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UHL ‘war zone’ is increasing Covid risk

Clare patient had to have dialysis on trolley

ENNIS kidney patient, Dermot Hayes, who spent 22 hours on a trolley, has claimed regular overcrowding in University Hospital Limerick’s “war zone” is increasing the risk of Covid-19 spreading from asymptomatic patients on trolleys to other patients.
His claim comes in a week when a national heath watchdog warned this persistent overcrowding contributes to the difficulty in managing healthcare associated infections, and has been previously highlighted as a problem by the authority through prior monitoring work.
Following an unannounced inspection of UHL on October 29, 2020, the Health Information and Equality Authority (HIQA) stated: “Overcrowding in hospitals has been shown to increase the risk of spreading infection and is of particular concern in the context of possible future additional demands posed by the pandemic at the hospital over the coming winter months.”
The number of patients on trolleys in UHL increased from 36 on Thursday to 44 on Tuesday, according to figures produced by the INMO’s Trolley Watch.
Mr Hayes (67) called on Health Minister Stephen Donnelly to allocate additional resources extra doctors and nurses to reduce overcrowding in UHL.
“The ED was chock a block, it was like a war zone. It was like entering a different world. There were trolleys and wheelchairs everywhere. I couldn’t believe it. I was really shocked.”
After spending about 10 minutes in Zone A, he was taken on a trolley to a corridor where other patients were being accommodated “head to toe” on trolleys.
He said it was impossible to sleep, and he had to get someone to release the side bar on the trolley and assist him to go to the toilet.
“The staff are completely overworked. I was being promised you will be fixed soon but I had no idea when I would get a bed.
“At the back of my head I was thinking about people who had spent 48 and 72 hours on a trolley. I called my wife several times, she was upset and I was upset,” said Mr Hayes.
He expressed concern about the risk of patients on trolleys spreading Covid-19 to each other as there wasn’t any large spaces between trolleys.
“It was really bad. You talk about Covid-19 restrictions, trolleys were placed together head to toe. It was scandalous in the midst of the pandemic.
“There was a high risk that patients could pass Covid-19 to one another. It has been reported there are Covid-19 patients in UHL and a few in the ED. I nearly freaked out when I heard that.
“I have avoided Covid-19. That is the last thing I want to get, I would be dead if I got it.
“I could listen to peoples’ stories in front and behind me, and they could listen to my story. It was a disaster.”

