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

Risk-based inspections were carried out in acute hospitals in September 2020 at:

• University Hospital Waterford and
• Mayo University Hospital

University Hospital Waterford, 6 September 2020

Inspectors found that, at the time of this inspection, the required structures to ensure COVID-19 preparedness plans were in place. The Crisis Management Team provided effective leadership, governance and management arrangements for the prevention and control of healthcare-associated infection at University Hospital Waterford. While the hospital had not experienced a COVID-19 outbreak up to the time of the inspection, recent experiences in the management of Carbapenemase-Producing Enterobacteriales (CPE) and other outbreaks provided assurances that the supporting systems and processes in place to manage such risks were effective.

The hospital had identified that more resources were required to support the microbiology and infection prevention and control services provided by the hospital to five other sites across two hospital groups. 

Overall, inspectors found that the areas inspected and visited were clean. Systems were in place to identify and manage risk in relation to the prevention and control of healthcare-associated infections. Some improvement was needed in the documentation of risks on the infection prevention and control risk register. 

Mayo University Hospital, 29 September 2020

Inspectors found that that there were clear lines of accountability and responsibility in relation to governance and management arrangements for the prevention and control of healthcare-associated infection at the hospital. 

The hospital had experienced two COVID-19 outbreaks at the outset of the pandemic and had put a number of important measures in place to reduce the likelihood of further outbreaks, as informed from learning from its experiences in April 2020. 

The COVID-19 Management Committee was responsible for preparing and overseeing the hospital’s COVID-19 response in line with National Guidance. Pathways for streaming patients into COVID-19 and non-COVID-19 services had been identified and, insofar as possible, each stream had separate infrastructure and staffing.

HIQA identified the emergency department had recently become significantly busier, with patients on trolleys and chairs for extended periods of time. This had resulted in non-adherence to HSE physical distancing guidelines to prevent the risk of COVID-19 transmission. HIQA identified this to the hospital as a significant concern at the time of the inspection. Efforts to mitigate this risk, inclusive of better use of available bed capacity within the hospital, physical distancing measures within the emergency department, and measures such as the planned expansion of the footprint of the emergency department through the addition of a new modular build, need to be advanced following this inspection. This finding is also of relevance in the context of possible future additional demands posed by the pandemic at the hospital over the coming winter months. 

The hospital had identified that more resources were required to support microbiology and infection prevention and control services. Occupational health services were not sufficiently resourced to meet the needs of the hospital during the ongoing COVID-19 pandemic.

Overall, patient equipment and the environment in the wards inspected were generally clean. A number of infrastructural and maintenance issues which had the potential to impact on infection prevention and control measures were identified during the course of the inspection. Hospital management was working to mitigate risks in respect of inpatient ward infrastructure through upgrading and ongoing refurbishment plans of two inpatient wards. 

Rehabilitation and community inpatient healthcare services

HIQA also carried out risk-based inspections in rehabilitation and community inpatient healthcare services during September 2020 at: 

• Carlow District Hospital
• The Rehabilitation Unit, St Ita’s Community Hospital, Co Limerick   
• Gorey District Hospital, Co Wexford and 
• St Theresa’s Hospital, Clogheen, Co Tipperary.

All hospitals had the required governance, management arrangements, systems and processes in place for the prevention and control of healthcare-associated infection.

Uptake of influenza vaccine among healthcare workers had significantly increased in all hospitals since 2019.

Antimicrobial stewardship activities were well developed in two hospitals, but needed to be advanced in St Theresa’s Hospital and Gorey District Hospital. Infrastructural risks which had the potential to impact on infection prevention and control were not on the risk register in Gorey District Hospital. 

The Rehabilitation Unit, St Ita’s Community Hospital had assurance processes in place for monitoring and auditing performance. However, inspectors identified scope to broaden the current auditing programme to include other aspects of infection prevention and control, such as standard and transmission-based precautions and antimicrobial stewardship in Gorey District Hospital. Oversight of cleaning schedules required improvement in St Theresa’s Hospital.

Staff were up to date with infection prevention and control training and had access to a suite of infection prevention and control policies, procedures and guidelines. However some of the infection prevention and control policies and guidelines required updating in the Rehabilitation Unit, St Ita’s Community Hospital.

The general environment and equipment in areas inspected in all hospitals were clean with some exceptions. Areas for improvement identified in Gorey District Hospital included the appropriate disposal of waste and usage of cleaning products. Improvements were identified as required in the management and storage of cleaning equipment and clean laundry in Carlow District Hospital.

Notes to Editor:

• The acute hospitals inspection programme monitors compliance against the National Standards for the prevention and control of healthcare-associated infections in acute healthcare services 2017. 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 two guides to its targeted monitoring programmes during the COVID-19 pandemic 2020 in acute hospitals and rehabilitation and community inpatient healthcare services which can be viewed at www.hiqa.ie 
• Carbapenemase-Producing Enterobacteriales (CPE) is the newest in a long line of 'superbugs' (bacteria that are hard to kill with antibiotics). Further details maybe found on the HSE website.