Jhansi: Oxygen concentration in the neonatal intensive care unit (NICU) was higher than in other parts of the hospital, which accelerated the spread of the blaze, said medical professionals and fire department officials, adding that the unit was overcapacity and an advisory issued just months earlier by a leading body of neonatologists was ignored.
More than two weeks have passed since a blaze in the special newborn care unit (SNCU) at the state-run Maharani Laxmi Bai Medical College in Uttar Pradesh’s Jhansi claimed the lives of 10 newborns. Of the 39 newborns rescued, eight others later succumbed to illnesses even as parents suspect their condition deteriorated due to inhalation of smoke.
On Wednesday, the Uttar Pradesh government removed the medical college’s principal and suspended three staff members after receiving a report from a four-member committee tasked with probing the 15 November fire.
As ThePrint reported earlier, the medical college was denied a fire No Objection Certificate (NOC) in February.
An SNCU or NICU is a special hospital unit where babies born prematurely are kept in a highly controlled environment. Each bed in an NICU has an incubator, equipped with an overhead heater, a suction unit, phototherapy light, 4-5 infusion pumps and a multi-channel monitor.
Higher oxygen concentration
Paediatricians ThePrint spoke to said oxygen is supplied to the NICU from outside via a gas pipeline and there are chances of leakage from the tubings. They added that if all newborns are on oxygen support and since the unit is insulated, there are chances that oxygen concentration would be higher in the NICU than in other units. This can result in a blaze spreading faster in case equipment catches fire.
DGP (UP Fire Service) Avinash Chandra told ThePrint that oxygen concentration in the SNCU was higher than in other units at the time of the incident.
“Newborns in the SNCU were on oxygen support and prima facie, it seems that the oxygen concentration in the SNCU was much higher than normal. This resulted in the fast spread of the fire in the unit,” he said.
Dr Devendra Gupta, former HOD of the department of pediatric surgery at AIIMS (New Delhi), said oxygen is supplied to the NICU from outside via a gas pipeline at high pressure. It is then supplied at reduced pressure to each bed via an oxygen tubing.
“There is high concentration of oxygen in these tubings. Sometimes there are leakages at these junctions,” he said.
Dr Sushma Nangia, HOD (neonatology) at Delhi’s Lady Hardinge Medical College and president of the National Neonatalogy Forum (NNF), added, “If there is sparking, higher oxygen concentration can only exacerbate the spread of fire but the solution is not to remove the source of oxygen because doing so is usually not possible in such situations.”
“In cases of fire, when newborns need to be saved, that cannot be achieved due to lack of time. We need a proper evacuation plan in place with a clear fire exit with arrows and markings,” she said.
Overcapacity
In addition to the controlled environment and high concentration of oxygen, the power overload caused by the SNCU overcapacity was another issue that contributed to the blaze spreading throughout the unit in no time.
At the time of the incident, there were 49 newborns under care in the SNCU—as against the official capacity of 18. This would mean that four-five newborns were sharing one bed.
Jhansi chief fire officer Raj Kishore Rai told ThePrint, “In an NICU/SNCU, there are four-five machines attached to a single bed. When so many machines are operating simultaneously, it can lead to electricity overload.”
Dr Nangia explained that hospital administrators, “especially in government set-ups, admit more babies to NICUs to ensure they survive but they need to check if the wiring can take the load”.
She also said that regular fire audits are essential and worn out wiring needs to be changed at periodic intervals because when there is a significant jump in power consumption, the wiring would not be able to bear the load, resulting in short circuit. Dr Nangia added that hospital administrators must keep in mind the NICU capacity before admitting newborns.
‘NNF advisory not being followed’
In the wake of the deaths of at least seven newborns in a fire at an NICU in East Delhi’s Vivek Vihar in May, the National Neonatology Forum (NNF) had issued an advisory detailing fire safety regulations aimed at NICUs. Surender Singh Bisht, secretary general of the NNF, lamented that the central government does not recognise these advisory ‘because of an assumption that state-run facilities would not be able to adhere to them’.
“In NICU/SNCUs of government facilities, overcrowding is not new because the population they cater to is too big. Despite no extra beds, machines or ventilators, medical colleges admit patients simply because there are no other facilities available for the poor,” he said.
Adding, “Unfortunately, the NNF advisory is not being followed by many government facilities and even the government’s own MusQan guidelines for paediatric healthcare areas issued by the Ministry of Health and Family Welfare are not being followed,” he said.
In its June advisory, NNF had said that the records of power audits of NICUs/SNCUs must be checked at defined intervals. It added that voltage stabiliser outlets and heavy-duty sockets must be provided in adequate numbers, since “these gold standards, which align with international benchmarks should be rigorously followed and enforced across all units to avoid any avoidable disasters and ensure the safety of newborns”.
The advisory went on to say that hospitals must ensure annual fire safety training for staff, in addition to periodic evacuation drills. “Training should incorporate a ‘fire exit signpost following exercise’ to ensure staff are familiar with evacuation routes,” it said, while stressing the easy availability of fire extinguishers and staff trained to use them.
It also said highly flammable substances (such as alcohol-based hand sanitizers) should not be used in an NICU near electrical equipment—like an electrosurgical unit, defibrillator, or a fiber optic light source.
The advisory emphasised regular maintenance and audit of fire safety equipment, besides mock drills. It underlined the need for a comprehensive evacuation plan for emergencies, which would include ensuring a minimum distance between each bed.
“Additionally, an analogue addressable (AA) fire alarm system is essential. The NICU should also be equipped with an adequate supply of water and carbon dioxide (CO2) fire extinguishers,” said the NNF.
(Edited by Amrtansh Arora)