NMH ‘unlikely’ to meet hygiene standards within infrastructure

The National Maternity Hospital says it is unlikely to be able to comply with hygiene standards required by the State health watchdog within its current resources and infrastructure.

Responding to a scathing report by the Health Information and Quality Authority (Hiqa) on hygiene and overcrowding in the hospital, Holles Street said it was absolutely committed to addressing the many infrastructural deficits that existed.

However, hospital master Dr Rhona Mahony said the infrastructure was unfit for purpose for delivering over 9,000 babies annually and the activity level "far exceeds the capacity of the building".

“It is for this reason that for the past 20 years the hospital has sought relocation to a modern facility that is fit for purpose.”

Dr Mahony said all rooms and areas were regularly cleaned by trained staff but it was difficult to adhere to best practice standards of deep cleaning when rooms were rarely vacant.

The Hiqa report “tends to the subjective,” Dr Mahony said, and it was difficult to determine in some parts the basis on which risk was quantified, particularly as clinical and infection outcomes were excluded.

Holles Street has had no outbreaks of MRSA or other bloodstream infections, or winter vomiting bug, for over five years, and 95 per cent of flu cases were acquired in the community, she said.

The Hiqa report represented a “snapshot” picture over a number of hours on a particular day and so caution should be exercised in drawing broader conclusions about healthcare standards at the hospital.

Dr Mahony said there were 10 delivery rooms, when 24 were needed. Last year, there were an average of 25 to 30 deliveries a day, and on occasion, up to 43. “Deep cleaning of each room requires access for a number of hours and due to the volume of activity, such access often proves to be very challenging.”

The site at St Vincent’s Hospital to which the maternity hospital is due to move in three years’ time has a footprint four times larger than the Holles Street site, she pointed out.

Hiqa report

The Hiqa report found that sick babies attending the National Maternity Hospital were at serious risk of infection from overcrowding and poor environmental hygiene.

Hiqa issued a formal warning to the hospital last October saying specific issues that posed a serious risk to the health and welfare of patients needed to be addressed.

A follow-up inspection in November found significant improvements in environmental hygiene though improvements were still required in cleaning practices and the problem of overcrowding in the neonatal intensive care unit.

Hiqa said overcrowding in the intensive care unit posed an infection control risk to vulnerable newborns accommodated there. Inspectors found a unit designed for 36 babies was accommodating 46 neonates on the day they visited. “There is an increased risk of infection spread in overcrowded environments, particularly with respiratory and gastrointestinal infections,” the report points out.

Dr Mahony, in a letter to Hiqa, said the hospital sometimes continues to admit babies to the unit even when full because “the risk of not doing so is greater and due to the unavailability of other options within the country”.

“For example, if a patient at 25 weeks gestation delivers unexpectedly . . . it may be safer to admit the baby to the unit despite overcrowding rather than attempt to transfer to another unit.”

In the delivery ward, inspectors warned of an infection risk arising from design factors and criticised the quality of cleaning as insufficient. Dust control measures were “suboptimal” and overall environmental hygiene was “very poor”.

Splashes of organic matters were present on patient’s beds, wall surfaces and patient equipment, thereby posing a risk of transmitting blood-borne viruses.

The hospital told inspectors high levels of activity made it difficult to access delivery rooms for cleaning, though on the day of the inspection up to four delivery rooms were vacant. The report says periods when rooms are unoccupied present an opportunity for enhanced cleaning.