Infection risk in patient transfers

THE Health Service Executive (HSE) has been asked to conduct an urgent review of all infection-control procedures, to reduce the risk of cross-contamination from the transfer of vulnerable elderly Clare patients from acute hospitals to nursing homes.
The call was made this week by HSE West Forum member, Councillor Brian Meaney, in the wake of public concern about the deaths of six elderly people at a Donegal private nursing home from influenza A (H3) over a 10-day period.
He queried the extent of screening for viruses and bacterial infections of elderly patients being transferred from Ennis Hospital and the Mid-Western Regional Hospital, Limerick to public and private nursing homes throughout the county.
The HSE confirmed screening protocols are in place for specific alert organisms, while public nursing homes in Clare have comprehensive infection control policies in place around training, surveillance and audit.
The Green Party councillor said it is vital that any patient who contracts any hospital-acquired infection, such as the winter vomiting bug and C-Diff, should be fully screened and isolated before being discharged to reduce the risk of reintroducing infections to nursing homes.
He said it is vital that infection-control measures adopted by the HSE are constantly under review because a new virulent infection “only had to be lucky once” to spread, while infection control measures “had to be successful all the time” to be effective.
“It is disturbing that so many elderly patients died from a respiratory illness in a nursing home. We need ongoing reviews of all infection-control measures and other practices to prevent the spread of respiratory diseases,” he said.
He said all the necessary measures must be put in place to ensure people’s lives are not put at risk.
However, his concern is not shared by Minister of State at the Department of Health, Deputy Kathleen Lynch, who believes there is not a lot of evidence of cross-contamination of patients and insists what happened in Donegal is a different issue concerning the spread of a ’flu.
“We all carry the MRSA bug somewhere on us, whether it is on our nasal passage or on our throat. But that doesn’t mean we give it to anyone. It is not as if elderly people are in the habit of going around hugging each other or anything.
“A ’flu is very easily spread by coughing or sneezing. It is not the same or has no connection in relation to cross-contamination. Before a patient from a nursing home gets to a hospital, they will have a blood and urine test.
“The only hospital-acquired infection is MRSA. If it is through an open wound, they will not be released from hospital until this is sorted out,” she said.
Minister Lynch stated she is happy with the stringent inspections of nursing homes in Clare operated by HIQA to the highest standards.
However, she admitted health authorities should have known about the difficulties in Donegal much earlier and advised all public and private nursing home operators in Clare to contact the Department of Health if anything untoward or above the norm happened, so as to get help.
In an official response, Mid-West Region Hospitals Group chief executive officer, Ann Doherty, acknowledged not all patients in all hospitals are screened for all alert organisms.
Ms Doherty stated the microbiology service is centralised in the HSE Mid-Western Regional Hospital, Dooradoyle, Microbiology/Serology Lab, which provides a 24/7, out-of-hours service for emergency/urgent samples.
“With respect to healthcare-associated infections and screening in respect to alert organisms, such as MRSA, VRE, CRE, KPC, ESBL etc, these specific infections are processed according to national and local guidelines. Specific screening protocols are in place for specific alert organisms,” she stated.
The Mid-West HSE confirmed there have been no reports of any such illness in HSE older persons’ premises in Clare in recent weeks. The authority stated all public and private nursing homes must notify any outbreaks of disease to its public health department and the HSE.
“The public nursing homes in Clare have comprehensive infection-control policies in place around training, surveillance and audit. An infection control nurse specialist is in place in Clare for the past 11 years. All HSE premises in Clare access this service,” the authority stated.
There are four public nursing homes – Ennistymon Community Nursing Unit, Raheen Community Nursing Unit, Regina House Community Nursing Unit and St Joseph’s Community Hospital.
Private nursing homes include Cahercalla Community Hospital, Carrigoran House Nursing Home, Kilrush District Hospital, Kilrush Nursing Home, St Theresa’s Nursing Home, St Dominic Savio Nursing Home, Lakes Nursing Home, Ennis Nursing Home, Athlunkard Nursing Home and Riverdale House Nursing Home.