The regulator tasked with conducting external infection and hygiene inspections at hospital wards across Northern Ireland, has never inspected the Neonatal Unit at Belfast’s Royal Jubilee Maternity hospital, according to Northern Ireland news and analysis website The Detail.
Last week it emerged that three babies had died in the ward over a two-week period within the last month as a result of Pseudonomas bacterial infection.
Pseudomonas can cause breathing difficulties and tissue damage. It is believed it can take hold in areas such as sinks and in water pipes with stagnant water. The bacteria can live for several days on surfaces but can be eradicated by vigorous hand-washing.
The Detail has carried out a series of investigations exploring the role of the Regulation and Quality Improvement Authority (RQIA) in providing oversight of hospital hygiene.
Following news of the infection outbreak, we asked RQIA of details of its oversight of the hygiene regime at the Royal’s neonatal unit.
It confirmed that the authority had not inspected the neonatal unit at the Royal and that, given the unannounced nature of its inspection programme, it was not in a position to advise of planned activity.
In 2008, following the outbreak of other C Diff cases in the Northern Trust area, the RQIA was tasked with conducting infection prevention/hygiene inspections at hospitals across Northern Ireland.
Even if the RQIA identifies concerns through inspections it can only make recommendations for improvement to the relevant trust or health board.
It is only in exceptional circumstances that the RQIA can refer a report directly to a chief executive of a health board or trust.
RQIA can also refer a report directly to Health Minister Edwin Poots.
RQIA was recently involved in the development of a new regional standards for hygiene and infection control as well as a review of the department’s Cleanliness Matters Strategy. These were approved by the Minister in early July 2011.
There were 29 individual inspections conducted during 2010 at acute and a further 36 inspection in 2011 at maternity and mental health facilities across all five health and social care trusts.
The RQIA carried out two unannounced infection/prevention hygiene inspections at the Royal Jubilee Maternity Hospital on the 31st March 2009 and again on 26th May 2010 .
However, both inspections focused on the delivery suite and did not include the neonatal unit, the RQIA confirmed to us in a statement.
The Belfast Health and Social Care Trust’s annual accounts for the year ending 31st March 2011, include a statement on internal control which says that infection control and hand hygiene procedures were not being adequately and consistently performed across sites.
It states: “The trust accepts that compliance with hand hygiene can still be improved. Service groups will be reminded of their responsibility for the implementation and review of hand hygiene audit results. Further support is provided through independent Infection Prevention Control Team audits.”
Through the Cleanliness Matters- A Regional Strategy for Improving the Standard of Envronmental Cleanliness programme, all trusts have a duty to ensure that high standards of environmental cleanliness are being met and maintained. Trusts are meant to undertake regular comprehensive “departmental” audits of functional areas. The regularity of the audit is based on the frequency recommended for the particular risk category of the functional area:
Very high risk – All rooms within a very high risk functional area should be audited at least weekly.
High risk – All rooms within a high-risk functional area should be audited at least monthly.
Moderate risk – All rooms within a moderate risk functional area should be audited at least once every three months. Low risk All rooms within a low risk functional area should be audited at least once every six months.
Apart from the RQIA inspections, trusts can seek an independent external audit of the quality of environmental cleanliness standards by consulting the Northern Ireland Communicable Disease Surveillance Centre (CDSC).
It was established in March 1999 by the Department of Health in Belfast in collaboration with the UK Health Protection Agency (HPA). Its aim was to provide high-quality information and knowledge to support policy makers, professionals and the public in order to facilitate the control of communicable disease in Northern Ireland.
The group is now overseen by the Public Health Agency and It is supposed to receive laboratory reports of significant infections, notifications of infectious disease and returns from genito-urinary medicine clinics. It also provides support and advice to health and social services boards with field investigations.
When outbreaks occur the body can be invited to participate in regional outbreak investigations and can assist Consultants in Communicable Disease Control and Consultant Microbiologists in local outbreak investigation. In a statement from the Public Health Agency it said:
“The Health Protection Service, Public Health Agency, is working closely with Belfast Trust on their investigation and management of the pseudomonas outbreak at the neonatal unit. PHA Health Protection staff are providing specialist advice for the epidemiological investigation, infection prevention and control within the unit and for identification of potential source.”
The questions that rermain
The latest results show that none of the 24 babies who were patients at the Belfast’s Royal Jubilee Maternity’s neo-natal unit at the time news of the outbreak broke last week have shown signs of an active infection of Pseudomonas. However five babies are being closely monitored because tests showed they have the bacteria on their skin.
The Belfast Trust is already undertaking a major investigation which they hope will answer not only how the infection got into the neonatal unit, but also how it was rapidly transmitted throughout the ward.
In the meantime many questions remain unanswered, such as: why did the trust wait almost two weeks before carrying out a deep clean and what measures are now being implemented to minimise risk in the ward after the deep clean operation?