THE DEPARTMENT OF Health has told the Rotunda Hospital to rely on short-term measures to keep vulnerable babies safe as the maternity hospital copes with overcrowding and infection outbreaks in its neonatal intensive care unit (Nicu).
The Department told the hospital that any further investment in the Parnell Square campus must be strictly limited to investments which are “essential to address priority patient safety risks”.
The Master of the Rotunda wrote to the Minister for Health in May warning him of an “intolerable patient safety crisis” due to overcrowding and poor infrastructure in the maternity hospital’s Nicu.
The Rotunda, which is responsible for over one-quarter of Ireland’s neonatal intensive care capacity, was forced to close the unit earlier this year due to the outbreak of a multi-drug resistant organism, as reported by TheJournal.ie following an investigation by Noteworthy.
Professor Fergal Malone told Simon Harris the only “viable” way to solve its space and patient safety crisis involved the construction of a new building on the west side of Parnell Square. He asked the minister for “urgent assistance” in progressing the required decision-making and funding necessary to advance such development plans.
In its written response – obtained under Freedom of Information by TheJournal.ie - the Department of Health told Professor Malone that these patient safety issues are “clinical risks which cannot be addressed in the short term by a capital development”, adding that any capital development solutions are a “number of years away”.
“Therefore, it is very important to ensure that short-term measures to manage and mitigate the identified risks, from an operational and clinical perspective, are in place,” the Department of Health said.
In that context, infection prevention and control precautions and interventions must be fully implemented, and specialist expertise support should, where required, be sought and actioned. I trust that this situation will continue to be very closely monitored.
In May, Malone said the hospital had been struggling to contain an infection, identified as “ESBL-producing Klebsiella”, for six weeks, adding that eight premature babies had been affected by the outbreak.
One baby which had been infected died after 25 weeks’ gestation – the exact cause of death is yet to be determined by the Dublin City Coroner. Three other babies developed an invasive infection with this bacteria.
The principal factor in the spread of this infection, Malone says, is overcrowding, as critically ill babies are being cared for just metres apart.
This week, a spokesperson for the Rotunda Hospital told TheJournal.ie the current situation is the subject of ongoing discussion with a number of stakeholders including the Department of Health, “which hopefully will lead to a positive outcome”.
The hospital confirmed that there have been no recent infection outbreaks.
Winging it
In 2015, the then-Minister for Health and current Taoiseach, Leo Varadkar announced that the Rotunda would be relocated to Connolly Hospital in Blanchardstown as part of a six-year health capital programme.
The Rotunda said it has had extensive interactions with HSE Estates, HSE Acute Hospital, RCSI Hospitals Group and the National Women and Infants Health Programme looking at the steps required to relocate to Connolly and also at the possibility of an interim structure on the current Parnell Square campus.
Malone said these interactions “reinforced the reality that the relocation of the Rotunda to Connolly is a minimum of 10-15 years away, and likely longer”.
Malone told Harris previously that the Rotunda’s West Wing development is the best solution to patient safety needs while also remaining consistent with its longer-term goal of relocation to the Connolly campus.
However, the Department of Health believes the issues “will be best addressed through the provision of a new co-located hospital at Connolly Hospital campus”.
You will, therefore, appreciate that in circumstances where there are plans to build a new facility at Connolly, the funding for which will be provided through the NDP, any further investment in the Parnell Square must be strictly limited to that investment which is essential to address priority patient safety risks.
The department added that the timeframe for the delivery of any capital project is determined by the availability of funding.
Overcrowding
A 2017 Hiqa report found that the infrastructure of the Rotunda’s neonatal unit and post-natal ward were outdated and did not meet desirable modern standards or “facilitate the implementation of effective infection prevention and control measures”.
Hiqa’s report noted that staff in the neonatal unit worked within a very challenging infrastructure. It said that space around cots in open plan areas was “very limited and was not in line with current recommendations which poses a risk of spreading infection in the unit”.
During the inspection, the hospital management team reported to inspectors and documentation showed that there had been an increase in the number of outbreaks of infection in the neonatal unit in 2017.
In August 2017, work began on a new four-bed extension to the special care area, followed in January 2018 by a renovation and modernisation of the remaining Nicu which was completed by December.
Despite these refurbishments, ideal incubator and cot spacing could not be achieved in the Nicu due to “space restrictions”.
Each Nicu cot area should have 16m2 of space but according to Malone, the Rotunda can only provide 5m2 of space for each baby’s care.
Speaking about the lack of space, Malone described how many of the Rotunda’s most critically-ill premature babies are being nursed in incubators less than one metre apart, making repeated infectious outbreaks “virtually inevitable”.
The Rotunda is currently engaging with the families of the eight babies involved in the outbreak from early this year, in line with HSE guidance on open disclosure.
Malone warned Simon Harris that the potential financial liabilities for the state associated with Clinical Indemnity Scheme payments for “damages or dead babies may be very significant, potentially exceeding the cost of our proposed interim development”.
The Department of Health said Minister Harris is keen to Malone, the CEO of the RCSI Hospital Group, the National Women and Infants Health Programme and HSE estates to discuss the issues.
The letter seen by TheJournal.ie stated that Simon Harris was very concerned regarding the content of Malone’s previous letter but that he has “reservations that this issue was not escalated to the HSE , and in turn the Department, in line with the normal operating procedures”.
“Given the nature and importance of this outbreak as a patient safety issue, the Department has activated the Department of Health/HSE Patient Safety Communications Protocol.”
The Department said this protocol is in place to facilitate a timely and relevant flow of information on patient safety issues where significant/major patient safety issues are identified. It is used for both the initial notification and ongoing follow up and updates.
With additional reporting from Ken Foxe and the team at Noteworthy.ie – find out more about their work here.
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