A lack of resources within and competing demands in University Hospital Limerick meant that there was very limited on site presence of qualified, experienced infection prevention and control staff and consultant microbiologists at Nenagh Hospital, Hiqa inspectors found during an unannounced inspection in August.
However, the inspectors found that the two clinical areas inspected were generally clean.
Inspectors found that there was a clearly identified governance and reporting structure for the prevention and control of healthcare-associated infections at the hospital.
The hospital had a process in place whereby identified risks could be escalated to hospital group management level.
The hospital did not have sufficient infection prevention and control resources on site from Monday to Friday.
An arrangement had been put in place in the previous two months whereby an infection prevention and control nurse from the hospital group infection prevention and control team attended the hospital on one day every second week
Infection prevention and control advice was available by telephone from the infection prevention and control team and a daily review of patients with infection prevention and control needs at Nenagh Hospital was performed by the
team based in University Hospital Limerick.
A consultant microbiologist did not Report of the unannounced inspection at Nenagh Hospital attend Nenagh Hospital in person to provide clinical advice but advice was provided over the phone as needed.
An antimicrobial pharmacist based in University Hospital Limerick attended Nenagh
Hospital on one day each week and performed a clinical round to review and advise on antimicrobial prescribing practice at the hospital.
However, the infection prevention and control service was significantly under resourced.
This service was provided across the hospital group by an infection prevention and control team based in University Hospital Limerick.
The hospital did not have sufficient isolation facilities to accommodate patients with transmissible infection and patients with airborne infection which needs to be taken into consideration when admitting patients to the hospital.
The hospital was working to address this issue through the addition of a new build inpatient ward with additional isolation rooms.
The older infrastructure of the hospital and larger open plan multi-occupancy rooms does not facilitate the implementation of the National Standards. This needs to be addressed.
Overall, the environment in the two clinical areas inspected was generally clean with few exceptions.
Hospital hygiene resources and supervision arrangements need to be sufficiently resourced at the hospital.
This was identified during a previous Hiqa inspection and had not been comprehensively addressed.
It is recommended that the hospital review safe injection practice and the procedures around the administration of medication for injection and the preparation of monoclonal antibodies.
The hospital needs to assure itself that the potential risks to patients and staff in this regard are fully understood, managed and mitigated.
Opportunities for improvement were identified in relation to the hygienic management of equipment used in the preparation of medicine for injection.
The infrastructure and design of the Infusion Centre was less than ideal from an infection prevention and control perspective and requires review and improvement.
Inspectors found that the hospital had a suite of policies in relation to the prevention and control of infection and hospital hygiene.
The hospital had recently implemented a training programme for staff in relation to the prevention and control of healthcare-associated infection, however on the day of the inspection not all staff had received up-to-date training.
The hospital had implemented evidence based care bundles for intravascular devices and urinary catheters and performed audit of care bundle implementation.