Saturday 23 February 2019

Shortfall in 'superbug' screening regime at Mallow General Hospital

HIQA inspectors also find infrastructure problems at hospital still not addressed

Bill Browne

An inspection by the Health Information and Quality Authority (HIQA) has found that Mallow General Hospital (MGH) was not in compliance with national guidelines on screening for the virulent CPE superbug.

The shortfall was discovered following an unannounced inspection undertaken by HIQA at the hospital in July, during which the inspection team focussed specifically on the "prevention and control of transmission of antimicrobial-resistant bacteria and healthcare associated infections." 

The inspectors found that MGH was not fully compliant with the screening guidelines in relation to Carbapenemase-producing Enterobacteriaceae (CPE), a highly antibiotic resistant bacteria that can be potentially fatal if it enters the bloodstream or gets into urine. It poses a particular risk to older people and those with reduced immune system function and has been linked to the deaths of eight patients at University Hospital Limerick.

CPE is a growing threat within Irish hospitals, with more than 400 cases reported last year, prompting the launch of a national public health emergency plan.  The HIQA report on MGH read that "specifically, the hospital was not routinely screening all patients who were transferred from nursing homes" and that screening for CPE was "considered an essential infection and control strategy". 

"Considering this in the context of the activation of the National Public Health Emergency Plan to address CPE in our health system, HIQA sought assurance regarding arrangements in place to ensure compliance with the national guidelines on screening for CPE at Mallow General Hospital," read the report. 

In response, hospital management wrote to HIQA saying that they accepted the inspection team's findings around CPE screening and had "updated the hospital risk register to reflect this".  In a letter to HIQA, Mr Brendan O'Reilly, operations manager for the Cork University Hospital (CUH) Group, wrote that in order to address the risk they were undertaking a number of actions. These included requesting additional resources to facilitate CPE screening with Cork University Hospital, which provides microbiological services to MGH; outsourcing CPE screening to other hospitals within the region and exploring the option of in-sourcing on-site molecular testing for CPE screening.

"Mallow General Hospital is fully committed to full compliance with the national screening guidelines for CPE and will endeavour to achieve full compliance within the very near future," wrote Mr O'Reilly.

The HIQA report also found the hospital continued to have "ongoing challenges" in relation to the upkeep and maintenance of the building. The inspection team found that, similar to the findings of inspections undertaken in 2014, 2015 and 2016, the hospital infrastructure was "outdated and not in line with recommended specifications and standards of a modern care facility".

Examples cited included poor bed-spacing in multi-bedded wards, that the hospital did not have an isolation room for the management of airborne infections, a lack of storage space causing clutter, not enough toilet and shower facilities to meet patient and staff needs, and that exposed pipe work and radiator design did not allow for effective cleaning.  The inspection team also noted that the design of dirty and clean utility rooms in the St Mary's ward did not "facilitate effective infection prevention and control measures".

The report pointed out that it was evident that in many instances the hospital had themselves "clearly identified areas of concern and had sought external assistance in dealing with many of these risks".

"Mallow General Hospital, as a member of the Cork University Hospital and the South/West Hospital groups, needs to be supported within group and national structures to effectively address issues in relation to hospital infrastructure and resources in order to facilitate compliance with the National Standards for the Prevention and Control of Healthcare Associated infections and other existing national healthcare standards," it concluded.

The entire 25-page HIQA report and its conclusions can be viewed in full at