Dublin hospital has been asked to address conditions in its national liver transplant unit
Poor facilities left liver transplant patients at St Vincent’s University Hospital at increased risk of infection by a superbug, according to the health watchdog.
A new inspection report by HIQA, based on an announced inspection in March, said the Dublin hospital failed to reduce risks to patients despite a past outbreak of the antibiotic-resistant bacteria VRE in 2014.
Surveillance results have since shown a higher incidence of VRE colonisation in a number of the hospital's clinical areas, the watchdog said.
Individuals found to be carrying the bacteria in their bowel are referred to as being colonised, meaning they do not experience tissue damage or demonstrate any symptoms.
In a small proportion of cases, however, colonisation may lead to bloodstream or heart infection, which can be difficult to treat and result in death.
The unannounced inspection on March 30th raised a number of concerns about poor infrastructure and precautionary procedures in the hospital's national liver transplant unit at St Brigid’s ward.
Inspectors noted that safeguards were not consistently taken to protect patients known to be at greater risk of acquiring infection.
Doors to isolation and cohort rooms were both left open, meaning patients carrying transmissible bacteria were not physically separated from others, in line with hospital policy.
HIQA additionally identified an insufficient number of ensuite isolation rooms and a lack of ensuite shower or toilet facilities in rooms used for isolation purposes.
This resulted in colonised patients using the same showers and commodes as patients not carrying resistant bacteria, inspectors said.
Commodes were found to be stored in the ward’s shower facility rather than in a dirty utility room, while precautionary signs on doors were deemed not to be clearly visible to staff and visitors.
"Failure to consistently implement transmission precautions increases the risk of spread of infection," HIQA said.
The health watchdog acknowledged in its report that the hospital performs “ongoing monitoring of VRE-related bloodstream infection”.
However, it said there was significant scope for improvement in its approach to infection prevention and control.
The hospital told HIQA that measures in place to address VRE include targeted screening, isolation/cohorting of cases and enhanced decontamination, in line with national guidelines
Documentation submitted by St Vincent’s to the watchdog showed it has explored the possibility of relocating St Brigid’s ward.
However, no agreed plan or timeframe in which to address these issue was provided before the report was completed, HIQA said.