Three 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 July and August 2017 at Cork University Hospital, Nenagh Hospital, Co. Tipperary and Beaumont Hospital in Dublin.

Cork University Hospital

An unannounced inspection of Cork University Hospital was carried out on 27 July 2017. On the day of inspection, HIQA found that Cork University Hospital did not have effective governance arrangements for the prevention and control of healthcare associated infection. A number of gaps were identified in the provision of the infection prevention and control service which were of concern given the size of the hospital and the complexity of services provided. Specifically, deficiencies were identified by hospital management in respect of consultant microbiologist resources and by the Infection Prevention and Control Team in respect of infection control nurse staffing levels. These risks were escalated through the South/South West Hospital Group governance structures.

Reporting and monitoring arrangements at executive management level described in this report did not provide assurance of clear, effective oversight of the prevention and control of healthcare-associated infection which is required in a large tertiary referral hospital.

Notwithstanding the identified areas for improvement found during this inspection, inspectors found that the hospital achieved 90% hand hygiene compliance in the National hand hygiene audit May 2017 which was in line with the HSE’s desirable target of 90% hand hygiene compliance among staff.

Overall, environmental surfaces and patient equipment in the two clinical areas inspected were visibly clean with few exceptions.

Improvement in the delivery of an effective infection prevention and control programme at the hospital will require improved leadership, governance and management both at senior management level, and within the infection prevention and control team.

Nenagh Hospital, Co. Tipperary

An unannounced inspection of Nenagh Hospital, Co Tipperary took place on 17 August 2017. HIQA found that the hospital had clearly identified governance and reporting structures for the prevention and control of healthcare-associated infections. There was a process in place whereby identified risks could be escalated to hospital group management level.

This inspection highlighted that infection prevention and control services at the hospital were significantly under resourced. This service was provided across the hospital group by an infection prevention and control team based in University Hospital Limerick. A lack of resources within this team and competing demands in University Hospital Limerick meant that there was very limited onsite presence of qualified, experienced infection prevention and control staff and consultant microbiologists at Nenagh Hospital.

Overall the environment in the two clinical areas inspected was generally clean with few exceptions. Hospital hygiene resources and supervision arrangements need to be sufficiently resourced at the hospital. This was identified during a previous HIQA inspection and had not been comprehensively addressed.

It is recommended that the hospital review safe injection practice and the procedures around the administration of medication for injection and the preparation of monoclonal antibodies. The hospital needs to assure itself that the potential risks to patients and staff in this regard are fully understood, managed and mitigated.

The hospital had implemented evidence based care bundles for intravascular devices and urinary catheters and performed audit of care bundle implementation.

Beaumont Hospital, Dublin

An unannounced inspection of Beaumont Hospital, Dublin was carried out on 24 August 2017. On the day of inspection, HIQA found that the hospital had effective leadership, governance and management arrangements in place for the prevention and control of healthcare-associated infection. The hospital was providing positive leadership in this regard and this provides good example for other service providers.

The hospital management team was clearly focused on monitoring structures, processes and outcomes and implementing evidence-based practice to inform any improvements in relation to the prevention and control of healthcare-associated infection at the hospital.

The hospital had implemented a number of quality improvement initiatives to address findings in relation to outcome-based information which represented a commitment to promoting safer patient care. The hospital had implemented evidence-based care bundles and had an active audit and feedback programme in place and should continue to drive full implementation of all essential care bundle components.

Overall, patient equipment and the patient environment was generally clean in the areas inspected. There was good ownership in relation to hospital hygiene and evidence of clear processes and responsibilities from clinical areas through to executive management level.

Notwithstanding new building developments at the hospital, factors in relation to the broader hospital infrastructure, insufficient bed capacity and lack of available isolation rooms which contribute to the onset of outbreaks of infection and hinder their management need to be substantively reviewed and addressed.

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.