Today, the Health Information and Quality Authority (HIQA) has published four 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 August and September 2020 at: 

• Swinford District Hospital, Mayo
• Grove House, Cork
• Peamount Healthcare Rehabilitation Services, Dublin
• The Royal Hospital, Donnybrook, Dublin.

There was a defined management structure with identified lines of accountability and responsibility in Peamount Healthcare Rehabilitation Services and the Royal Hospital Donnybrook. Grove House opened as a transitional care unit in March 2020 in response to the COVID-19 pandemic, but governance structures and processes were still evolving at the time of the inspection. Inspectors were informed that there were no local committees or formalised management meetings held within the unit. Established communication pathways were in place, including access to external expertise in infection prevention and control, for these three services. In Swinford District Hospital, there was scope to improve local awareness of infection prevention and control supports provided by the HSE Community Health Organisation (CHO) 2 and the role of the CHO2 Infection Prevention and Control Committee.

Staff in Peamount Healthcare Rehabilitation Services and the Royal Hospital Donnybrook had access to on-site specialist infection prevention and control advice and support. Staff in all services had received infection prevention and control education and training. The antimicrobial stewardship programme in Grove House and The Royal Hospital Donnybrook needed to be further developed.

There were systems in place in Peamount Healthcare Rehabilitation Services and the Royal Hospital Donnybrook to identify, manage and escalate risks in relation to the prevention and control of healthcare-associated infection. However, risk registers in Grove House need to be managed and reviewed in line with national policy. Hospital management in Swinford District Hospital was unsure if any escalated risks had been entered on the risk register at CHO2 level.

Three services had a number of effective assurance processes in place in relation to the standard of hospital hygiene. However, inspectors identified scope in Swinford District Hospital to broaden the current auditing programme to include other aspects of infection prevention and control such as hand hygiene practice, standard and transmission-based precautions, and antimicrobial stewardship. 

Management in CHO2 for Swinford District Hospital and in CHO4 for Grove House should be assured that sustainable and safe staffing levels are maintained going forward, particularly in consideration of potential surges in capacity due to the ongoing COVID-19 pandemic.

Staff in all services demonstrated awareness and understanding of their roles and responsibilities in working to prevent and control infection during discussions with inspectors. Up-to-date infection prevention and control policies and procedures, based on national guidelines, were available to staff in all services. However, while infection prevention and control policies, procedures and guidelines were developed locally in Swinford District Hospital, an approval process at senior management level within the CHO2 was not evident.

All services had systems in place to manage and control outbreaks of infection in a timely and effective manner. Three services had developed COVID-19 preparedness plans. Swinford District Hospital had an emergency management plan in place but it had not been approved by appropriate governance structures in line with national guidance. Improvements were also needed in plans for cohorting and zoning patient areas in the event of another outbreak occurring at the hospital.

Three services experienced a COVID-19 outbreak in 2020. Peamount Healthcare Rehabilitation Services and The Royal Hospital Donnybrook had effectively accelerated and streamlined COVID-19 testing and tracing processes. Outbreak control teams were convened to oversee the timely management of the outbreaks and public health departments were notified. Inspectors identified many examples of good practice in the management of COVID-19 in both hospitals. 

Swinford District Hospital had experienced a COVID-19 outbreak in April 2020. HIQA identified that a local outbreak committee had not been activated during the outbreak period. Furthermore, an outbreak report had not been completed by the hospital to evaluate performance in managing the outbreak, at the time of the inspection, which is best practice. This needed to be addressed following the inspection. Improvements were also required in the documentation on daily communication between the hospital and the public health department.

Overall, the general environment and equipment in the areas of the four services inspected were clean and well maintained with some exceptions. Improvement was required in the management and oversight of daily and deep cleaning records in Swinford District Hospital. A number of infrastructural issues which had the potential to impact on infection prevention and control measures were noted in Grove House, Peamount Healthcare Rehabilitation Services and The Royal Hospital Donnybrook.

Notes 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 inspections focus 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