Tallaght hospital told it must do more to prevent C diff

Tallaght Hospital needs to take further measures to protect against a reoccurrence of a C diff outbreak, the Health Information and Quality Authority has warned.

An outbreak of the superbug, probably caused by inadequate cleaning of shared equipment, occurred in the William Stokes geriatric ward last April and was not declared over until June.

Despite the implementation of control measures, inspectors who visited the ward in September found brown staining on the under surfaces of commodes, which they said was of particular importance in controlling transmission of the superbug.

"On the day of inspection, a patient was isolated on contact precautions within a multi-occupancy room on William Stokes Unit.

However, there was no visible precautionary signage to communicate the precautions to staff.”

Hiqa recommended recommends the hospital carries out an immediate deep clean of the unit and reviews the systems for maintaining the physical environment and all equipment.

The report says the overall standard of hygiene in the theatre department was sub-optimal with unacceptable levels of dust in all areas inspected. “This indicated that cleaning and dust control measures were insufficient.”

“Surfaces, finishes and flooring were damaged and poorly maintained and as such did not facilitate effective cleaning and likely facilitated the production and accumulation of dust.”

Inspectors criticised the storage of large amounts of equipment and supplies stored alongside waste bins in the disposal corridor of the theatre department.

Inspectors, who observed 15 out of 24 hand-washing movements properly carried out, found a culture of hand hygiene best practice was not yet fully embedded at all levels of the hospital.

The report acknowledges the progress made by the hospital since a previous inspection in 2014, including the implementation of infection control measures and the refurbishment of all wards. But it says further improvements are required in relation to the management of the physical environment and patient equipment.

“It is essential that the maintenance of high risk areas such as the Theatre Department are prioritised by the nature of the risks posed by the services provided.”

Tallaght Hospital said it accepted the findings in the Hiqa report and recognised the need for action and vigilance in relation to the issues raised.

The hospital has taken appropriate actions to address the causes of an increase in C diff, a spokesman said.

A separate Hiqa report into Tullamore hospital identified a number of high risks in relation to infection prevention and control. It criticised the hospital's poor performance in relation to infection indicators, with a higher than expected rate of C diff infection since 2013.

Among the factors suggested by Hiqa for a “significant and persistent increase” in C diff infection were poor environmental hygiene, rapid patient turnover and staff shortages.

The hospital said it has undertaken a number of iniatives in reponse to the report findings, including increased hygiene auditing, recruitment of new staff and better structures to manage infection control.