Today, the Health Information and Quality Authority (HIQA) has published three inspection reports on compliance with infection prevention and control in rehabilitation and community inpatient healthcare services during the COVID-19 pandemic.

Risk-based announced inspections were carried out between July and September 2020 at: 

• Belmullet Community Hospital, Co Mayo
• St Patrick’s Hospital, Co Waterford
• St Camillus’ Hospital, Co Limerick.

Many of the required leadership, governance and management arrangements were evident around the prevention and control of healthcare-associated infection in St Camillus’ Hospital and St Patrick’s Hospital. However, increased oversight of infection prevention and control was identified as being required within the governance structures of the HSE Community Healthcare Organisation (CHO) area 2, which is responsible for Belmullet Community Hospital.

At St Patrick’s Hospital, inspectors identified a lack of adherence with Health Service Executive/Health Protection Surveillance Centre guidance relating to the need for patient testing for COVID-19 and isolation, following admission from an acute hospital. 

In light of this finding, HIQA sought assurance regarding arrangements in place to ensure compliance with the national guidelines. In response St Patrick’s Hospital provided written assurance to HIQA that full compliance with national guidelines had been implemented following the inspection.

All hospitals had systems in place to identify and manage risks in relation to the prevention and control of healthcare-associated infection. A variety of systems were used to ensure that environmental and equipment cleaning standards were met. It was evident that Belmullet Community Hospital had escalated locally identified infection prevention and control related risks to CHO2 level. However, HIQA had concerns that such escalation was not resulting in a sufficiently timely and reciprocal response, and it was not clear if escalated risks were being actioned at CHO2 level. Local risk registers in Belmullet Community Hospital need to be better managed, reviewed and escalated in line with national policy. 

While the antimicrobial stewardship programme was developed in St Camillus’ Hospital, it needs to be progressed in Belmullet Community Hospital and St Patrick’s Hospital.

St Camillus’ Hospital had a number of effective assurance processes in place in relation to the standard of hospital hygiene. The general environment and equipment in the areas inspected were clean. However, there was room for improvement in relation to the oversight and auditing of environmental and patient equipment hygiene at St Patrick’s Hospital and Belmullet Community Hospital.

All hospitals had systems in place to manage and control outbreaks of infection in a timely and effective manner. All hospitals had COVID-19 preparedness plans in place, and had access to external expertise in infection prevention and control. However, such access to specialist staff with expertise in infection prevention and control needs to be formalised by CHO2 for Belmullet Community Hospital.
Longstanding infrastructural and maintenance issues, which had the potential to impact on infection prevention and control measures were identified during the course of the inspections in St Patrick’s Hospital, St Camillus’ Hospital and Belmullet Community Hospital. While these issues have been escalated to the CHO, they have not been addressed. 

Up-to-date infection prevention and control policies were in place. Infection prevention and control training was delivered to all staff in two hospitals. There was a lack of formal training provided to multi-task attendants on the cleaning systems in Belmullet Community Hospital.

Hospitals need to address the areas for improvement identified on inspections and require the support of the CHO to effectively address issues highlighted in order to facilitate compliance with the National Standards for infection prevention and control in community services and other existing national healthcare standards.

Note to Editor:

• The rehabilitation and community inpatient healthcare services inspection programme monitors compliance against the National Standards for Infection Prevention and Control in Community Services. The focus of inspection is on governance and risk management structures and measures to ensure the prevention and control of healthcare-associated infections during the COVID-19 pandemic 
• HIQA has developed a Guide to HIQA’s targeted monitoring programme against the National Standards for Infection Prevention and Control in Community Services in rehabilitation and community inpatient healthcare services during the COVID-19 pandemic 2020 which can be viewed at www.hiqa.ie