,” he says.

In any emergency, call ER24 on 084 124 for real help, real fast.