KARACHI: Nearly nine months after an HIV outbreak among children brought Karachi's Kulsoom Bai Valika Hospital under intense public and regulatory scrutiny, provincial healthcare watchdog has found that several critical infection prevention and control recommendations remain unimplemented, raising fresh concerns about patient safety and institutional accountability.
A follow-up inspection conducted by the Sindh Health Care Commission (SHCC) on July 17, 2026 found multiple deficiencies in infection prevention practices, medical waste management, staff training and operating theatre protocols, despite earlier directives issued to the hospital after previous inspections.
The findings suggest that although some administrative steps have been taken, many of the systemic issues identified earlier continue to persist.
Hospital formed IPC committee—but critical deficiencies remain
According to the SHCC, the hospital complied with one key administrative recommendation by establishing an Infection Prevention and Control (IPC) Committee. It also initiated procurement of colour-coded waste bins and auto-disable syringes.
However, inspectors said these measures have yet to translate into comprehensive improvements in day-to-day clinical practice.
The Commission noted that most of its earlier recommendations had not been fully implemented and said it would forward a detailed report, along with recommendations for further action, to the relevant authorities.
Unsafe needle handling raises fresh alarm
Among the most serious findings was the handling of used syringes.
The inspection team observed that needles were being manually removed from syringes after use instead of being discarded directly into designated sharps containers.
Even more concerning, technical staff could not explain where the removed needles were ultimately disposed of.
Medical waste experts consider manual needle removal a high-risk practice because it increases the likelihood of accidental needle-stick injuries and exposure to blood-borne infections, including HIV and hepatitis B and C.
Proper infection prevention protocols require used needles to be discarded immediately into puncture-resistant sharps containers without being separated from the syringe.
What is Infection Prevention and Control—and why does it matter?
Infection Prevention and Control (IPC) refers to internationally accepted measures designed to prevent infections from spreading within healthcare facilities.
These include:
• safe injection practices;
• sterilization of medical instruments;
• hand hygiene;
• proper use of personal protective equipment;
• safe disposal of medical waste; and
• continuous staff training.
Healthcare experts consider IPC one of the most fundamental pillars of patient safety, particularly in hospitals performing dialysis, surgery and other invasive procedures.
Staff lacked IPC training, guidelines and knowledge
The inspection team reported that no formal IPC training had been conducted for hospital staff.
Inspectors were also unable to obtain written IPC policies or guidelines from hospital management.
The report further stated that hospital personnel demonstrated poor understanding of safe medical waste handling procedures, while even the private contractor responsible for collecting and disposing of infectious waste had not received appropriate training.
Autoclave performance could not be verified
Another concern involved the hospital's sterilization system.
Inspectors said they could not verify whether the hospital's autoclave—a machine that sterilizes surgical instruments using high-pressure steam—was functioning properly.
Reliable sterilization is considered essential for preventing healthcare-associated infections during surgical and invasive procedures.
The inspection team also reported that nursing staff and Operation Theatre personnel were not present during duty hours, preventing assessment of routine infection control practices.
Operating theatre practices and waste management remain weak
The SHCC also identified deficiencies in infection control inside the Operation Theatre.
Medical waste was reportedly not being segregated or disposed of according to IPC guidelines, while inspectors observed weak coordination between hospital management and nursing staff.
Although the Commission acknowledged that the Medical Superintendent and senior management appeared committed to implementing reforms, it also observed that staff unionization and resistance among some employees appeared to hinder implementation of corrective measures.
The SHCC's observations on staff unionization were included as findings of the inspection team.
The HIV outbreak that changed everything
Kulsoom Bai Valika Hospital came under national attention in late 2025 after multiple children undergoing dialysis tested positive for HIV.
Subsequent investigations by provincial and federal authorities linked the outbreak to unsafe infection control practices, including the reuse of syringes, triggering disciplinary proceedings, regulatory investigations and calls for sweeping reforms across healthcare facilities.
The incident prompted widespread concern among healthcare professionals, patient safety advocates and families affected by the outbreak.
Nine months later, the latest findings raise difficult questions
The latest SHCC inspection raises important questions about the pace and effectiveness of reforms introduced after one of Sindh's most serious patient safety crises.
While the hospital has taken initial administrative measures, inspectors say many frontline infection prevention practices still fall short of required healthcare standards.
For families affected by the HIV outbreak, the findings are likely to deepen concerns over whether lessons from the tragedy have translated into lasting systemic change.
A reminder that patient safety depends on systems—not promises
Public health experts consistently emphasize that preventing healthcare-associated infections requires more than committees or policy announcements.
Sustained staff training, strict adherence to infection prevention protocols, effective supervision, safe medical waste management and continuous regulatory oversight are all essential to protecting patients.
The SHCC said it will submit its detailed inspection report and recommendations to the relevant authorities for immediate corrective action and implementation.
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