Hiqa criticises infection control at liver transplant unit

The Health Information and Quality Authority (Hiqa) has criticised infection control and prevention measures at the National Liver Transplant Unit in St Vincent’s University Hospital in Dublin.

The authority’s report, published on Thursday, follows an unannounced inspection in March this year. It highlights inadequate and insufficient isolation facilities within St Brigid’s Ward where the unit is based.

It criticised the infrastructure and facilities of the ward which “do not facilitate effective infection prevention and control” for patients at greater risk of acquiring infections.

It pointed to a "high and increasing incidence of the detection of healthcare associated vancomycin resistant Enterococci (VRE) colonisation at the hospital".

VRE are a type of bacteria that have developed a resistance to treatment. In a small proportion of vulnerable patients the bacteria can result in urinary tract infection and sometimes bloodstream or heart infection.

Hiqa recommends that “effective infection prevention and control measures need to be prioritised in higher risk clinical areas”.

St Vincent’s plans to move the liver unit but Hiqa noted “there is no agreed plan or timeframe” for this.

The authority acknowledged “the hospital performs ongoing monitoring of VRE-related bloodstream infection and intravascular-device-related infection and has reported a 43 per cent reduction” in the overall rate of infection in 2015 compared with the previous year.

Its inspection “identified significant scope for improvement” in relation to the hospital’s approach to aspects of VRE prevention and control.

Information provided by the hospital after the inspection “did not assure Hiqa that this ongoing issue had been comprehensively managed by the hospital at the time of the inspection”.

Disappointed

Hiqa was disappointed the experience of a VRE outbreak at the liver unit in 2014 and reports of outbreaks internationally “have not been used to reduce risks to patients”.

The inspectors noted that the hospital had consistently achieved hand hygiene compliance of more than 90 per cent in audits since 2013, which it described as “commendable”.

It said however that the small samples in hand hygiene audits “is not statistically significant and therefore results on hand hygiene compliance do not represent all groups of staff across the hospital as a whole”.

In a statement, St Vincent’s said it accepted all the report’s findings “which we will use to further improve the delivery of our services for our patients”.

It pointed to the 43 per cent reduction in infection but said it “fully recognises that additional work needs to be done as we wish to continually reduce any residual risk to our patients.