Independent Clare TD, Michael Harty raised the issue of acquired infections at University Hospital Limerick in Dáil Éireann this week.
He is looking for an external investigation to properly tackle the issue which he believes could be responsible for up to twenty nine deaths at the hospital and is associated with an increasing number of new cases.
A HIQA review in 2014 found risks to patient safety when looking at the governance structure of UHL. The review highlighted the risks overcrowding had for increasing health-care associated infections such as multidrug resistant infections. If contracted by frail elderly patients in overcrowded units these infections pose fatal dangers.
Speaking in the Dáil, Harty outlined the challenges infections will have on hospitals. “Multidrug resistant infections pose a problem in all acute hospitals and their origin is multifactorial. Antibiotic resistant infections arise from overuse and misuse of antibiotics both in hospital and in the community, resulting in increased numbers of new multiresistant bacteria. This poses huge challenges for hospitals where these infections predominate and require intense efforts to control and eradicate. However, University Hospital Limerick seems to have a much higher incidence of infections than other hospitals.
“In July 2014, the infection prevention and control team at University Hospital Limerick wrote to the executive management team to highlight its serious ongoing concerns regarding the management of patients with multidrug resistant micro-organisms. They highlighted the difficulties with identification of patients who are infected, lack of single rooms to isolate infected patients, serious environmental hygiene concerns with current cleaning standards and lack of basic education of cleaning staff in their role in controlling the spread of infection.
“The cleaning of patient equipment was sub-optimal and poor environmental cleaning, hand hygiene and antibiotic prescribing contributed to clusters of infection in the hospital. Finally, it was stated there should be a dedicated infection prevention and control clinical nurse specialist for the management of infected patients” he added.
“Between 2009 and 2014, there are were in excess of 50 cases of CPE-produced enterobacteria. As a result, in 2014, a member of the infection control team at University Hospital Limerick became so concerned about the escalation of multidrug resistant infections in the hospital that she made a protected disclosure to HIQA” the Independent TD stated.
Michael put pressure on Minister of State for Health Promotion, Marcella Corcoran Kennedy to carry out an external review. “HIQA, carried out an unannounced inspection in November 2014 whose findings were summarised as especially poor standards of environmental hygiene; ward maintenance not carried out in a timely fashion; long-standing extra beds in wards; and inappropriate bed spacing which led to increased risk of spread of infection between patients. This has a knock-on effect on planned admissions and elective procedures. Given the incidence of multidrug-resistant infection in Limerick University Hospital, an external investigation needs to be urgently carried out to identify the cause of this cluster of infection”.
An internal report dated July 2016 highlighted the extent of the problem. In 2009, there was one case; in 2010, two; in 2011, 11; in 2012, nine; in 2013, three, yet in 2014 there were 33 and in 2015, 53, and in the first two quarters of this year 19 new cases were identified.
In her response Deputy Corcoran Kennedy thanked Harty for discussing the matter. “I am advised that Irish hospitals, like other hospitals internationally, are taking steps to reduce health care associated infections and antimicrobial resistance including the prudent use of antibiotics. I am aware of the challenges in tackling multidrug-resistant superbug infection rates in all hospitals including at University Hospital Limerick. The hospital has confirmed that it has a focused quality improvement plan in place to tackle the issues of control of HCAIs and AMR. This is in line with recommendations of the HIQA unannounced inspection reports at the hospital on 28 November 2014 and 13 January 2015”.
The Offaly TD stated that she will raise Harty’s suggestion for an independent review with the HSE and Health Minister Simon Harris.