Royal Victoria Hospital's neonatal ward 'should be replaced'
A hospital neonatal unit where three babies died in Belfast should be replaced to improve infection control, a report into the pseudomonas outbreak said.
The design does not allow enough space around each cot and there is a lack of appropriate accommodation for isolation or cleaning equipment in the regional neonatal intensive care centre at the Royal Victoria Hospital's maternity section. This does not help maintain good infection and prevention control practices, the review team said.
"It is recommended that the move to a new unit is expedited as quickly as possible," its report said.
"In the interim, steps should be taken to create improved facilities for segregation of babies with infections and for cleaning equipment and incubators."
The review panel from the Regulation and Quality Improvement Authority is investigating the deaths of four babies who had contracted the infection.
Its first interim report addresses the causes and impact of the outbreak, and the full report is due by the end of May.
Three babies died in the Royal Jubilee Maternity Unit in January, while another newborn died at Londonderry's Altnagelvin Hospital in December. The report said there were delays in sharing information about the outbreak between health trusts.
All 175 taps in Northern Ireland's neonatal units are being replaced, with priority being given to taps where contamination had been detected.
Neonatal wards also conducted deep cleans and intensive checks for the bacteria that can be found in water supply units.
Only sterile water is being used for the direct care of patients and the report recommended that this be made permanent.
Pseudomonas aeruginosa is found widely in soil and stagnant water.
The team, chaired by Professor Pat Troop, made 15 recommendations including that sterile water should be used when washing all babies in neonatal care until recent guidance issued by the Department of Health in England has been considered.
:: The development of the new Regional Neonatal Intensive Care Unit at Royal Jubilee Maternity Service should be expedited as soon as possible. In the interim period, improved accommodation for the purposes of isolation and for the cleaning of equipment should be made available for the current unit. Steps to improve the space around each cot should be considered.
- Tap water should not be used in maternity and neonatal units during the process of defrosting frozen breast milk. Fresh guidance for water testing in all units should be reviewed.
- The presentation of test results of water samples should be standardised across the laboratories which undertake the tests.
- Guidance on cleaning sinks should be reviewed and regional advice on cleaning incubators and other specialist equipment should be produced.
- Hand hygiene audits should be carried out on a regular basis.
- The intensive care accommodation at the neonatal unit at Antrim hospital should be expanded to allow more circulation space around cots.
- When cases of pseudomonas are identified taps and sinks should be tested in rooms which have been occupied by the baby since birth.
- Organisations should establish a regional protocol for declaring outbreaks, and arrangements for identifying the strain of pseudomonas in Northern Ireland should be made.
- The hours of availability for the regional transfer service for neonates should be expanded with plans put in place to move to a 24-hour service.
The outbreaks of infection of Pseudomonas aeruginosa, which occurred in the neonatal units at Altnagelvin and Royal Jubilee Maternity Hospitals, were linked to contaminated tap water in the intensive care rooms of the units. There is no definitive evidence to link a cluster of cases in Craigavon Neonatal Unit, and a single case of a colonised baby in Antrim Neonatal Unit to water sources in those units.
Installation of sensor taps in Altnagelvin Royal Jubilee Maternity and Craigavon hospitals prior to the incidents may have contributed to creating an environment for pseudomonas to become established.
The most likely method of spread of pseudomonas from contaminated taps to babies in Altnagelvin and Royal Jubilee neonatal units was through the use of tap water for washing during nappy changes.
The use of tap water in the Royal Jubilee Maternity Services to defrost breast milk may also have contributed. Invasive procedures (like inserting drips) are likely to have contributed to the development of infection when babies had been colonised with the organism on their skin.
Information about cases which had occurred in other trusts was not always readily available to inform critical decisions, the report added.
There is no agreed system for the surveillance of pseudomonas colonisation and infection and this led to delays in sharing of information between trusts. It is recommended that a surveillance system is established as soon as possible.