Vomiting bug at hospital is down to ‘inadequate isolation’
An inspection report by HIQA at Sligo University Hospital says two outbreaks of the so called winter vomiting bug last year was down to inadequate isolation facilities, high occupancy rates and increases levels of Norovirus infection inn the community.
Difficulty assigning dedicated nursing staff to affected areas was identified as a contributory factor.
Documentation reviewed by inspectors showed the hospital had two outbreaks of the Norovirus infection in 2016, both with extended durations of 40 days and 17 days respectively.
Documentation reviewed showed that members of the Infection Prevention and Control Team presented an outbreak report at the Executive Management Team meeting July 2016.
Recommendations following the outbreak included training on decontamination and cleaning techniques, staff education in relation to standard and transmission-based precautions and the introduction of molecular screening methods in the microbiology department.
The HIQA inspection report was completed following an unannounced inspection carried out on 20 th July.
During this inspection inspectors spoke with hospital managers and staff, and members of the Infection Prevention and Control Team.
Inspectors requested and reviewed documentation and data and observed practice within the clinical environment in a small sample of clinical areas which included the Coronary Care Unit and a surgical ward.
The Coronary Care Unit could accommodate eleven patients with six beds located in a multi-occupancy room in the unit, in addition to five single cubicles.
The infrastructure of patient accom- modation and some ancillary areas in the Coronary Care Unit was very poor and did not facilitate the management of patients with transmissible infection stated the report.
On the day of inspection all beds were occupied and patients requiring isolation were managed in single cubicles.
None of the single cubicles had ensuite toilet/shower facilities which meant that patients shared one toilet on the corridor or needed to walk to the opposite end of the unit to access toilets or showers. Only two of the five cubicles had hand washing facilities for staff.
“It is recommended that patients with diarrhoea are accommodated in rooms with hand washing facilities.
“The single cubicles did not have ante rooms and they opened directly into the main corridor area, which was not ideal from an infection control perspective.
“Spacing between beds in the six bed area was limited and shelves and cupboards for general storage were located within one patient zone which is not recommended.
Patient equipment was generally clean with few exceptions”
Ventilation in the unit was reported by staff to be poor and this was apparent on the day of inspection.
Deficiencies in relation to environmental and patient equipment hygiene were identified at the time of inspection with regard to a surgical ward which had 28 beds which included six single rooms, one four-bedded and three six-bedded rooms all with en-suite toilet and shower facilities.
Stains and or dust were observed on a number of items of patient equipment. Inspectors found that commodes in the dirty utility room were unclean.
These details were communicated and addressed at the time of inspection. On the day of inspection, HIQA found that the hospital had formalised governance arrangements with clear lines of accountability and responsibility for the prevention and control of healthcare-associated infections.
The Infection Prevention and Control Team had put in place many elements of an infection prevention and control programme.
The hospital had systems in place to identify and manage risk in relation to the prevention and control of healthcare-associated infection.
Inspectors were informed that major risks on the hospital’s corporate risk register included lack of isolation facilities and hospital beds and poor hospital infrastructure.
Infrastructural deficiencies and requirement for additional hospital beds and isolation facilities had been escalated by the hospital through the (HSE) hospital group structure.
The hospital achieved 90% compliance rate in the national hand hygiene audit in October and November 2016.
Inspectors were informed that the hospital also achieved 90% compliance with hand hygiene practice in May 2017 reaching the required HSE national hand hygiene compliance target of 90% which is commendable, said the report.