PESHAWAR: Peshawar Institute of Cardiology, which stopped elective services after recording cases of infection five months ago, is set to resume operations within a fortnight.

“The institute went operational in December 2020. We started noticing some wound infections a couple of months ago due to which we shut down elective services temporarily,” Prof Syed Shahkar Ahmed Shah, the medical director of PIC, told Dawn.

He said that about 13 per cent of their patients, against the international standard of five per cent, recorded deep wound infection. He said that they set up a separate operation room (OR) and high dependency unit (HDU) to cope with infected patients. However, emergency surgeries were still in progress, he added.

“In February, mycobacterium other than tuberculosis (MOTT) infection, a non-TB but similar bacteria, was first diagnosed in some children and the biopsies were sent to Aga Khan University Hospital (AKUH), Karachi to trace out the source,” said Prof Shahkar. He added that water samples were also sent to Pakistan Council of Scientific and Industrial Research (PCSIR) and the regional TB centre and the results were negative.

The hospital suspended the services five months ago after recording infection cases

“Several experts from Shifa International Hospital, Islamabad and Shaukat Khanum Memorial Cancer Hospital (SKMCH) were called in to check and help us to assess Central Sterile Services Department (CSSD) processes and all their recommendations were implemented,” he said.

He said that the CSSD processes were reviewed and further strengthened and more senior staffers were hired to regulate sterilisation area. He added that the particle count was also found above normal during environmental checks by a team of Association of Operating Room Nurses, an American organisation, and steps were taken to reduce it.

Prof Shahkar said that the steps were helpful but did not fully eliminate the infection. He said that the nature of infection mainly changed from deep to superficial. An infection control team from AKUH visited the institute in May 2022 and brought special culture media bottles for MOTT source tracing. Using special techniques, the team found out MOTT colonisation in two water taps in scrub areas and in one of the hypothermia machines in the institute.

“The whole water system in the hospital has gone through intense hyperchlorination and desired levels have been achieved,” he said. He said that the false ceiling in operating rooms were also opened and gaps were sealed to reduce the particle count and all elective cases had been stopped till all the cultures from the operation rooms turned negative for bacteria.

“The particle count has since come down from millions to 200,000 and we are hopeful that with negative bacterial cultures soon, we hopefully would have eradicated infection from our environment. Throughout this period, we have supported the affected patients and their families to the best of our abilities and a vast majority has since recovered completely though occasional patients are still trickling in,” said Prof Shahkar.

He said that a root cause analysis (RCA) was already completed and remedial measures were taken while an internal inquiry was ongoing. “We feel that the dust generated during civil works for laying three new catheterisation laboratories caused this problem around September 2021 though all other factors are being looked at in the inquiry,” he added.

The 295-bed hospital, otherwise, has continued to function normally. More than 1,700 heart surgeries have been performed at PIC so far with results matching international standards. The cardiology and catheterisation laboratories are working normally. More than 10,000 angiographies and angioplasties have been performed and around 50,000 cardiac patients have been dealt in the OPD and more than 13,000 emergencies have been treated in the hospital.

“As soon as the bacterial cultures come negative, the hospital will restart elective surgeries,” said Prof Shahkar.

PIC has the services of 23 specialists including cardiologists, cardiac surgeons and others. In January, PIC became the first public sector institute to get International Standardisation Organisation (ISO) certification.

He said that the next step would be to get Joint Commission International (JCI) accreditation in March 2023 to become the only public sector hospital in the country to be JCI-accredited. He said that the credit of the achievements of PIC went to its staff as well as government for its support.

“We conduct all surgeries free of cost on Sehat Card Plus,” said Prof Shahkar.

Published in Dawn,June 20th, 2022