AN INVESTIGATION into the outbreak of Clostridium difficileat Ennis General Hospital last year has found the hospital had no effective system for surveillance of the superbug and, as a result, was unaware it had an outbreak at the time. Eithne Donnellan, Health Correspondent, reports.
The damning report of the investigation, published by the Health Service Executive (HSE) yesterday, lists a litany of problems at the hospital, ranging from overcrowding to faulty equipment, as contributing to the spread of the infection.
Staff absenteeism at critical periods, a lack of specialist staff and a lack of hygiene were also cited.
In total, 46 mainly elderly female patients became infected in the first six months of 2007. Some had the virulent and highly transmissible 027 strain of the infection.
Of the 46 patients infected, 15 died within 30 days of being diagnosed with Clostridium difficile, a condition which causes severe diarrhoea. Another six had died by the end of the year. The review found Clostridium difficilecontributed to 13 of the deaths but was not the primary cause.
In four of these 13 cases, the bug was not recorded on their death notification forms, even though it was on their medical charts as contributing to death.
The investigation, conducted by two senior doctors with the HSE, began last October after a statistical exercise showed up more cases of the bug than would be expected at the Ennis hospital in the first six month of the year. "This trend was markedly different to . . . other hospitals in the region which were showing a downward trend," the report says.
The review noted 22 of the episodes of infection occurred on the hospital's female medical ward. It said this ward had been identified "as an area of particular concern" from a hygiene perspective. The bed pan washer in this ward - equipment that would be in demand among elderly patients with diarrhoea - was leaking and breaking down in early 2007. It was not replaced until June. In addition, the investigation found this ward was effectively overcrowded for most of the first half of 2007. Occupancy levels ranged from a high of 105.9 per cent in February to a low of 99.9 per cent in May, it said.
The report notes the hospital did not have a designated consultant microbiologist and its infection control committee stopped meeting in 2006.
Furthermore, it says while infection-control nursing at the hospital raised concerns about background Clostridium difficilelevels and drew up guidelines, adherence was "patchy" and there was "poor attendance by support staff at infection-control training sessions".
The report says "the extent of the problem was not appreciated initially by either management or clinical staff at the hospital, many of whom considered MRSA or norovirus a bigger threat. The main focus was on best management of individual patients."
A further issue, it says, which "may have contributed to the delay in taking definitive action" was that key staff were absent. The director of nursing was away on an assignment from March to October, the manager of the female medical ward was on sick-leave for a year until April 2007 and the infection-control nurse was on holidays in April 2007, the month when the number of cases of Clostridium difficilepeaked.
The HSE said last night that levels of the bug in the hospital are now very low. It has given the report to the families of those who died and has apologised to them. People who may have concerns about their care at the hospital can call a helpline at 061-464444. It will be manned from 9.30am until 8pm today.
Minister for Health Mary Harney described the findings as "serious" but said all new cases of Clostridium difficilewill be recorded nationally from May 4th so an outbreak should not go unchecked again.