The Health Information and Quality Authority (HIQA) has today published five inspection reports on infection prevention and control practices in public acute hospitals.

Inspections were carried out between April and June 2019 in:

• Croom Hospital, Limerick
• Nenagh Hospital, Tipperary
• Tallaght University Hospital, Dublin
• Our Lady of Lourdes Hospital, Drogheda
• and Sligo University Hospital.

HIQA’s inspections evaluate how hospitals organise themselves to minimise the spread of healthcare-associated infections, and the approach taken to reduce the risk of reusable medical device-related infection in decontamination facilities. These two areas are internationally recognised as being major contributors to potentially preventable patient harm as a consequence of healthcare provision.

Leadership, governance and management arrangements for infection prevention and control were in place in all five hospitals.

Inspectors found that all five hospitals were in compliance with the Health Service Executive’s (HSE’s) February 2018 guideline on screening patients for Carbapenemase-Producing Enterobacteriales (CPE).

HIQA found that hospitals faced recurring challenges to effectively prevent and control the CPE, for example the design of and aging hospital infrastructure, general ward maintenance, a lack of isolation facilities and high occupancy rates. Infrastructural and maintenance deficits were identified by HIQA on previous inspections and had not been fully addressed. Three hospitals (Croom Hospital, Nenagh Hospital, and Sligo University Hospital) require increased oversight of environmental and patient equipment hygiene.

HIQA found that all hospitals inspected were endeavouring to implement the HSE’s national standards and recommended practices in relation to decontamination of reusable medical devices in decontamination facilities inspected. However, further investment was required to address deficiencies relating to the design of decontamination facilities, progression of centralisation of decontamination activity and facilitate changeover to validated and automated equipment for decontamination.

All hospitals inspected had systems in place to identify and manage risks and incidents in relation to decontamination. No high risk was identified in relation to decontamination of reusable medical devices in the decontamination facilities inspected.

Defined management and responsibility arrangements were in place in relation to reusable medical device decontamination; however, there was no designated decontamination lead or coordinator in Croom Hospital and Nenagh Hospital. To meet with HSE national recommendations and national standards, each hospital and or hospital group must identify a decontamination lead.

While academic training and education for staff working in centralised decontamination units was progressing with good initiatives evident in some hospitals, opportunities for improvement were identified during these inspections. These included a requirement to continue with academic education, training programmes and regular review of staff competencies for all staff involved in providing decontamination services. Some hospitals need to embed a culture of regular review, continual audit, feedback and quality improvement cycles in relation to decontamination service provision. All hospitals need to be assured that cleaning specifications and hygiene auditing regimes are in line with national recommendations for higher-risk functional areas.

Notes to Editors

• HIQA’s approach to monitoring against the National Standards for the prevention and control of healthcare-associated infections in acute healthcare services was revised in 2017.
• HIQA focused in the first instance on decontamination facilities outside of designated controlled decontamination units to ensure that structures, systems, processes and outcomes were aligned to national guidelines.
• A National Public Health Emergency Plan was declared on 25 October 2017 by the Minister for Health in response to the increase and spread of Carbapenemase-Producing Enterobacteriales (CPE) in Ireland. As a result a National Public Health Emergency Team was convened. Further details as to the work of this team may be viewed here.
• Carbapenemase-Producing Enterobacteriales (CPE) is the newest in a long line of 'superbugs' (bacteria that are hard to kill with antibiotics). Of all the superbugs, CPE is among the most difficult to kill with antibiotics. It is carried in the bowel and can cause blood stream infection in people who are vulnerable, such as the elderly and those with low immunity. More than half of all patients who develop blood stream infections with CPE die as a result of their infection. Further details may be found on the HSE website.
• The HSE has developed detailed national screening guidelines that are available to view the HSE website.