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HIQA criticises small hospitals on antimicrobial resistance

03 Aug 2016

An up-to-date national plan must be developed urgently to tackle antimicrobial resistance, HIQA has said in a report that is critical of the HSE’s efforts to address the problem.

While the report released last month (July 19) found that many larger academic teaching hospitals had made significant progress to reduce the risks to patients, it said more needed to be done in smaller hospitals and in the community. The Authority carried out its review last year, which involved all 49 acute hospitals completing a self-assessed questionnaire and 14 unannounced inspections. It also examined the overall national approach to managing antimicrobial stewardship.

HIQA found that a number of smaller local hospitals had no antimicrobial stewardship programme in place, and had not received resources to set one up. “We identified that a number of hospitals need urgent support from the national Health Service Executive in this area, as they do not have an antimicrobial stewardship programme in place and lack specialised resources. This is a significant patient safety concern and should be reviewed as a matter of urgency by the HSE,” said HIQA’s Acting Head of Healthcare Regulation Sean Egan.

The review found that while MRSA and Clostridium difficile rates had fallen, the incidence of multi-drug resistance amongst Gram-negative organisms was increasing.

“Unlike MRSA, patients who carry these bacteria cannot be treated to eradicate them from their bodies. Antimicrobial prescribing and infection control practices in hospitals, and equally in community health and social care settings, needs to be of a high standard to fully address this emerging problem,” Egan said.

He added that the nature of this change meant that a different, nationally coordinated HSE response was required, which extended beyond acute hospitals into residential and community care settings.

The report said it was likely the true incidence of multi-drug-resistant organism colonisation was underestimated due to the relative lack of screening. Furthermore, it said Ireland had the highest proportion of vancomycin-resistant Enterococci (VRE) causing bloodstream infection observed in Europe.

HIQA said the HSE’s organisational structure of seven hospital groups, nine Community Health Organisations and eight Public Health Departments that were not geographically aligned meant seamless coordination across areas of responsibility was “additionally complicated”.

It also pointed out that most hospital information and communication technology (ICT) systems dealing with infection operated independently of each other, and that there was greater potential for ICT to support antimicrobial stewardship and infection control.

However, it acknowledged that the Government had started planning for a new national action plan, which was due to be ready by the middle of next year.

At the start of the review process, HIQA said national structures within the HSE lacked coordination, but it added that early this year the HSE identified a named person responsible for managing the national antimicrobial stewardship programme.

It also said the Executive had established good systems for recording and benchmarking antimicrobial prescribing and for recording and comparing antimicrobial resistance rates for serious infections with other European countries.

“This review found much commendable progress by highly committed front-line staff in advancing antimicrobial stewardship, but this has been hampered by the lack of an up-to-date national plan in this area,” Egan said.

The HSE said it would actively address the opportunities for improvement identified by HIQA. “The HSE is committed to ensuring that antimicrobial stewardship, along with the prevention and control of HCAI [healthcare-associated infections], remain key priorities for 2017 and will be included in the HSE’s National Service Plan,” it stated.

Niamh Mullen

Click here to view the full article which appeared in Irish Medical Times