HIQA has recommended that the HSE nationally provide “all necessary supports” to University Hospital Limerick in its efforts to contain a relatively new superbug that is especially resistant to antibiotics.
Carbapenemase producing enterobacteriaceae (CPE) are bacteria that reside in the bowel which while harmless in most patients can cause serious and sometimes deadly infection in vulnerable patients, including those receiving chemotherapy or in intensive care. Identifying CPE early is crucial for doctors to know with what drugs infected patients can be effectively treated.
And the Mid-West has a particular challenge with CPE, it has emerged in a HIQA report on two unannounced inspections carried out at UHL in November and January - and measuring the hospital’s performance against the national standards for the control of healthcare associated infections.
The hospital confirmed to the Limerick Leader this week that the first known case of CPE had been identified in Limerick in 2009.
“As a result, a comprehensive screening programme was put in place and approximately 15,000 screen tests have taken place. To date 77 patients have been identified as CPE carriers,” a UHL spokesperson commented.
The HIQA report states:
“University Hospital Limerick was among the first hospitals in Ireland to report the identification of CPE, which are especially resistant Gram-negative bacteria that can cause infection in patients. Historically, the hospital has experienced outbreaks with bacteria that contain this antibiotic resistance mechanism. It has been explained to the Authority by the hospital that a certain small proportion of the patient population in the hospitals catchment area are chronically colonised with organisms which contain this resistance mechanism.
“The hospital must therefore continually ensure that patients who are colonised with CPE who present for treatment are rapidly identified and appropriately managed to ensure that they do not become infected with CPE during treatment, and that the risk of spread to other patients is managed effectively.”
HIQA notes UHL’s “effective” CPE screening programme, staff training initiatives and the hospital’s “preliminary efforts to better understand the epidemiology of this issue across healthcare settings in the region”.
But it goes on to observe that the hospital’s efforts to study, track and contain CPE are being carried out against the backdrop of outdated infrastructure, chronic emergency department overcrowding and a limited number of isolation rooms.
HIQA notes the plan to open a new ED in 2016 and a ward block with 96 single rooms the following year.
“However in the interim period, it is vital that the hospital ensures that all measures are in place to manage the risk from multidrug resistant Gram-negative organisms, and other potentially transmissible infectious diseases, within current accommodation constraints,” the report states.
And HIQA is also concerned that UHL is dealing with the CPE risk
“in relative isolation, within the considerable constraints of legacy infrastructure in some wards, and relative overcrowding across the hospital in general”.
“In addition, effective management of this risk represents a significant additional financial burden to the hospital. To this end, the Authority therefore acted to escalate the risks associated with Gram-negative resistance at the hospital to senior management within the HSE so that the hospital may be afforded all necessary supports to ensure that the risk associated with Gram-negative resistance are managed as comprehensively as they can be from a system-wide perspective.”
For all its efforts in dealing with CPE, the HIQA report criticises UHL for failings in environmental and hand hygiene observed during its inspection in November 2014. These included significant layers of dust in clinical areas, unclean equipment, inadequate isolation of patients at risk of passing on infection and other concerns.
UHL CEO Prof Colette Cowan wrote to HIQA last December notifying them of actions taken to follow up on their concerns. And HIQA acknowledged “significant progress” made between their November and a reinspection last month.
Welcoming the report this week, UL Hospitals said among the improvements were “an increase in allocated cleaning hours for wards and the introduction of structured walkabouts by members of the executive team to support improvements in hygiene standards.
“The report provides assurance to the hospital by highlighting good infection prevention and control practices and also support the management teams in focusing on actions to ensure continuous improvement in the management of infection control in the hospitals.
Following the report, University Hospital Limerick will be undertaking a review of their quality improvement plans to progress the recommendations outlined in the report and further improve our patient experience. The hospitals priorities are to ensure that the patient environment, particularly hand hygiene facilities and patient equipment are effectively managed and maintained to promote infection control.
The quality improvement plans will be available on our website within six weeks as required by regulation.”