The UL Hospitals Group is defending it’s infection prevention and control measures in the wake of an investigation into the deaths of 74 patients at University Hospital Limerick who had contracted the CPE Superbug.
It follows reports that a whistleblower maintains that concerns raised about the issue haven’t been taken seriously.
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Between January 1st 2009 and May 31st 2017, there were 193 new detections of the CPE Superbug in the Midwest, of these, 166 cases related to patients from the UL Hospitals Group, and the remainder were from the community.
During this period there was a downward trend in the incidences of CPE, with the number of detections dropping from 60 in 2015 to just 16 at the end of March this year.
The UL Hospitals Group says its proactive in screening patients for CPE, which helps to identify those carrying CPE, allowing for the appropriate control measures to be put in place.
95% of patients were deemed to be colonised and had no adverse affects as they were not infected by the bug.
UL Hospitals Group is examining 74 cases where patients with a CPE detection subsequently died, and is working with the Limerick City Coroner, who is now investigating a list of 29 deaths highlighted by a whistle-blower.
In response to queries from Clare FM, the UL Hospitals Group says it has also commissioned an external review by a UK microbiologist and says it will share the results of that review with the coroner and other interested parties.
Statement From UL Hospitals Group
The management of multidrug resistant organisms through infection prevention and control (IP&C) procedures and proper antimicrobial stewardship is taken with the utmost seriousness by UL Hospitals Group. Antimicrobial resistance is one of the most serious challenges faced by health systems all over the world. UL Hospitals Group welcomes the establishment this week by the Minister for Health of the Public Health Emergency Team on CPE.
While UL Hospitals Group accepts – and has acted on – the findings on hygiene referred to in the above HIQA reports, the Group also draws attention to HIQA’s positive assessment of the screening and other mitigation measures around CPE within the Group.
Between January 1st, 2009 and May 31st 2017 there have been 193 confirmed new detections of CPE in the MidWest (2009-2017). Of these, 166 cases related to patients from UL Hospitals Group and 27 from the community.
It should be noted that these are the requesting locations of the first positive lab specimen for the patient and this does not imply that the patient acquired CPE in this location. Indeed, high numbers of detections are to be expected within UL Hospitals as the group has a comprehensive screening programme in place.
UL Hospitals Group is proactive in screening patients for CPE in line with national and international best practice and guidance. This helps identify at risk colonised patients asymptomatically carrying CPE, allowing for the appropriate control measures to be put in place.
In 2015, there were 60 new CPE detections in the MidWest (57 from UL Hospitals Group and three from the community). In 2016, this reduced to 38 new detections (30 UL Hospitals, eight community). As of May 31st 2017, there were 16 new detections (15 UL Hospitals and one community).
The distinction between those colonised with and carrying CPE and those infected with CPE is a crucial one.
Infection relates to the presence of micro-organisms in the body causing adverse signs or symptoms. Healthy people usually do not get CPE infections. These usually occur in patients in hospitals, nursing homes, and other healthcare settings. Patients whose care requires devices like ventilators; urinary or intravenous catheters; and patients who are taking long courses of certain antibiotics are most at risk for CPE infections.
Colonisation relates to the presence of micro-organisms living harmlessly on the skin or within the bowel and causing no signs or symptoms of infection. However, carriers may serve as an important reservoir for dissemination of CPE in healthcare facilities. Additionally prolonged carriage can occur after colonisation and patients colonised or infected with CPE may seek medical care in more than one hospital and serve as a reservoir that can facilitate the spread of CPE from one facility to another.
Once CPE infects the bloodstream, it can be very difficult to treat and is associated with high mortality of up to 50%.
The vast majority of the cases detected in the MidWest referred to above relate to CPE carriers, where the organism is living harmlessly in the gut. In 2016, for example, 95% of cases were deemed to be colonised and not infected with CPE. It should be further noted that 87% of all patients identified with CPE for the first time in 2016 came from screening specimens.
This is not in any way to minimise the very real risks to public health presented by CPE. UL Hospitals Group takes these risks very seriously as outlined in the procedures set out in the additional note below around governance, screening, surveillance, reporting, infection prevention and control, hygiene training, infrastructural improvements, antibiotic prescribing and much more.
UL Hospitals is fully cooperating with Limerick City Coroner on this matter.
UL Hospitals Group is examining approximately 74 cases where patients with a CPE detection subsequently died. Please note as above the distinction between colonisation and infection.
UL Hospitals Group has recently completed its own internal review on the matters raised. In addition it has commissioned an independent external review by a senior microbiologist from the UK, which is imminent. The Group looks forward to sharing the findings of both reviews with the coroner and other interested parties.
