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By Daniel O'Donoghue
BBC News
Nurse Lucy Letby has blamed "dirty" conditions as a factor in the deaths of babies she is accused of killing.
The 33-year-old is accused of murdering seven babies and attempting to murder 10 others at Countess of Chester Hospital between 2015 and 2016.
Continuing her defence, Ms Letby told the court the hospital had plumbing problems with "raw sewage coming out of sinks" in one of the nurseries.
The nurse, originally from Hereford, denies all 22 charges against her.
She said: "It's a contributory factor if the unit is dirty and staff were unable to wash their hands properly.
"Potentially that's not a safe working environment."
Earlier, the jury was also told she had "made up" parts of her evidence about a baby twin, who she is said to have murdered, and was repeatedly accused of lying and adding details to her account.
She was asked about her recollections of the baby boy - referred to in court as Child E - who she is said to have first injured, causing a bleed, and then killed with an injection of air.
Child E was a twin and was born prematurely alongside brother Child F in late July 2015.
The jury at Manchester Crown Court has heard that Ms Letby was the designated nurse caring for both boys on the night shift of 3 August.
The court has previously heard the mother of the twins heard Child E making "horrendous" sounds and found him bleeding from the mouth when she arrived at the nursery at 21:00 with breastmilk.
Under cross examination, Ms Letby was asked whether Child E's mother's recollection was correct.
She said she "accepted" that mothers bring breast milk to the unit and that was a "normal occurrence", but could not "specifically" recall Child E's mother visiting.
Prosecutor Nick Johnson KC put it to Ms Letby that Child E was bleeding at 21:00.
She said "I don't agree", adding: "There wasn't blood prior to 22:00."
Mr Johnson referenced Ms Letby's initial defence statement, agreed in February 2021, in which she said Child E's mother "may have" visited "later than 21:00".
"You're now saying it cannot have been before 22:00," Mr Johnson said.
Ms Letby told the court she could not say "definitively" what time it was but repeated that "there was no blood prior to 22:00".
Mr Johnson responded: "You're lying aren't you Ms Letby?". "No", she responded.
The barrister put it to Ms Letby that Child E's mother made a phone call to her husband at 21:11, in which she expressed concern about the blood around their baby boy's mouth.
Ms Letby accepted there was a phone call, as has been established through phone records, but did not accept the content of the conversation.
"Do you accept what she and her husband said was said in that call," Mr Johnson asked.
Mr Johnson went on to accuse Ms Letby of lying and adding additional detail to her statement, which she denied.
The nurse told the court that if she had "seen blood at any point I would have escalated that to somebody".
Mr Johnson noted that a doctor was not called to respond to the blood until 22:00, an hour after Child E's mother said she saw it.
Mr Johnson again accused Ms Letby of not telling the truth and put it to her that Child E was bleeding as a result of her having "inflicted an injury" on him.
"I don't accept that. That did not happen," she said.
"You killed [Child E] didn't you?" Mr Johnson said.
"No," Ms Letby responded.
The nurse earlier said Child E's deterioration and death could have been the result of "medical incompetence" of doctors on shift that night.
She told the court she thought "doctors could have acted sooner to respond to [Child E's] bleeding issue".
Ms Letby was also asked if she reported the issue of sewage, to which she replied "not personally, no".
Mr Johnson then turned to a premature baby girl, Child G, who Ms Letby is accused of overfeeding with milk through a nasogastric tube in an attempt to kill her in September 2015.
The court has heard Child G was clinically stable until 7 September, when she projectile vomited at about 02:00.
Ms Letby said the vomit "potentially" could have been caused by a nursing colleague having mis-measured a feed.
"I can't say for definite that didn't happen. I'm not saying she did do that, but it is a possibility", Ms Letby said.
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