The health watchdog has found the spread of a potentially fatal superbug at the region’s main hospital has “not effectively been controlled”.
HIQA inspectors carried out an inspection of University Hospital Limerick in July, when staffing deficits were noted in the infection control team.
During the course of this unannounced inspection at UHL, inspectors placed particular focus on the prevention and transmission of infection.
CPE is a potentially-fatal superbug that is easily passed on and is of particular concern to people with a weakened immune system.
HIQA noted in its inspection that additional staff had been made available at the Dooradoyle facility to help control the spread of infections.
However, it was also found that deficits remained; with surveillance scientists continuing to be redeployed to microbiology laboratory technical work, which has delayed the production of some surveillance reports.
It was further stated while improvements had been made, there was “no indication” that the spread of CPE has been effectively controlled at UHL.
But inspectors did note that University Hospital Limerick management are committed to improving infection prevention and control and were endeavouring to fully implement national standards.
UL Hospitals Response on HIQA Report UHL
UL Hospitals Group welcomes publication of the HIQA Report on University Hospital Limerick. We are committed to working with HIQA on meeting the National Standards for the Prevention and Control of Healthcare-Associated Infections.
This report highlights a number of improvements made in the two years since the previous such inspection. This includes strengthened governance, surveillance and audit; full implementation of national CPE screening standards; additional staffing resources (e.g. consultant microbiologist, infection prevention and control nurses) etc.
The report identifies many areas of good practice where UHL staff take action to protect their patients from any potential harm. This includes the isolation or – where there is an insufficient number of single rooms – the cohorting of patients colonised with or who have come into contact with an organism. The report notes that all patients colonised with CPE in the area relevant to the inspection were appropriately isolated in single rooms on the date in question.
Other examples of good practice noted in the report include restrictions in the prescribing of certain antibiotics associated with multidrug resistant organisms; comprehensive environmental screening in clinical areas and the communication with patients discharged from hospital prior to their status as a CPE contact being confirmed by a positive lab result.
The inspection is positive about cleanliness and hygiene both in the ward environment and in relation to equipment. This is consistent with feedback from the recently published National Patient Experience Survey 2019 where nineteen out of every 20 patients described their room or ward at UHL as very clean (68%) or fairly clean (27%).
The report has highlighted a number of areas for improvement including on rapid lab testing; antibiotic prescribing; communication with patients on outbreak wards etc. In the CSSD, areas for improvement include the lack of an automated disinfection process for some equipment and the need to appoint a group decontamination lead.
All of the shortcomings identified by HIQA are being addressed through a Quality Improvement Plan which has been developed at UHL and we are committed to implementing these improvements.
Some, however, are subject to additional resources including capital development to address the acknowledged shortage of isolation facilities in UHL. The new Emergency Department has modern isolation facilities which allow us to take necessary IP&C precautions when patients present. However, on the general medical and surgical wards, there are only 60 single rooms and this limits our ability to isolate patients. Single rooms may also be required for patients with specific care needs including patients at end-of-life.
With the completion of the 60-bed block at UHL in late 2020, our ability to isolate patients will be considerably enhanced.
It is acknowledged that CPE is endemic in the MidWest and this presents a serious challenge. UHKL is fully implementing the national screening guidelines. The number of screens being carried out, and the number of detections, increases year-on-year and this allows us to take the necessary precautions at an early stage. In line with the national profile, the vast majority of positive CPE results at UHL relate to screening samples rather than clinical specimens. This indicates that staff are proactive in seeking it out and putting appropriate controls in place.
Noreen Spillane, Chief Operations Officer, UL Hospitals Group, commented: “Staff and patients can take encouragement from this report that University Hospital Limerick is making progress in managing the spread of healthcare associated infections. HIQA has a vital role to play in improving the quality and safety of our health services and I welcome the publication of its report on UHL. Every time such a report is published, it is an opportunity for us to continue to improve.
“Staff and management at UHL work conscientiously to provide a safe and clean environment for our patients and to minimise the risk of infection. And it is heartening to see their good practice also highlighted in this report.
“The screening programme is one of a number of measures put in place by the hospital in recent years to manage CPE or other healthcare associated infections. These include strengthened governance; infrastructural improvements; increased staffing; staff training and education initiatives; improved surveillance and reporting; implementation of new guidelines around antimicrobial prescribing and more.
“It is also encouraging that there has not been a CPE bloodstream infection detected at UHL since June 2015. The vast majority of patients with CPE in the MidWest are colonised rather than infected, meaning they suffer no ill effects. But it is important we continue to work with all stakeholders to minimise the spread of CPE – both in our hospitals and in our communities – to the most vulnerable patients for whom it can cause serious harm.”
