Babies at risk of infection in Holles Street, report finds

Sick babies attending the National Maternity Hospital were at serious risk of infection from overcrowding and poor environmental hygiene, a report by the State's health watchdog has found.

The Health and Quality Information Authority (Hiqa) issued a formal warning to the hospital last October saying specific issues that posed a serious risk to the health and welfare of patients needed to be addressed.

A follow-up inspection in November found significant improvements in environmental hygiene though improvements were still required in cleaning practices and the problem of overcrowding in the neonatal intensive care unit.

Hiqa said overcrowding in the intensive care unit posed an infection control risk to vulnerable newborns accommodated there. Inspectors found a unit designed for 36 babies was accommodating 46 neonates on the day they visited. “There is an increased risk of infection spread in overcrowded environments, particularly with respiratory and gastrointestinal infections,” the report points out.

Hospital master Dr Rhona Mahony, in a letter to Hiqa, said the hospital sometimes continues to admit babies to the unit even when full because "the risk of not doing so is greater and due to the unavailability of other options within the country".

“For example, if a patient at 25 weeks gestation delivers unexpectedly . . . it may be safer to admit the baby to the unit despite overcrowding rather than attempt to transfer to another unit.”

In the delivery ward, inspectors warned of an infection risk arising from design factors and criticised the quality of cleaning as insufficient. Dust control measures were “suboptimal” and overall environmental hygiene was “very poor”.

Splashes of organic matters were present on patient’s beds, wall surfaces and patient equipment, thereby posing a risk of transmitting blood-borne viruses.

The hospital told inspectors high levels of activity made it difficult to access delivery rooms for cleaning, though on the day of the inspection up to four delivery rooms were vacant. The report says periods when rooms are unoccupied present an opportunity for enhanced cleaning.

The report acknowledges staff work in a “compromised” physical environment, in a hospital building dating back to the late 1800s, with a high level of activity, very complex cases and multiple birth scenarios.

A planning application is to be made this year to move the hospital from Holles Street to a new site at St Vincent’s Hospital. Currently, it has 10 delivery rooms for over 9,000 births a year; in the new hospital, there will be 24 delivery rooms.

In relation to the intensive care unit, the report says the practice of continuing to admit babies to an overcrowded unit remains a significant risk.

“The ongoing need to admit unwell neonates above the unit’s design and staffing capacity must be assessed in the context of the risks posed to babies already accommodated in this high risk clinical area.”

The hospital told inspectors there are not enough cots and not enough appropriately skilled specialised staff to meet increases in activity levels.

“Chronic overcrowding and staffing deficiencies appear to be tolerated and accepted as the day to day reality for the hospital. Inspectors were not fully assured that this issue was being managed effectively at local or national level.”

Hiqa says the multiple risks identified during the inspection need to be effectively managed pending a move by the hospital to a new site. “It is recommended that overcrowding issues in the National Maternity Hospital are prioritised and addressed, with the assistance of the wider Ireland East Group and at a national level, within an agreed timeframe.”

Dr Mahony pointed out in her letter to Hiqa that Holles Street has had no bloodstream infections such as MRSA in the last five years and its perinatal mortality rates are exceptionally low by international standards. “We would appreciate if the context of our challenges are acknowledged.”