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 July and August 2017 at University Hospital Sligo and Our Lady’s Hospital, Navan, Co Meath respectively. 

University Hospital Sligo

An unannounced inspection of Sligo University Hospital was carried out on 20 July 2017. On the day of inspection, HIQA found that the hospital had formalised governance arrangements with clear lines of accountability and responsibility for the prevention and control of healthcare-associated infections. These arrangements included a formalised link with the Saolta University Health Care Group infection prevention and control hospital group committee. 

The Infection Prevention and Control Team had put in place many elements of an infection prevention and control programme. With additional resources, surveillance in the hospital could be further expanded to facilitate wider evaluation of the impact of infection prevention and control measures across the hospital.

The hospital had systems in place to identify and manage risk in relation to the prevention and control of healthcare-associated infection. Inspectors were informed that major risks on the hospital’s corporate risk register included lack of isolation facilities and hospital beds and poor hospital infrastructure. Infrastructural deficiencies and requirement for additional hospital beds and isolation facilities had been escalated by the hospital through the Health Service Executive (HSE) hospital group structure. 

Hospital hygiene plays an important role in the prevention and control of healthcare-associated infection. During this inspection deficiencies were identified in relation to environmental and patient equipment cleaning. The hospital should conduct a comprehensive review of all aspects of hygiene service delivery including resources, cleaning practices and related assurance arrangements to ensure compliance with National Standards and recommended guidelines. Hospital management confirmed that a cleaning training programme had been arranged which is a positive development. 

The hospital achieved 90% compliance rate in the national hand hygiene audit in October and November 2016. Inspectors were informed that the hospital also achieved 90% compliance with hand hygiene practice in May 2017 reaching the required HSE national hand hygiene compliance target of 90% which is commendable.

Our Lady’s Hospital, Navan, Co Meath

An unannounced inspection of Our Lady’s Hospital, Navan, Co Meath took place on 11 August 2017. During this inspection, HIQA found that governance and management arrangements in respect of clinical microbiology services were aligned to the previous Louth/Meath Hospital Group structure rather than current Ireland East Hospital Group structure. This needs to be addressed in light of the need to formally allocate provision of infection prevention and control advice by a consultant microbiologist at the hospital and to review resources required in respect of surveillance scientist input. 

There were good monitoring and evaluation arrangements in place in relation to the prevention and control of healthcare-associated infection at the hospital with regular reporting to hospital management and Ireland East Hospital Group. 

The hospital had an up-to-date infection prevention and control manual for staff, but local policies for invasive device management were either due for review or absent. 

Inspectors found that the content of the infection prevention and control training programme included education in relation to hand hygiene and standard precautions. This needs to be expanded to include transmission-based precautions and aseptic technique for clinical staff involved in direct patient care.

Opportunities for improvement were identified in relation to some aspects of patient equipment cleaning which requires dedicated resources and oversight. A lack of isolation facilities, ‘Nightingale’ style multi-occupancy wards and the older hospital infrastructure did not readily facilitate the implementation of the National Standards. This needs to be addressed in the site development plan going forward. 

The hospital achieved 90% hand hygiene compliance among staff in May and June 2017, which was in line with the HSE’s desirable target of 90% hand hygiene compliance. 

Read the full reports here. 

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.