Some hospitals in Ireland are struggling to effectively prevent and control the spread of healthcare-associated infections, due to issues such as a lack of isolation facilities, high occupancy rates and ageing hospital infrastructure, the Health Information and Quality Authority (HIQA) has said.

It has just published inspection reports on infection prevention and control practices in place in five public acute hospitals - Beaumont Hospital, the Mater Hospital, Wexford General Hospital, University Hospital Waterford and Louth County Hospital.

The unannounced inspections took place between January and March of this year. They focused on the prevention and control of antimicrobial-resistant bacteria and healthcare-associated infections, including carbapenemase-producing enterobacteriales (CPE), which is the newest of the so-called ‘superbugs'.

CPE are bacteria that live in the gut. They are usually harmless. However, if they get into the wrong place, such as the bloodstream or the bladder, they can cause infection. Symptoms of CPE infections include fever, pneumonia, urinary tract infection and sepsis.

Of all the superbugs, CPE is the most difficult to kill with antibiotics, making treatment more difficult. It is particularly dangerous for older people and those with low immunity.

However, according to the reports, of the five hospitals inspected, only Louth County Hospital was in compliance with the HSE's February 2018 guidelines on screening patients for CPE.

In the case of Beaumont Hospital - one of the busiest acute hospitals in the country - not only was there non-compliance with these screening guidelines, but the hospital continued to admit patients to a CPE outbreak ward, which had been closed to admissions. This was contrary to advice from the infection prevention and control team.

The report noted that Beaumont had been managing an ongoing outbreak of CPE since August 2018.

"While the hospital had acted to implement outbreak control measures, evidence at the time of the inspection did not provide assurance that the measures implemented were sufficiently effective or in line with national guidelines," the report stated.

Meanwhile in the Mater Hospital, it was reported to the inspectors that the infection prevention and control programme there "had been severely restricted due to staffing constraints within key roles over the previous 10-month period".

"The hospital's direct and indirect infection prevention and control committees had been inactive for the previous 12 months. Infection prevention and control team meetings were also infrequently held during this period. This was a particular concern in the context of two outbreaks of CPE in critical care areas in 2018.

"Inspectors were informed that the additional workload generated by CPE outbreak management had been absorbed by the existing infection prevention team members. It was reported that this had severely restricted the implementation of the wider infection prevention and control programme throughout 2018. The hospital acknowledged that this had led to deficits in the prevention and control of other healthcare-associated infections in the hospital," the report stated.

In Wexford General, the inspectors found that the hospital was "not screening in line with national guidance".

"The hospital was not routinely screening all patients who were transferred from nursing homes. HIQA considered the hospital's non-compliance with these guidelines to be a high risk," the report said.

The same issue was identified in University Hospital Waterford.

HIQA noted that each hospital had provided assurances that this risk would be managed, and training and education for staff working in decontamination "was progressing across all hospitals inspected".

"Overall, HIQA found recurring challenges faced by hospitals to effectively prevent and control the CPE outbreak, such as design of and ageing hospital infrastructure, a lack of isolation facilities and high occupancy rates.

"To concur with HSE national recommendations, each hospital group must identify a group decontamination lead and each hospital should progress the centralisation of decontamination activity. Microbiological testing of environment and equipment also needs to be implemented," it added.

The inspection reports can be viewed here.