PATIENTS in the overcrowded emergency department of a major hospital are being put at risk of a range of infectious diseases including TB, MRSA and flu on a daily basis.
The stark admission is made in an unpublished letter by Liam Duffy, chief executive of Beaumont Hospital in Dublin. The hospital was recently castigated in a report by inspectors for poor standards of hygiene.
Mr Duffy outlined the potential dangers to patients in a letter to the Health Information and Quality Authority (HIQA) months before it sent in its inspectors and produced the damning findings.
He said the emergency department was struggling to cope with a huge volume of patients, that space was limited and that toilet facilities were inadequate.
"There are no isolation rooms with en suite facilities and there are no appropriately ventilated rooms for accommodating patients with suspected infectious tuberculosis," he wrote.
It was leaving patients at risk of exposure to infectious disease such as flu, C Difficile, norovirus, TB, and multi-drug resistant bugs, the letter obtained under freedom of information rules revealed.
Patients were also at risk of blood-borne viruses in the kidney dialysis section because of a shortage of space and other restrictions.
There is also a lack of proper ventilation and single-room facilities for highly at-risk patients who are undergoing kidney and pancreas transplants.
The hospital had already warned about the implication of the outdated hospital building for "our increasingly vulnerable patient population".
He also expressed serious concern about the overcrowded and inadequate bed space in the intensive care unit where patients who undergo neurosurgery are placed. They were built 25 years ago and were not "fit for purpose".
When inspectors made an unannounced visit, they found most doctors failed to wash their hands or change aprons between patients.
A string of failures was identified in the hospital's neurosurgical intensive care unit, such as poor hand hygiene among medical staff.
In the emergency department, trolleys and shelving with equipment were found to be dusty, while a bin in a men's toilet was "encrusted with dust and grime".
Following publication of the report last month, Mr Duffy again wrote to HIQA to say it was withholding car parking rights from junior doctors who did not attend hand washing training.
The hospital was considering extending this penalty to other staff, he said.
In a statement, the hospital said the HSE had recently approved funding for a purpose-built transplant unit that would meet current standards for prevention and infection control.
"The hospital is awaiting similar investment in intensive care and coronary care facilities for a number of years," it added.
Meanwhile, the documents also reveal that HIQA also had to seek a report from Our Lady's Hospital for Sick Children in Crumlin, Dublin, after it emerged that children were treated with a contaminated colonoscope.
In reply, the hospital's chief executive Lorcan Birthistle said the instrument had been withdrawn and the washer used to decontaminate it suspended from service to allow for an engineering assessment.