Conditions for superbug outbreak present ‘across hospital system’

The Health Information and Quality Authority (Hiqa) has warned that many deficits identified at University Hospital Limerick (UHL) linked to outbreaks of the superbug CPE are also present across the rest of country's hospital system.

In a letter sent to the Department of Health dated October 6th, the healthcare regulator set out its continuing concerns at the response to CPE and antimicrobial resistance across the health service in general and in respect to UHL on foot of a recent inspection of the campus.

In November 2016, the Irish Times reported that a whistleblower had claimed up to 30 patients died at University Hospital Limerick after being infected with antibiotic-resistant superbugs.

The University of Limerick Hospitals group said on Tuesday it was examining 74 cases where patients with a CPE detection had subsequently died.

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The whistleblower, a Health Service Executive staff member, alleged there had been a long-term failure by local health managers to adequately tackle an outbreak of infection that dated back to 2009. Last week the Government declared CPE a national public health emergency.

The national public health emergency team, which will oversee the response of the healthcare system to CPE, is to hold its first meeting on the issue on Thursday.

Hiqa said that through its monitoring against national standards in public acute hospitals, it had repeatedly raised concerns to the HSE and department in relation to the effectiveness of the national response to the management of the risk of what it described as emergent Gram-negative resistance, dating back to 2014.

Deficits

A spokesman for Hiqa said its published monitoring work at UHL had repeatedly identified deficits that had required both more effective management at local level, and more concerted tangible support from a national level to assist them in dealing with an ongoing outbreak of CPE.

“Many of the underlying deficits identified in Limerick are equally present across the wider acute hospital system – not least acute hospital overcrowding, poor infrastructure and environmental hygiene, and inconsistency in infection prevention and control team resourcing.”

Hiqa said it welcomed and fully supported the national public health emergency team and its associated actions “which we believe to be a critically important development”.

“Hiqa believes that this emergency measure has the potential to address such issues as the required level of patient screening and additional specialist supports that are immediately required at the frontline in our hospitals, and indeed in community care settings.”

Last week The Irish Times reported that HSE chief Tony O'Brien had separately warned the Government that new superbugs were leading to avoidable deaths in hospitals across the State and could undermine the sustainability of the entire healthcare system if not tackled.

He urged the Government to immediately direct health chiefs to prioritise tackling healthcare associated infections and antimicrobial resistance.

Mr O'Brien warned Minister for Health Simon Harris that tackling the spread of superbugs in hospitals could clash with plans to deal with overcrowding in emergency departments this winter.

The HSE was seeking nearly €8 million in additional funding to allow it to recruit about 80 key personnel such as pharmacists, microbiologists and laboratory staff to deal with the threat, he added.

The University of Limerick Hospitals group said the management of multidrug-resistant organisms through infection prevention and control procedures and proper antimicrobial stewardship was taken with the utmost seriousness.

“Between January 1st, 2009, and May 31st, 2017, there have been 193 confirmed new detections of CPE in the Midwest (2009-2017). Of these, 166 cases related to patients from UL Hospitals Group and 27 from the community.”

“It should be noted that these are the requesting locations of the first positive lab specimen for the patient and this does not imply that the patient acquired CPE in this location. Indeed, high numbers of detections are to be expected within UL Hospitals as the group has a comprehensive screening programme in place.”

University of Limerick Hospitals group said it was “proactive in screening patients for CPE in line with national and international best practice and guidance”.

“In 2015, there were 60 new CPE detections in the Midwest (57 from UL Hospitals Group and three from the community). In 2016, this reduced to 38 new detections (30 UL Hospitals, eight community). As of May 31st, 2017, there were 16 new detections (15 UL Hospitals and one community),” it added.