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 and November 2017 at The Mater Misericordiae University Hospital, Dublin and Wexford General Hospital.

Mater Misericordiae University Hospital

An unannounced inspection of the Mater Misericordiae University Hospital was carried out on 27 October 2017. On the day of inspection, HIQA found that that there were clear governance and management arrangements for the prevention and control of healthcare-associated infection at the hospital. There was also ongoing monitoring of healthcare-associated infection which is good practice.

There were systems in place to identify and manage patients with transmissible infection and improvements in hospital isolation facilities meant that most patients who required isolation could be isolated in single rooms as recommended. Hospital management was working to address ongoing overcrowding issues in the emergency department and also hoped to increase inpatient bed capacity. 

Peripheral vascular catheter care bundles had been implemented in most clinical areas. The hospital needs to progress implementing care bundles in relation to urinary and central vascular catheters.

Surveillance of surgical site infection was performed in the cardiac and spinal surgery services. This is good practice and should be used to identify and address any opportunities for improvement.

Opportunities for improvement were identified in relation to the hygiene and storage of patient equipment in the surgical ward. Deficiencies in the infrastructure, maintenance and design of the Renal Dialysis Unit, which was located in the oldest part of the hospital, needs to be addressed in the hospital site development plan going forward.

Hospital staff achieved 94% hand hygiene compliance in the national hand hygiene audit in May 2017, which exceeded the HSE’s desirable target of 90% hand hygiene compliance.

Wexford General Hospital

An unannounced inspection of Wexford General Hospital took place on 9 November 2017. Overall HIQA found that the hospital was committed to improving infection prevention and control practices in the hospital.

Although the hospital had systems in place to identify and manage risk in relation to the prevention and control of healthcare-associated infections, on this inspection HIQA identified a risk in relation to the lack of onsite consultant microbiologist presence at the hospital for the two months previous to the inspection. The hospital had also identified this risk and had escalated it through governance structures to the Ireland East Hospital Group. HIQA wrote to the hospital about this issue and in response, the hospital outlined key actions taken to address the risk identified.

The Infection Prevention and Control Team had put in place many elements of an infection prevention and control programme, however, the hospital should implement workforce contingency planning for the specialist staff in infection prevention and control so that the service continues seamlessly at all times.

HIQA recommended that Wexford General Hospital continues to work with the Ireland East Hospital Group to progress with the full implementation of the national guidelines for screening patients for Carbapenemase producing Enterobacteriaceae.

Overall the patient environment and equipment 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 which is commendable. The hospital had improved upon hygiene service delivery and this was evident on the day of inspection.

The hospital needs to continue to build awareness and best practices relating to hand hygiene compliance to ensure it reaches and sustains the national target of 90%.

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.