Liver transplant patients at risk of infection - lessons have not been learned at St Vincent’s unit

Patients at the National Liver Transplant Unit at St Vincent’s University Hospital in Dublin continue to be at risk of contracting a serious bacterial infection, it has emerged.

The Health Information and Quality Authority (Hiqa) found that lessons had not been learned from a previous outbreak of the antibiotic-resistant infection.

Hiqa identified a “high risk” of infection during an unannounced inspection of the 21-bed National Liver Transplant Unit in March this year. In particular, there has been an increased incident of hospital-acquired vancomycin-resistant enterococci (VRE).

Inspectors also found that the poor overall infrastructure of St Brigid’s Ward — the National Liver Transplant Unit — did not facilitate effective infection prevention and control. There was also poor compliance with transmission-based precautions and other deficiencies about aspects of infection prevention and control.

Hiqa wrote to the hospital following the inspection seeking an assurance about the management of the risks.

In 2014 the hospital reported an outbreak of linezolid-resistant VRE infection in the National Liver Transplant Unit. It was the first report of this type of antimicrobial resistance pattern in Ireland.

The inspection report, published yesterday, states that linezolid-resistant VRE is a concern because it limits treatment options for critically ill patients.

Overall, the patient environment and equipment were generally clean at the time of the inspection. However, the infrastructure and facilities in St Brigid’s Ward did not facilitate effective infection prevention and control for vulnerable patients.

In particular, there were not enough ensuite isolation rooms for patients needing infection transmission precautions. Inspectors found that commodes were stored in the shower facility rather than in a ‘dirty’ utility room.

St Vincent’s told Hiqa it recognised that the incidence of VRE and the infrastructure of St Brigid’s Ward were significant issues. It had taken action to deal with VRE that included targeted screening, isolating cases and enhanced cleaning and decontamination.

However, at the time of the inspection, Hiqa found that learnings about ward infrastructure and control measures from the previous outbreak in the hospital and past reports of VRE outbreaks had not been used to reduce risk to patients.

In a statement, St Vincent’s Hospital said it fully recognised that more work needed to be done to reduce the infection risk. It also accepted that St Brigid’s Ward was no longer of an appropriate standard for the National Liver Unit, and the solution was to relocate it to another part of the hospital campus. It had prepared a detailed business case for a new unit.

Meanwhile, Colm Bering, infectious diseases consultant at St James’s Hospital in Dublin expressed alarm at the high number of patients found to have HIV or hepatitis since routine testing started at the hospital on World Hepatitis Day last year. Since then, 14,800 patients have been tested, with 15 new cases of HIV diagnosed, as well as 21 new cases of hepatitis B and 57 new cases of hepatitis C.

“The routine testing programme that commenced in July of last year clearly demonstrates high prevalence rates for all three infections in attendees of our ED and we find it alarming to continue to find the high number of new diagnoses,” said Prof Bergin.


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