Hospital told act to prevent superbug outbreak

The State’s health services watchdog told a hospital to take immediate steps to prevent another outbreak of the superbug Clostridium difficile (C diff).

The Heath Information and Quality Authority said it was not assured that Portiuncula Hospital in Ballinasloe, Co Galway, was effectively managing the infection risk.

“Clostridium difficile infection can have serious outcomes for patients that may result in devastating illness or death, and increased hospital stay,” it said.

Towards the end of last year the hospital experienced an extensive outbreak of the infection that affects the bowel and causes diarrhoea.

“Hiqa is not assured that the incidence of Clostridium difficile infection is being effectively managed by the hospital management team,” it said.

The hospital was told to make urgent improvements in three critical areas — antimicrobial stewardship, environmental hygiene and hand hygiene.

“Measures must be instituted before a further outbreak develops,” the health authority stressed in its report on the inspectors’ unannounced hospital visit in May.

The overall incidence of C diff infection in the hospital last year was 4.8 per 10,000 bed days used, which is significantly higher than what would be expected.

Hiqa said it was concerned that data for the first three months of this year showed the incidence of the infection remained high at 4.7 cases per 10,000 bed-days.

“If further outbreaks are to be prevented, prevention and control of Clostridium difficile infection must remain a priority for all relevant staff in the hospital, including hospital management.”

It also found that the frequency of hygiene audits for very high functional areas, such as operating theatres was not in line with national guidance or best practice.

Opportunities for improvement relating to medication management and unsafe injection practices were identified during the inspection.

Hiqa also raised concern about the hospital’s preparedness for an outbreak of Legionella and said the hospital should take steps to assure itself that the risk to patients was sufficiently mitigated.

The hospital was also told to ensure that its hand hygiene performance improved after inspectors found that only two of nine areas audited achieved the Health Service Executive’s target of 90% this year. The average result for hand hygiene audits completed across nine different wards/departments was 78%.

Inspectors noticed that one out of four hand hygiene opportunities was missed by staff in the maternity ward — before touching a patient.

Another unannounced inspectors’ visit to University Hospital Galway, in May, found a poorly maintained paediatric ward. There were stained floors in the toilet facilities and evidence of leakage around the toilet outlet pipes.

Inspectors found there was no dedicated hand wash sink in the ‘dirty’ utility rooms serving the hospital’s theatres.

A sink used for handwashing was directly behind a sluice hopper used for disposing of liquids and waste.

“This presents a risk of contamination of staff hands with faecal organisms and is a potential risk factor in the spread of enteric bacteria that can cause infection,” Hiqa said.