Hospital non-compliant in screening for superbug

Health watchdogs have identified the failure of Midland Regional Hospital in Tullamore to be in compliance with HSE guidelines around screening patients for a superbug in its intensive care unit as a high risk.

The Midland Regional Hospital in Tullamore was one of seven hospitals inspected in the first three months of 2018 for non-compliance with the Health Service Executive’s (HSE’s) guidelines for patient screening for the superbug Carbapenemase Producing Enterobacteriaceae (CPE)

CPE is a very resistant type of bacteria that can cause serious infections.

In a letter to the hospital, HIQA said its inspectors identified that the hospital is not in compliance with HSE guidelines around screening patients for (CPE) in the Intensive Care Unit. 

“We consider this to be a high risk in light of the ongoing National Public Health Emergency Plan to address CPE in our health system which was activated by the Minister for Health on 25 October 2017. 

The unannounced inspection of Midland Regional Hospital Tullamore took place on January 30, this year and found the hospital had not successfully ensured that screening patients for CPE was fully embedded in line with national HSE guidelines.

Hospital management responded highlighting key actions which the hospital has instigated to address this risk. Among these were specific training for relevant staff in ICU, initiated in February and which will be biannual. 

HIQA said inspectors found that governance and management arrangements around the prevention and control of healthcare-associated infection were not fully aligned to the current Dublin Midlands Hospital Group whereby a consultant microbiologist and an assistant director of nursing provided a regional service across three hospitals and had a remit in two hospital groups; the Dublin Midlands Hospital Group (in the case of hospitals in Portlaoise and Tullamore) and the Ireland Hospital East Hospital group (in the case of Mullingar Regional Hospital).

The microbiologist provided cover to three acute hospitals over two hospital groups, including a clinical advice service, 24-hours-a-day, seven-days-a-week. 

It found hospital management should review this arrangement, given the required workload relative to resourcing levels found in other similar hospitals, in the interest of ensuring continued sustainability.

While the hospital had a suite of up-to-date infection prevention and control policies, staff in clinical areas had some difficulty accessing policies, procedures and guidelines stored electronically. 

In addition, clear written communication about patients’ infection control assessment or infectious status, prior to transfer from one department to another during hospitalisation was not always evident.

HIQA found staff attendance at regularly scheduled hand hygiene training required improvement, as only 65% of hospital staff had attended hand hygiene training in the previous two years.

In light of the suspension of the previous programme of surgical site infection surveillance and the revised surveillance programme now in place, management of surgical site infection surveillance requires further review to ensure that it is effectively structured, resourced and governed by senior management, the report said, so that they are assured of the safety of surgical services provided.

HIQA also found the hospital had implemented a suite of evidence-based practices (care bundles), but audits were not carried out on a regular basis.

"The general environment and equipment in the areas inspected were clean and well maintained with some exceptions. HIQA recommends the frequency of auditing of very high risk areas is increased in line with national guidance," report finished.