Guidelines for collating sepsis data not in place

Important guidelines for the collection of data on maternal sepsis in Irish hospitals are not yet in place, despite recommendations made in June last year in a report into the death of Savita Halappanavar, the Health Service Executive has confirmed.

Only two of the country’s leading public maternity hospitals could provide figures on maternal sepsis to The Irish Times under the Freedom of Information Acts, reporting more than 270 cases of the condition in women under their care in the past 10 years.

But there are no figures available on maternal sepsis for most of the country’s maternity units, despite the recommendations made in the HSE’s own investigation into Ms Halappanavar’s death.

Ms Halappanavar died of sepsis in 2012 after miscarrying at Galway University Hospital.

Maternal sepsis is caused by a bacterial infection contracted during pregnancy, or in the days and weeks following delivery. It is the leading cause of maternal death in the UK and although deaths from the condition here have historically been low, they are on the increase.

Of 10 women who died in 19 maternity hospitals and units in Ireland in 2011, none had sepsis, but in 2012 sepsis was a contributory factor in the death of three women out of 11.

'No mechanism'
The Coombe Women and Infants University Hospital and the National Maternity Hospital, Holles Street, in Dublin were the only public maternity units that could supply figures on the condition. Dublin's other leading maternity hospital, the Rotunda, said it was unable to provide information on sepsis as it had "no mechanism in place for the correlation" of the information.

Between 2004 and the end of November 2013, Holles Street recorded 166 cases of maternal sepsis. The hospital delivers babies for an average of 9,600 women each year. In 2009, it had its highest number of sepsis cases with 24 recorded.

Over a similar period, from 2004 to the end of June 2013, 107 cases of maternal sepsis were recorded in the Coombe hospital, which has in the region of 8,000 deliveries a year. It recorded its highest number of sepsis cases in 2010 when it had 19.

'No outbreaks'
A spokeswoman for Holles Street hospital pointed out that the hospital "had no outbreaks occurring during this time" and there were no multidrug resistance organisms. "Less than 0.2 per cent of our obstetric patients will develop sepsis," she said. "The majority of these women recover fully."

No one was available to comment from the Coombe hospital.

An FOI request to the HSE asking for cases of sepsis in women during pregnancy and after delivery in HSE hospitals around the country over the past 10 years was denied. The HSE said the information was “not collected, collated or reported nationally”.

The HSE also said the national implementation support group, set up to oversee the introduction of recommendations made in the HSE June 2013 report into the death of Ms Halappanavar, would be developing guidelines to support and facilitate the collection of information on maternal sepsis.

However, more than six months after the report, the guidelines have yet to be advanced.

In a statement, a spokeswoman for the HSE said the group was in place and was in the process of developing the guidelines. “The data collection will follow on when the guidelines are published,” the spokeswoman said.