Analysis:Hospitals need resources to tackle super bugs, writes Muiris Houston, Medical Correspondent
The publication of the first national hospital hygiene review to be carried out by the Health Information and Quality Authority (HIQA) is most welcome. Not alone does it provide information on the cleanliness or otherwise of specific hospitals, but it tells us much about management performance within the Health Service Executive (HSE).
While there have been previous hospital hygiene audits, these were undertaken by the HSE assessing its own hospitals. Yesterday's report is the result of a more robust, transparent and comprehensive exercise involving unannounced visits by outside teams of assessors.
The hygiene standards, on which the hospitals were assessed earlier this year, focus on two main areas: service delivery and corporate management. Service delivery includes front-line issues such as staff hand-washing practices, the handling of clinical waste, including needles and dressings, as well as the quality of equipment and buildings.
Overall, hospitals did better on service delivery than corporate governance. However, some serious service deficiencies were noted. The review identified a cross-contamination problem in one hospital where an operating theatre shared space with the sterile services unit. The transfer of bacteria from infected wounds in theatre to supposedly sterile equipment represents a real danger to patients and not surprisingly resulted in a poor rating for the hospital concerned.
But most of the 51 acute hospitals fell down on how they prioritise, govern and monitor hygiene issues. The report is blunt about the absence of corporate management structures at St Mary's Orthopaedic Hospital, Cork, and the non-compliance in five other institutions, describing their performance as unacceptable.
A further five hospitals had no process in place to monitor outside cleaning contractors.
Perhaps the most alarming finding of all is that less than half of acute hospitals responded to queries about key performance indicators for the prevention of hospital acquired infection such as MRSA. And of the 22 hospitals that did list their practice in this area, no two hospitals defined their assessment of the super bug risk in the same way.
The latest infection control report from Beaumont Hospital, reported earlier this week by The Irish Times, found a rise in the number of MRSA cases in the national centre for neurosurgery and renal transplantation. And while the hospital was rated "good" in yesterday's Hiqa assessment, its infection control team said it was not possible to isolate one in three patients with MRSA last year because of a lack of isolation beds and patient overcrowding.
This is the other side of the hygiene equation. While hospitals clearly need to up their game on cleanliness issues, without proper resources to isolate patients and avoid the overcrowding that promotes the spread of MRSA, they cannot be expected to reduce the number of patients affected by dangerous super bugs.
On a broader note, HIQA has exposed serious management deficiencies within the HSE.
It suggests that recent concern about the quality of management within the health service is justified. The fact that HIQA has had to tell the HSE that it "should establish a national set of indicators for monitoring hygiene and infection prevention and control performance", some two years after problems in this area were highlighted by health authorities, reflects poor management.