Shortcomings in hygiene and infection control found at four hospitals

Shortcomings in hygiene and infection control found at four hospitals
Our Lady’s Children’s Hospital, Crumlin

Inspections by health watchdog HIQA have found shortcomings in hygiene and infection control at four hospitals.

The inspections by the Health Information and Quality Authority were carried out in June and July this year in Our Lady’s Children’s Hospital, Crumlin, St. Columcille’s Hospital, Loughlinstown, Croom Orthopaedic Hospital in Co Limerick, and Mallow General Hospital in Co Cork.

The inspectors found poor infrastructure in all hospitals and a failure to screen patients in line with HSE policy, against Carbapenemase-Producing Enterobacteriales (CPE) – a very resistant type of bacteria that can cause serious infections - in three hospitals.

The HSE had said that requirements for screening of patients for CPE in the acute hospital sector were to be implemented in all hospitals from March 1 last, to allow hospitals to better reduce the risk of colonised patients going on to develop CPE infection during the course of their medical treatment.

However, the HIQA inspections found that Croom was the only one of the four hospitals inspected were in full compliance with the HSE guideline on screening patients for CPE.

"Given that the threat associated with CPE has been declared a national public health emergency, HIQA escalated concerns to hospital management in three hospitals and the HSE to seek assurances around how each hospital might ensure compliance with the HSE’s own guidelines," HIQA said.

The unannounced inspection at Our Lady’s Children’s Hospital, Crumlin took place on June 15.

While overall it was found to have made significant progress in implementing the National Standards for the prevention and control of healthcare-associated infections in acute healthcare services, it was not adhering to the national HSE patient screening guidelines for CPE.

The matter was escalated and the chief executive officer and the consultant microbiologist said that, due to differing multidrug-resistant organism’s epidemiology in paediatric settings when compared to adults, the hospital considered it appropriate to modify the national CPE screening guidelines and that this was risk assessed and based on clinical opinion, previous screening and national surveillance data.

HIQA said:

To date, the hospital has not had a case of CPE cross transmission within the hospital.

Similarly, in Loughlinstown the general manager provided assurances about arrangements put in place to actively manage the risk in the interim of full CPE screening compliance. In Mallow, the hospital's general manager outlined key actions which would be explored to manage the risk.

Regarding Croom, HIQA identified many good practices in relation to the infection prevention and control programme during this inspection. It said the hospital was in compliance with the HSE's national hand hygiene compliance target.

But it said "it was of concern that significant findings made during the 2014 and 2016 HIQA inspections, in particular in relation to the hospital fabric and infrastructural deficiencies, which had also been identified and escalated as risks by the hospital, had not been prioritised and addressed at corporate HSE level".

HIQA said the executive management team of the UL Hospitals Group needed to address a number of areas, including infrastructural deficiencies and inadequate provision of single rooms, oversight of environmental hygiene, and inadequate preventative maintenance programmes.

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