Contributing factors to Covid-19 outbreaks at Mayo hospital identified

Several causes contributed to Covid-19 outbreaks at Mayo University Hospital including a lack of understanding of the virus and the importance of wearing face masks, a report has found.

Two outbreaks last April and May occurred on two inpatient wards leading to 75 confirmed cases, 33 among patients and 42 staff.

On April 24th Leaving Cert student Sally Maaz (17) died 10 days after being admitted to the hospital's Covid-19 ward. Her parents have raised questions over the circumstances of her death.

The case is not referenced in Thursday’s inspection report on the hospital published by the Health Information and Quality Authority (Hiqa).

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It conducted an unannounced visit last September to assess Covid-19 related aspects of management. And while it found the hospital to be either compliant or substantially compliant in five of six areas, it raised concerns over its emergency department and addressed the causes of the earlier outbreaks.

“Contributory factors [to the outbreaks] included key information deficits relating to the nature of the Sars-CoV-2 virus at that time, inclusive of the potential for asymptomatic and pre-symptomatic spread, and the importance of mask wearing to prevent cross-transmission,” it found.

Other factors included a delay in turnaround time for tests (subsequently addressed with increased on-site capability), the absence of proper contact tracing, a lack of appropriate isolation facilities, staff crossover between wards and asymptomatic transmission to staff and patients.

During the course of this inspection, Hiqa noted the hospital had implemented several measures to reduce the likelihood of further outbreaks.

However, it said while affected areas of outbreak wards were subsequently closed, “it was of concern” that other areas of the wards remained open to admissions for two weeks afterwards.

Was there an overcrowding problem?

The hospital was found to be non-compliant with standards governing infection prevention and control, specifically relating to overcrowding in its non-Covid emergency department A, where the original outbreak occurred.

“Patients admitted . . . had been boarded [overnight] on trolleys and chairs for extended periods of time,” it said.

“Patient placement within this department was not optimal from an infection prevention and control perspective as overall the treatment areas were cramped and cluttered. Minimal spatial separation between trolleys did not comply with public health guidelines.”

By contrast, emergency department B, used for Covid patients, was found to have adhered to national guidelines on social distancing.

“If further outbreaks are to be avoided the hospital must urgently address ongoing risks through improvements in the wider hospital infrastructure, addressing emergency department overcrowding, and through the early closure of outbreak wards to new admissions.”