HIQA 'concerned' over Tullamore Hospital's failure to protect patients against 'superbug'
A recent HIQA report into compliance rates of hospitals with regard to screening patients against superbug CPE has found Midland Regional Hospital to be largely non-compliant.
Inspections also took place at Portiuncula University Hospital Ballinasloe, Co. Galway; Cappagh National Orthopaedic Hospital, Dublin; St Vincent’s University Hospital, Dublin; South Infirmary Victoria Hospital, Cork; Royal Victoria Eye and Ear Hospital, Dublin; St James’s Hospital, Dublin.
HIQA monitors infection prevention and control practices in hospitals against the National Standards for the prevention and control of healthcare-associated infections in acute healthcare services.
These inspections represent the first to have been conducted by HIQA following the declaration of a National Public Health Emergency Plan to address Carbapenemase Producing Enterobacteriaceae (CPE) — a very resistant type of bacteria that can cause serious infections — by the Minister for Health on 25 October 2017.
The inspections that HIQA conducted focused on how hospitals are implementing the National Standards, with a particular focus on how implementation of these standards ensures that patients are protected against the CPE threat.
As part of this investigation, an unannounced HIQA inspection of Midland Regional Hospital, Tullamore took place on 30 January 2018 where inspectors found the hospital "had not successfully ensured that screening patients for CPE was fully embedded in line with national HSE guidelines."
The Royal Victoria Eye and ear Hospital and the Portiuncula University Hospital Ballinasloe, Co. Galway were the only hospitals of the seven to be found compliant with guidelines.
In Tullamore, inspectors found that governance and management arrangements around the prevention and control of healthcare-associated infection were not fully aligned to the current Dublin Midlands Hospital Group whereby a consultant microbiologist and an assistant director of nursing provided a regional service across three hospitals and had a remit in two hospital groups; the Dublin Midlands Hospital Group (in the case of hospitals in Portlaoise and Tullamore) and the Ireland Hospital East Hospital group (in the case of Mullingar Regional Hospital).
The microbiologist provided cover to three acute hospitals over two hospital groups, including a clinical advice service, twenty four hours a day, seven days a week. HIQA advised that "hospital management should review this arrangement, given the required workload relative to resourcing levels found in other similar hospitals, in the interest of ensuring continued sustainability."
The report continued: "While the hospital had a suite of up-to-date infection prevention and control policies, staff in clinical areas had some difficulty accessing policies, procedures and guidelines stored electronically. In addition, clear written communication about patients’ infection control assessment or infectious status, prior to transfer from one department to another during hospitalisation was not always evident."
They found that staff attendance at regularly scheduled hand hygiene training requires improvement in Tullamore as only 65% of hospital staff had attended hand hygiene training in the previous two years.
They also advised further review of the management of surgical site infection surveillance to ensure that it is "effectively structured, resourced and governed by senior management so that they are assured of the safety of surgical services provided."
The HIQA findings continued to say that "the general environment and equipment in the areas inspected were clean and well maintained with some exceptions." HIQA recommended the frequency of auditing of very high risk areas is increased in line with national guidance.
HIQA escalated concerns related to the non-compliant screening finding to the hospital in writing following the inspection in January. They say that hospital management responded highlighting key actions which the hospital has instigated to address this risk.
They stated: "It is a public health imperative that all required measures to address the CPE issue are both quickly and universally implemented by the HSE. It is HIQA’s intention to continue to monitor hospitals to ensure that these measures are implemented over the coming months."
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