My Department and I were kept informed of an external review commissioned in 2017 by University of Limerick Hospitals Group (ULHG), regarding patients with CPE and concerns regarding whether CPE was a factor in the deaths of a number of these patients. An internal review was also conducted. The final report, 'Report on the death of patients in whom CPE had been detected', combines the two review findings and was published in October 2018.
I am aware that the final Report was produced on foot of concerns raised under Protected Disclosures procedures and also concern by ULHG about the increase in detection of CPE in UHL in recent years.
I note that the Report found that out of a final group of 73 patients in which CPE was detected from February 2009 to May 2017, 8 patient deaths were identified in whom CPE was considered to be a contributory factor. The conclusion of the external review, however, which ULHG has accepted, was that no deaths were a direct result of CPE acquisition. All 8 patients had serious underlying diseases and co-morbidity factors. In addition, of the remaining 65 deceased patients, the external reviewer concluded that CPE was found not to have been an associative factor in their deaths. This is an important finding and will inform the work already ongoing in my Department and the HSE to tackle healthcare associated infections and antimicrobial resistance (HCAI/AMR).
The Deputy will be aware that since the first outbreak of CPE in a group of patients at UHL in 2011, the Hospital Group has been active in screening for CPE. ULHG have advised that they limited its spread within the hospital through enhanced 'cohorting' or isolating of patients known to be carriers of or those infected with this bacteria. Screening protocols have been in place at UHL for a number of years and indeed have been used as a template for the development of the national screening policy for CPE, published in February 2018. Measures taken by the ULHG over the past three years include the refurbishment of an inpatient ward at UHL to facilitate an Infection Prevention and Control (IP&C) isolation ward; a second ward at UHL has also been refurbished. The new Emergency Department which opened at UHL in May 2017 was designed with IP&C in mind and has facilitated the management of relevant patients in en-suite isolation rooms.
My Department has provided funding to expand the HSE HCAI/AMR National Team to progress work on HCAIs/AMR across the HSE, including Hospital Groups and Community Healthcare Organisations. My Department has also provided funding for additional capacity in IP&C and laboratory services. This includes new posts for University Hospital Limerick.
I have been previously assured that ULHG have measures in place to appropriately support and manage patient care needs in line with national and international best practice.
The challenges of CPE are not unique to UHL. In October 2017, I convened the National Public Health Emergency Team (NPHET) as a result of the activation of the Public Health Emergency Plan, as a public health response to CPE in Ireland.
My Department and the HSE will continue to work closely together on this important issue. This is also in line with the priorities identified under Ireland's National Action Plan on Antimicrobial Resistance 2017-2020.
As part of the enhanced surveillance of CPE established via the National Public Health Emergency Team, the HPSC now publishes a monthly CPE surveillance report. This surveillance report includes national data on rates of CPE infection and colonisation as well as data on outbreaks, screening and other related information. The information is available for all hospitals including UHL. Data are available from December 2017 and all reports are available on the HPSC’s website hpsc.ie.