The health authority has admitted it has a 'particular problem' with hospital superbugs in the MidWest.
It follows claims by a whistleblower that more than 2 dozen people have died at University Hospital Limerick, after being infected with the drug resistant bugs.
In a statement to Clare Fm this afternoon, the HSE confirmed that 92 cases of so-called superbugs have been detected in the Mid-West between 2009 and the end of May 2015.
27 deaths have been recorded – and in 3 – superbugs were found to be a contributing factor in their deaths.
The HSE is blaming a lack of isolation facilities on older wards and has asked for a new 96 bed facility at UHL.
In the meantime, it's housing patients with similar infections in the same ward – but acknowledges it's not the ultimate solution.
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.
Among the measures taken by the Group over the past two years are included:
The refurbishment of an inpatient ward at UHL, at a cost of €400k, to facilitate an IP&C cohort ward.
The €300k refurbishment of another ward at UHL to address IP&C concerns, including replacement of some of the infrastructure such as sinks etc.
Significant investment in additional ward based cleaning teams.
Deep cleaning measures are put in place following the discharge of an identified infected patient
Infrastructural issues and staffing deficits in the IP&C team are identified as risks on the corporate risk register and escalated appropriately
Given the concerns around our ward infrastructure at UHL, with large nightingale wards the norm in the older parts of the building, we have submitted a request to the HSE national capital group for funding for a new 96 bedded single block to address our accommodation difficulties and lack of adequate isolation facilities.
We have also sought additional IP&C resources to ensure that further surveillance and follow-up of at-risk patients in the community is undertaken.
Inappropriate use of antimicrobials and the spread of multidrug resistant organisms in hospital and community healthcare settings are among the most difficult challenges health systems face today.
A particular problem exists in the MidWest, reflected in the hospital population, with CRE. In line with national guidelines, the Group proactively screens patients for CRE to help prevent infections associated with same.
Research conducted last year found that of the 92 cases of CRE detected in the Mid-West between 2009 and the end of May 2015, 27 deaths had been recorded. In 3 of these cases, CRE was found to be a contributing factor in their deaths. In the remainder, a CRE detection was associated but was not the primary cause of death.
UL Hospitals has developed a quality improvement plan in regard to CRE, a plan which incorporates much of the NHS Toolkit For the Control of CRE 2013. This includes an intensive screening programme; use of an isolation ward for newly detected or known positive patients to reduce the risk of cross-transmission; flagging all CRE positive cases and CRE contacts through the management, surveillance and reporting software ICNet; and reporting new cases appropriately through our microbiology team.
In addition UL Hospitals Group has introduced a preferred prescribing policy for antibiotic selections. Strict guidelines are issued to all NCHDs in relation to antibiotic prescribing in terms of first line and second line antibiotics. More complex antibiotics are referred to the microbiology team before they are prescribed.
It is of note that there has been an overall reduction of 40% of new detections in the first six months of this year compared to the corresponding period of 2015.
UL Hospitals Group continues to work through the issues identified in the recent HIQA report on Antimicrobial Stewardship. The Group has in place an Antimicrobial Stewardship Committee to guide progress and strengthen policy in this area.
UL Hospitals Group will continue to work with HIQA and with the HSE nationally to ensure best practice is followed in this regard.
UL Hospitals Group acknowledges the support of the HSE for major capital projects such as the new Emergency Department, which once complete will mitigate the infection prevention and control risks.
A cohort ward for patients with infections was opened at UHL in November 2015. It is acknowledged that this is not the ultimate solution to the shortage of isolation facilities at UHL. The Group wishes to acknowledge the excellent work done by all the staff on the cohort ward and by our infection prevention and control team in relation to environmental hygiene, hand hygiene, compliance with personal protective equipment guidelines etc. These and other quality improvement measures have resulted in a much improved patient experience on the cohort ward.
A shortage of isolation facilities is a problem encountered by many acute hospitals in the country, particularly in older buildings such as the main ward block at UHL. Twentieth century buildings are simply not equipped to deal with all of the challenges of 21st century medicine. The long-term solution for this is single occupancy rooms for inpatients such as that provided at the 50-bedded block in Ennis Hospital. UL Hospitals Group has made a bid under the capital programme to provide a new 96-bedded block at UHL and looks forward to a favourable outcome in this regard to support best practice.
Protected Disclosure
UL Hospitals Group encourages staff to raise any of their concerns either directly or through the protective disclosure mechanism. The hospital group recognises the rights that staff and the public have in this regard, and would in no way try to undermine or penalise any staff member in this regard.
Additional comment from UL Hospitals Group on CRE:
Antimicrobial resistance is a growing issue for health systems internationally and what is happening in Irish hospitals is a reflection of this global phenomenon Research on CRE conducted by a multidisciplinary team of professionals from the Department of Clinical Microbiology, UHL; the Infection Prevention and Control Nursing Team at UHL; the Department of Public Health, University Hospital Limerick and the Centre for Intervention in Infection, Inflammation & Immunity (4i), University of Limerick has been presented at various conferences and published in international journals in recent years. HIQA reports published in 2015 and 2016 have shown that UL Hospitals has been completely transparent in how it has managed and reported cases of CRE since the first detection in 2009 and escalated matters appropriately at a national level. Research conducted last year found that of the 92 cases of CRE detected in the Mid-West between 2009 and the end of May 2015, 27 deaths had been recorded. In 3 of these cases, CRE was found to be a contributing factor in their deaths. In the remainder, a CRE detection was associated but was not the primary cause of death. It is important to note also that these patients included those colonised with CRE as well as those infected and to note the distinction between these two groups. Infection relates to the presence of micro-organisms in the body causing adverse signs or symptoms. Healthy people usually do not get CRE 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 CRE 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. Carriers may serve as an important reservoir for dissemination of CRE in healthcare facilities. Additionally prolonged carriage can occur after colonisation and patients colonized or infected with CRE may seek medical care in more than one hospital and serve as a reservoir that can facilitate the spread of CRE from one facility to another.
