HIQA’s infection prevention and control inspections in hospitals during July and August 2019

Date of publication:

The Health Information and Quality Authority (HIQA) has today published three inspection reports on infection prevention and control practices in public acute hospitals.

Inspections were carried out between July and August 2019 in:

  • University Hospital Limerick
  • Cavan and Monaghan Hospital
  • Galway University Hospitals.

HIQA’s inspections evaluate how hospitals organise themselves to minimise the spread of healthcare-associated infections, and the approach taken to reduce the risk of reusable medical device-related infection in decontamination facilities. These two areas are internationally recognised as being major contributors to potentially preventable patient harm as a consequence of healthcare provision.

Leadership, governance and management arrangements for infection prevention and control were in place in all three hospitals. No high risks were identified on inspections.

All three hospitals were in compliance with the Health Service Executive’s (HSE’s)  April 2019 guideline on screening patients for Carbapenemase-Producing Enterobacteriales (CPE).

Concerted infection prevention and control interventions succeeded in promptly halting a recent CPE outbreak at Cavan and Monaghan Hospital. However, Galway University Hospitals and University Hospital Limerick were experiencing ongoing outbreaks of CPE. HIQA found that these hospitals faced recurring challenges to effectively prevent and control CPE, for example the design of and aging hospital infrastructure, general ward maintenance, a lack of isolation facilities and high occupancy rates.

Galway University Hospital had a comprehensive antimicrobial stewardship programme and ongoing surveillance in place. While University Hospital Limerick and Cavan and Monaghan Hospital had some antimicrobial stewardship interventions in place, there was scope to further enhance and develop current antimicrobial stewardship programmes.

It was apparent that progress had been made in addressing the findings from previous HIQA inspections in all three hospitals. However, infrastructural and maintenance deficits identified by HIQA on previous inspections had not been fully addressed. All hospitals required increased oversight of patient equipment hygiene and staff compliance with hand hygiene.

HIQA found that all hospitals inspected were endeavouring to implement the HSE’s national standards and recommended practices in relation to decontamination of reusable medical devices in decontamination facilities inspected. However, further investment was required to address deficiencies relating to the design of decontamination facilities, progression of centralisation of decontamination activity and facilitate changeover to validated and automated equipment for decontamination.

All hospitals inspected had systems in place to identify and manage risks in relation to infection prevention and decontamination.

Defined management and responsibility arrangements were in place in relation to reusable medical device decontamination; however, there was no designated decontamination lead or coordinator in University Hospital Limerick or Cavan and Monaghan Hospital. To concur with HSE national recommendations and national standards, each hospital and or hospital group must identify a decontamination lead and or decontamination coordinator.

While academic training and education for staff working in centralised decontamination units was progressing in all hospitals, opportunities for improvement were identified during these inspections. These included a requirement to continue with academic education, training programmes and regular review of staff competencies for all staff involved in providing decontamination services. Some hospitals need to embed a culture of regular review, continual audit, feedback and quality improvement cycles in relation to decontamination service provision including ‘out-of-hour’ decontamination service provision.

Hospitals need to be assured that cleaning specifications and hygiene auditing regimes are in line with national recommendations for higher-risk functional areas such as decontamination facilities.

Notes to Editors

  • HIQA’s approach to monitoring against the National Standards for the prevention and control of healthcare-associated infections in acute healthcare services was revised in 2017.
  • HIQA focused in the first instance on decontamination facilities outside of designated controlled decontamination units to ensure that structures, systems, processes and outcomes were aligned to national guidelines.
  • A National Public Health Emergency Plan was declared on 25 October 2017 by the Minister for Health in response to the increase and spread of Carbapenemase-Producing Enterobacteriales (CPE) in Ireland. As a result a National Public Health Emergency Team was convened. Further details as to the work of this team may be viewed here.
  • Carbapenemase-Producing Enterobacteriales (CPE) is the newest in a long line of 'superbugs' (bacteria that are hard to kill with antibiotics). Of all the superbugs, CPE is among the most difficult to kill with antibiotics. It is carried in the bowel and can cause blood stream infection in people who are vulnerable, such as the elderly and those with low immunity. More than half of all patients who develop blood stream infections with CPE die as a result of their infection. Further details may be found on the HSE website.
  • The HSE has developed detailed national screening guidelines that are available to view the HSE website.