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 November and December 2017 at Cork University Maternity Hospital, Connolly Hospital, Blanchardstown, Dublin and the Rotunda Hospital, Dublin.

Cork University Maternity Hospital, Cork

An unannounced inspection of Cork University Maternity Hospital took place on 30 November 2017. HIQA found that the hospital did not have formalised governance arrangements for the prevention and control of healthcare-associated infection. Inspectors were informed that the Clinical Director for Maternity Services in the South/South West Hospital Group had recently been delegated direct management responsibility for Cork University Maternity Hospital and therefore had overall responsibility for the prevention and control of healthcare-associated infection at the hospital. However, during this governance transition there was a joint infection prevention and control committee between Cork University Hospital and Cork University Maternity Hospital.

HIQA found that there were systems in place to identify and manage risk in relation to the prevention and control of healthcare-associated infection. Local monitoring arrangements should be expanded to provide effective oversight to the Executive Management Team in relation to the prevention and control of healthcare-associated infection at Cork University Maternity Hospital.

The hospital had a suite of up-to-date infection prevention and control guidelines and regular education sessions were offered to staff in relation to hand hygiene and infection prevention and control.

The hospital had systems in place to identify and manage patients with transmissible infection and had appropriate facilities in which to isolate patients if required. There was good local ownership in relation to standards of hygiene and maintenance. The hospital was built ten years ago and the infrastructure, layout, finishes, space and light in the clinical areas inspected readily facilitated cleaning. Overall, the environment in the areas inspected was visibly clean and well maintained and patient equipment was visibly clean with few exceptions.

Connolly Hospital, Blanchardstown, Dublin

An unannounced inspection at Connolly Hospital, Blanchardstown, Dublin was carried out on 14 December 2017. On the day of inspection, HIQA found that there were established governance and management arrangements around the prevention and control of healthcare-associated infection at the hospital. Hospital management and the Infection Prevention and Control Team had developed and implemented a detailed monitoring and evaluation system which provided good oversight of the effectiveness of the infection prevention and control programme at the hospital.

The hospital had systems in place to identify risks in relation to the prevention and control of healthcare-associated infections. A number of outbreaks of infection had occurred at the hospital in both 2016 and 2017. Potential contributory factors such as insufficient isolation facilities and insufficient bed capacity need to be reviewed and addressed going forward. Hospital staff were supported to implement best practice through the availability of a comprehensive up-to-date suite of infection prevention and control policies, procedures and guidelines.

Overall the patient environment was generally clean in the areas inspected. However, it is recommended that storage and management of patient equipment is reviewed and cleaning specifications are revised to ensure that they are aligned to national minimum cleaning frequencies for higher risk areas.

The completion of a legionella risk assessment needs to be prioritised at the hospital to ensure that potential risks associated with water-borne infections are effectively monitored and managed in line with current Irish national guidelines.

Rotunda Hospital

An unannounced inspection of the Rotunda Hospital, Dublin took place on 07 December 2017. HIQA found that effective leadership, governance and management arrangements were evident around the prevention and control of healthcare-associated infection at the hospital. The hospital management team were 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.

The hospital had systems in place to identify and manage risk relating to infection prevention and control however, the limited physical infrastructure and related planning and development restrictions remain a challenge for hospital management. These challenges had been identified in previous HIQA inspections.

Overall the patient environment inspected was generally clean with few exceptions and there was good ownership in relation to cleaning in the areas inspected. However, opportunities for improvement were identified in relation to the management and storage of equipment in both areas inspected.

An inherent risk in relation to the increasing number of outbreaks in the Neonatal Unit was of concern to HIQA. A number of factors which likely contributed to these outbreaks of infection were identified on the day of inspection. The hospital was endeavouring to address these contributing factors by implementing interim refurbishment measures and ongoing recruitment of staff.

Inspectors found that the hospital had a suite of up-to-date infection prevention and control policies to support staff to implement best practice in relation to infection prevention and control. The hospital had consistently achieved the required HSE hand hygiene compliance target which is commendable. Care bundles had been implemented and the hospital had an active audit and feedback programme in place and should continue to drive full implementation of all essential care bundle components.

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.