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 October 2017 at Louth County Hospital, Dundalk and St Michael’s Hospital, Dun Laoghaire, Dublin.

Louth County Hospital, Dundalk
An unannounced inspection of Louth County Hospital, Dundalk was carried out on 6 October 2017. On the day of inspection, HIQA found that the hospital had effective leadership, governance and management arrangements in place around the prevention and control of healthcare-associated infection.

Risks identified in relation to prevention and control of healthcare-associated infections were monitored, recorded, evaluated and escalated through hospital governance structures as appropriate. Hospital management was working to mitigate risks in respect of hospital infrastructure through gradual upgrading and ongoing refurbishment plans of existing facilities. Notwithstanding this, factors in relation to broader hospital infrastructure and a lack of available isolation rooms which can contribute to the onset of outbreaks of infection remains a challenge for the hospital.

Overall, the environment in the clinical area inspected was generally clean with few exceptions. There was good ownership in relation to hospital hygiene and evidence of clear responsibilities within the clinical area inspected. The hospital has exceeded the national performance indicator in relation to hand hygiene compliance which is commendable. 
The hospital had implemented evidence-based care bundles for peripheral vascular devices and urinary catheters and performed audit of care bundle implementation. Notwithstanding the progress made to date, the hospital needs to continue to fully implement urinary catheter care bundles in line with national guidelines. 

HIQA recommended that Louth County Hospital continues to progress with the implementation of the national guidelines for screening patients for Carbapenemase Producing Enterobacteriaceae.

St Michael’s Hospital, Dun Laoghaire, Dublin
An announced inspection of St Michael’s Hospital took place on 13 October 2017. On the day of inspection HIQA found that the hospital was endeavouring to fully implement the National Standards for the prevention and control of healthcare-associated infections in acute healthcare services. 

Governance and reporting arrangements for the prevention and control of healthcare-associated infections were in place in the hospital. The hospital had systems in place to identify and manage risk and escalate serious risks to the St. Vincent’s Healthcare Group and Ireland East Hospital Group level. 

Inspectors were informed that peripheral vascular catheter care bundles and urinary catheter care bundles had been implemented throughout the hospital in line with national guidelines. The hospital needs to continue its progress towards full compliance with all essential care bundle components as full compliance has shown improved patient outcomes. 

Factors that increase the risk of transmission of infection such as poor hospital infrastructure, lack of isolation rooms with en-suite facilities, inadequate bed spacing in multi-occupancy rooms and the infrastructure and design of the High Dependency Unit and Coronary Care Unit need to be addressed in the hospital site development plan going forward. 

Overall the patient environment was generally clean in the areas inspected. However, it is recommended that patient equipment cleaning specifications and resources are revised and aligned to national minimum cleaning frequencies. 

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.