Increase in use of penicillin during Nenagh Hospital superbug infection in 2018

The incidence of superbug infection in Nenagh Hospital during 2018 was almost 10 times the target set by the HSE at a time when the use of penicillin, an antibiotic, had also increased.

Health experts have repeatedly warned that the rise in drug-resistant superbugs is linked to antibiotic overuse.

When inspectors from the health watchdog, HIQA, visited last April, documentation showed that the hospital incidence of Clostridium difficile (C diff) infection in August 2018 was 20.4 cases per 10,000 bed-days used, against a HSE metric of no more than 2.5 cases per 10,000 bed-days.

There had been a 14% hike in broad-spectrum penicillin use in Nenagh in the preceding six months.

The inspectors warned that antimicrobial consumption, which includes antibiotics like penicillin, “contributes to the incidence" of C diff infection.

An inspection in Our Lady of Lourdes Hospital, Drogheda, says 13 cases of C diff infection were diagnosed in the first three months of 2019, which included four recurrent cases and two hospital-acquired cases - which did not appear to be linked.

Inspectors said this could reflect, inter alia, “excessive use of broad-spectrum antibiotics”.

HIQA conducted a series of unannounced inspections in April, where the focus was on how hospitals organise themselves to minimise the spread of healthcare-associated infections.

It honed in on systems to detect, prevent, and manage multidrug-resistant micro-organisms, and the approach taken to reduce the risk of reusable medical device-related infection.

HIQA found that in relation to the use of reusable medical devices such as endoscopes, transvaginal and transrectal ultrasound probes, hospitals were generally using a manual system for decontamination even though a “validated automated system” is best practice.

At Nenagh Hospital, inspectors were told that prior to introducing automated decontamination for nasopharyngeal endoscopes, additional endoscopes would be required to maintain the clinical service. “However, there was no agreed funding or timeframe for this development at the time of this inspection.”

While there was much evidence of good practice at all of the hospitals, HIQA made the general point that hospital groups need to support their member hospitals to effectively address issues in relation to decontamination and reprocessing of reusable medical devices in order to comply with the National Standards.

At Our Lady’s Hospital in Manorhamilton, Co Leitrim, the inspector said it was clear that the hospital had embedded a number of effective infection prevention and control practices locally.

However the use of a “nightingale” ward - one long ward with a large number of beds along the side - increased the risk of infection transmission, “especially if beds were placed too close together”.