Michael Harty (Clare, Independent) | Oireachtas source

I thank the Minister for taking this matter. The incidence of multidrug resistant infections in University Hospital Limerick has not been adequately controlled, according to the Health Information and Quality Authority. It may have been a contributing factor in 29 deaths and is associated with increasing numbers of new cases. This is a cause of great concern to patients and their families, and requires an urgent examination of the infection control policies in the hospital. I ask the Minister of State, Deputy Corcoran Kennedy, to direct an investigation into this matter.

As background, in June 2014 HIQA found there were risks to patient safety when it reviewed the governance structure of University Hospital Limerick. In particular, overcrowding in emergency departments of the hospital resulted in significant compromises in maintaining adequate levels of environmental cleanliness, which in turn increased risk of health care-associated infections, including multidrug resistant infections. These infections are life-threatening if contracted by frail elderly patients who are placed at risk in trolley queues for prolonged periods of time in the emergency department or placed in congested, overcrowded wards.

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.

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.

Subsequently, the Health Information and Quality Authority, 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.

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