HSE REPORT:A REFERENCE laboratory which would work to identify the types of Clostridium difficilein circulation at health facilities across the State should now be established, according to a report published yesterday. Eithne Donnellan, Health Correspondent, reports.
The report, which examined the circumstances surrounding an outbreak of the superbug at Ennis General Hospital last year, said that in light of the emergency of the virulent 027 strain of Clostridium difficileand the difficulty in getting molecular typing of the bug carried out in the Republic, a reference laboratory for Clostridium difficile should be set up.
This 027 strain, which affected a number of the patients at Ennis hospital, was first reported a few years ago. It causes more serious disease resulting in more serious outcomes.
It is understood it may already have been responsible for a number of outbreaks of infection in other Irish hospitals and they had to send samples to the UK to find out what strain of Clostridium difficilewas involved.
A national MRSA reference laboratory is already in existence.
The report published yesterday makes 15 recommendations in relation to improvements which must be made at Ennis hospital.
It says the hospital's infection prevention and control committee, which has now been re-established, must meet regularly; the hospital should designate a senior executive with responsibility for infection control; dedicated sessions involving a consultant microbiologist should be identified for the hospital; and a planned programme of upgrading hand-washing facilities should proceed as a matter of urgency.
Furthermore, it says the executive management team of the hospital must regularly receive information about incidence and trends in healthcare-associated infections in the hospital and this team must ensure there is rapid identification and notification of outbreaks.
In addition, it says there should be an intensive programme of hand hygiene education and training for all staff followed by audits to vet compliance, while the hospital "needs to ensure effective isolation for those patients who pose a potential or actual high risk of infection to others".
The report also says that death certificates should record details of hospital-acquired infections where appropriate.
The investigation found that in four cases of patients who died at Ennis hospital last year, Clostridium difficilewas not mentioned on their death notification forms, although it had been noted in their medical notes as contributing to death.
The review states awareness sessions are required to ensure all managers are aware of "the serious and significant impact" of healthcare-associated infections, including Clostridium difficile.
Outbreaks of the bug in Britain have resulted in staff being fired and police investigations being instituted.
The review of the Ennis outbreak was conducted by Dr Mary Hynes and Dr Kevin Kelleher, both assistant national directors with the HSE.
The HSE said last night it had already begun to implement the report's recommendations.
It said a consultant with a special interest in microbiology had begun two sessions a week at Ennis hospital and hand hygiene sessions for staff were running weekly.
It also said planning permission has been received for the hospital development project.
"The HSE will ensure that learning from this specific incident is applied nationally and on that basis will be holding a briefing session with hospital and other appropriate healthcare managers in coming weeks," it said.