A dozen of the 16 patients identified as carriers of a potentially lethal superbug at the Mercy University Hospital (MUH) in Cork picked it up while in hospital, according to a new report by the health watchdog.
The 16 new cases of CPE colonisation were detected at MUH between January and October this year. Of all the superbugs, CPE - Carbapenemase-Producing Enterobacteriales (CPE) - are the most difficult to kill with antibiotics.
The worrying rise in the incidence of CPE in Ireland prompted Health Minister Simon Harris to declare it a public health emergency in October 2017. Figures from the Health Protection Surveillance Centre (HPSC) show the number of patients with newly confirmed CPE increased to 435 in 2017 from 282 in 2016.
Inspectors from the Health Information and Quality Authority (HIQA), who carried out an unannounced inspection at MUH on November 2 last, were told that in addition to the 16 new cases, 110 CPE contacts have been identified since December 2017.
A person is identified as a CPE contact when they have spent hours in the same space in a hospital as someone who is carrying CPE. Being a contact does not mean that the person is carrying the superbug, but the odds are higher.
All CPE contacts identified at MUH were informed “either verbally or by letter” and a dedicated CPE clinic was run to screen patient contacts.
Inspectors were informed that the hospital experienced a CPE outbreak, with a cluster of cases in January 2018, and while numbers had reduced after the first quarter, intermittent hospital attributed cases continued to arise “such that the outbreak was still considered ongoing,” the report said.
HIQA identified a number of factors that likely contributed to the transmission of CPE at MUH including
While the hospital has introduced a series of positive measures to tackle that spread of the superbug, such as screening above and beyond the national recommendations, MUH said it may not be possible to fully eradicate the superbug in the hospital because of background rates of CPE it has identified in the community.
HIQA itself acknowledged that “the true burden of CPE colonisation may be unknown in some other Irish hospitals and in the community because of limited screening”.
Despite its efforts, MUH “had not seen a reversion to zero incidents of CPE”, however its efforts "had succeeded in containing the number of new CPE cases and maintaining CPE related bloodstream infections at very low levels”.
A statement from hospital CEO Sandra Daly said MUH was "actively implementing a number of major initiatives to address the issues raised".
Ms Daly said: "The hospital wishes to assure the public that the situation is being addressed and monitored on a continuous basis.
"MUH has fully implemented the National Requirements for Screening of Patients for CPE in the Acute Hospital Sector," Ms Daly said.
A capital submission for a 30 Bed Modular Ward at MUH was submitted to the HSE in February last. This accommodation would provide for an additional 12 single rooms in line with the ‘Interventions for Control of CPE in the Acute Hospital Sector’
While CPE can live harmlessly in the gut it can be deadly if it gets into the bloodstream; more than half of patients who develop bloodstream infections with CPE die.