Two inspection reports on infection prevention and control practices in public acute hospitals have been published today by the Health Information and Quality Authority (HIQA). HIQA monitors infection prevention and control in hospitals against the National Standards for the prevention and control of healthcare-associated infections in acute healthcare services. Inspections were carried out in June 2017 at University Hospital Kerry and at South Tipperary General Hospital.

At University Hospital Kerry, HIQA found a number of risks related to Infection Prevention and Control which needed to be addressed by the hospital following the inspection. The nature of these risks, combined with a lack of clarity regarding ongoing leadership arrangements, prompted HIQA to write to the CEO of the South/Southwest Hospital Group to seek assurance that identified risk would be addressed.

At South Tipperary University Hospital considerable progress had been made since the previous inspection however, further actions needed to be addressed to fully comply with the National Standards.

University Hospital Kerry

An unannounced inspection was carried out at University Hospital Kerry on 15 June 2017. This inspection identified a composite of risks. Specifically, risks were identified in relation to:

• a lack of testing of the hospital’s water supply and storage system to check for legionella bacteria
• non-compliance with national screening guidelines in relation to multi-drug resistant organisms
• unsafe storage and preparation of medication for injection
• lack of decontamination equipment to thermally disinfect reusable items such as bedpan holders, urinals and measuring jugs in clinical areas.

In addition, risks which were identified by HIQA in November 2015 had not been addressed by the time of this 2017 inspection. These risks included:

• lack of routine consultant microbiologist oversight of microbiology laboratory result reports
• lack of an up-to-date understanding of local patterns of antimicrobial resistance required to guide antimicrobial prescribing practices
• a microbiology laboratory that could not be considered for national accreditation because of deficiencies in governance and resourcing.

Moreover, HIQA also identified during the course of the inspection that there was a lack of clarity in relation to ongoing leadership and management arrangements at the hospital.

In light of this collection of findings, HIQA twice wrote to the CEO of the South/Southwest Hospital Group to raise concerns, and seek assurance that the issues raised would be addressed following this inspection. In response, the hospital group CEO wrote back to HIQA outlining measures that had been enacted, or were in train to address each identified area of risk. In light of persistent findings at the hospital related to non-compliance with National Standards and guidelines related to Legionella control, HIQA also highlighted the findings from this inspection related to this issue, to the Health and Safety Authority (HSA) given the possible relevance of these findings to the HSA under the Health and Safety at Work Act.

South Tipperary General Hospital

An unannounced inspection was carried out at South Tipperary General Hospital on 29 June 2017. This inspection identified a number of improvements in relation to infection prevention and control practice relative to prior inspections, and the areas inspected were generally clean. The hospital had worked to strengthen local governance and management arrangements, and improved support from hospital group level was evident. Moreover the hospital had worked to implement infection prevention care bundles, in line with best practice.

While progress has been made, the hospital still has much work to do to further enhance its infection prevention and control programme. In particular, Consultant Microbiologist contracted hours remain extremely limited. In addition, the overarching infrastructure at the hospital is dated and does not facilitate compliance with desirable standards. Moreover difficulties related to capacity at the hospital, and a relative lack of isolation facilities, likewise hinder infection prevention and control best practice. This issue is understood by management, and interim measures to address this problem through the introduction of a new 11-bay unit may provide some short-term improvement. However, longer term measures to address these deficits will be needed to comprehensively address risk in this regard.

Notes for Editors

• HIQA’s infection prevention and control monitoring programme aims to examine and positively influence the adoption and implementation of evidence-based practice in public acute hospitals regarding infection prevention and control.
• HIQA’s approach to monitoring public acute hospitals against the National Standards has been revised in 2017 in consideration of infection risk factors for patients, previous HIQA inspections and review findings, and increasing antimicrobial resistance in Ireland. The revised monitoring programme seeks to determine if service providers have essential elements in place in order to prevent and control healthcare-associated infections.
• HIQA’s Guide to the Health Information and Quality Authority’s Infection Prevention and Control Monitoring Programme in Public Acute Hospitals outlines the requirements for service providers in this programme.
• Legionella are a type of bacteria which may be found in water. Exposure to this bacteria in aerosol form may cause respiratory infection, especially in vulnerable patients with weak immune systems. Infection may take the form of a mild flu like illness (know as Pontiac Fever), or in some cases potentially life threatening pneumonia (known as Legionnaire’s Disease). The chance of the emergence of legionella in water systems is increased if water remains stagnant in the system, if the system is not correctly maintained, or if temperature controls are not kept within certain limits. Hospitals are expected to follow national guidelines to manage their water systems, with the aim of reducing this risk.