Concern has also been expressed by INMO assistant director of industrial relations officer, Mary Fogarty, who said it much harder for UHL to manage any kind of infection including Covid-19 when it is experiencing persistent overcrowding.
Ms Fogarty claimed that placing patients on tolleys in corridors back-to-back is hazardous in the midst of a Covid-19 pandemic.
After experiencing a pain in his stomach, Mr Hayes went into UHL at 12 noon on Thursday. A number of diagnostic investigations were completed including a CT scan. He was discharged on Sunday at 2pm.
While doctors suspected Mrs Hayes may have a hernia, this wasn’t the case.
In order to keep Mr Hayes overnight, he had to be admitted through the ED department.
After experiencing a pain in his stomach Mr Hayes went into UHL at 12 noon on Thursday. A number of diagnostic investigations were completed including a CT scan.
Mr Hayes thought this would be a fast process and he would get a bed fairly quickly in view of his kidney issues.
He was transported on a wheelchair to the ED on Thursday at 8pm.
Having been discharged on Sunday at 2pm, he wondered how long it takes before his bed was occupied again. He is currently on home dialysis.
On Friday morning, a nurse from the renal unit came to him and carried out manual dialysis on a quieter section of the ED at 10am and completed another one at 2pm.
“I went up to the desk a few times looking for a bed and threatened to leave. I was told if I left, they would not be able to admit me back that quickly. I decided to stay.
He is receiving dialysis treatment from nephrologist Professor Austin Stack, who visited him on Friday afternoon at 3pm and was annoyed he was still on a trolley.
Finally, he got a bed in the renal unit on Friday at 6pm after spending 22 hours on a trolley.
“I was really horrified about the whole idea of spending so long on a trolley. My back and legs aren’t great. I am paying taxes most of my life. It was my worst experience, having spent 52 years being treated in different hospitals in the Mid-West, Cork and Dublin.
He said a friend of his from Corofin who is 81 and is visually impaired was admitted to the ED at 1am that night. He said this man had to lobby for his daughter to come in and help him go to the toilet.
“There were a lot of older people than me who couldn’t speak up. It is very bad, I couldn’t describe it to you. I have mobility issues and walk with two canes Getting up on the trolley is one thing, getting down is another.
“The overcrowding is very bad and it shouldn’t be necessary to have so many people in a tight space. I had an awful job to find out who is in charge of the ED.”
Meanwhile, the HIQA inspection found UHL was compliant with two of the six of the National Standards for the Prevention and Control of Healthcare-associated Infections in Acute Healthcare Services assessed.
A judgment of substantially complaint was made against two standards and a judgment of
partially complaint was made against two standards.
The hospital had a suite of infection prevention and control guidelines which covered
aspects of standard precautions, transmission-based precautions and outbreak
management.
In addition, inspectors were provided with a number of Covid-19
plans developed by directorates to support and guide staff on the management of
scheduled and unscheduled patient care during the pandemic.
Up-to-date guidelines and Covid-19 information was made available to staff in
electronic format on computer desktops via the “iHub”.
“The clinical areas visited on the day of HIQA’s inspection were visibly clean.
However, further actions are needed to reduce infection control risks at the hospital,
especially when one considers the aforementioned difficulties University Hospital
Limerick faces in relation to ward infrastructure in some of its older wards, and the
potential for overcrowding, which pre-pandemic was severe.
Concern has also been expressed by INMO assistant director of industrial relations officer, Mary Fogarty, who said it much harder for UHL to manage any kind of infection including Covid-19 when it is experiencing persistent overcrowding.
Ms Fogarty claimed that placing patients on tolleys in corridors back-to-back is hazardous in the midst of a Covid-19 pandemic.
After experiencing a pain in his stomach, Mr Hayes went into UHL at 12 noon on Thursday. A number of diagnostic investigations were completed including a CT scan. He was discharged on Sunday at 2pm.
While doctors suspected Mrs Hayes may have a hernia, this wasn’t the case. In order to keep Mr Hayes overnight, he had to be admitted through the ED.
After experiencing a pain in his stomach Mr Hayes went into UHL at 12 noon on Thursday. A number of diagnostic investigations were completed including a CT scan.
Mr Hayes thought this would be a fast process and he would get a bed fairly quickly in view of his kidney issues. He was transported on a wheelchair to the ED on Thursday at 8pm.
Having been discharged on Sunday at 2pm, he wondered how long it takes before his bed was occupied again. He is currently on home dialysis.
On Friday morning, a nurse from the renal unit came to him and carried out manual dialysis on a quieter section of the ED at 10am and completed another one at 2pm.
“I went up to the desk a few times looking for a bed and threatened to leave. I was told if I left, they would not be able to admit me back that quickly. I decided to stay.
He is receiving dialysis treatment from nephrologist Professor Austin Stack, who visited him on Friday afternoon at 3pm and was annoyed he was still on a trolley.
Finally, he got a bed in the renal unit on Friday at 6pm after spending 22 hours on a trolley.
“I was really horrified about the whole idea of spending so long on a trolley. My back and legs aren’t great.
“I am paying taxes most of my life. It was my worst experience, having spent 52 years being treated in different hospitals in the Mid-West, Cork and Dublin,” said Mr Hayes.
He said a friend of his from Corofin who is 81 and is visually impaired was admitted to the ED at 1am that night. He said this man had to lobby for his daughter to come in and help him go to the toilet.
“There were a lot of older people than me who couldn’t speak up. It is very bad, I couldn’t describe it to you. I have mobility issues and walk with two canes Getting up on the trolley is one thing, getting down is another.
“The overcrowding is very bad and it shouldn’t be necessary to have so many people in a tight space. I had an awful job to find out who is in charge of the ED.”
Responding, UL Hospitals’ Group stated sustained high volumes of attendances, including many frail elderly patients with complex medical conditions, have continued over several weeks now.
“In line with national guidance, at the point of presentation to ED, patients presenting for assessment are segregated into Covid/query Covid and non-Covid streams.
“Stable medical and surgical patients in the non-Covid stream are directed to the Medical Assessment Unit and Surgical Assessment Unit, which since March 2020 have been operating as medical and surgical EDs.
“Those non-Covid patients who must remain in ED are completely separated from patients in the Covid/query Covid pathway and there is no crossover of staff.
“Every effort is made to comply with social distancing in the ED but such has been the volume of emergency presentations and admissions in recent weeks that this is at times difficult to achieve.
“In delivering care in ED, we need to balance infection prevention and control precautions against promptly assessing and treating patients in line with their clinical need.
“The risk of asymptomatic transmission of Covid-19 remains in all healthcare and non-healthcare settings as long as the virus is not suppressed.”

by Dan Danaher

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