Thousands of patients infected with MRSA were the victims of hospitals chronically ill-equipped to control the disease, damning HSE files reveal.
The pressure group MRSA and Families maintains that new information displays a "cover-up" of the extent of the infection and of a hygiene crisis in hospitals.
Released for the first time, minutes from infection-control meetings at five major hospitals obtained by the Sunday Tribune show the inability to deal with a problem that now threatens meltdown in the health service as a result of pending legal actions.
The files – obtained from the Mater and Beaumont hospitals in Dublin, Waterford Regional Hospital and the South Infirmary and Mercy University hospitals in Cork – expose damning shortfalls in medical systems.
They detail incidents including the re-use of disposable syringes, trolleys covered in blood and dirty ventilation systems.
"I knew how bad things were but we never got the whole story; it was covered up," said Margaret Dawson of MRSA and Families.
"When we spoke out for the first time, people were amazed. There was something terribly sinister about it but if we knew the truth about infection in our hospitals we would all be out there [campaigning]."
Dawson maintains a "culture of silence" rotates around the need not to scare the public. And while hospitals insist there have been dramatic improvements in recent years, some of the findings by infection-control teams are frightening.
Difficulties faced by hospitals primarily relate to hygiene control, an inability to contain infection by isolating patients and the behaviour of staff.
Many patients who contracted MRSA were not told by medical staff.
In terms of basic hygiene, the files show a failure by staff to follow procedures for the cleaning of equipment and rooms, possibly the most common and disturbing aspect of shortfalls.
Complaints over cleaning standards are rife. At Waterford Regional, a letter relating to theatre-cleaning describes dirty trolleys, in some instances "covered in blood and bodily fluid".
Chairs, beds and equipment were routinely found to be unacceptably unclean. Kitchens, ventilations units, bed pans, bed pan washers, bed frames, food tables, telephones, ambulances, rooms, and floors were all noted as major potential contributors to the spread of infection.
In 2004, Waterford was criticised for "cleaning dirty equipment containing blood and vomit in an old bath".
The following year, a report said cups were washed in the same sink that was used to wash down blood.
A report at the Mercy University Hospital in Cork in 2004 lambasted staff after a blood-stained X-ray request form was submitted by the oncology unit. "This was a very serious offence with the potential for enormous implications for both hospital and staff," it said.
In one bathroom, towels, soap and toilet paper had not been checked for almost two weeks, while cleaners were unaware of special procedures for MRSA- infected areas.
While removing cardboard from the hospital, a waste-collection agency complained that clinical waste, including blood- stained gloves and syringes, had been discovered.
Linen in the laundry room was found to contain needles, scissors, urinary catheter bags, a kidney dish, surgical swabs, holy communion cards and oxygen masks.
The Mater Hospital noted in 2006 that hospital beds were in urgent need of power-washing.
As with all infection-related illnesses, the lack of isolation facilities remains a serious problem. All of the hospitals note this, with cases of patients being mixed together quite common.
A letter in 2006 from Dr Samuel McConkey, a consultant in general medicine and infectious diseases, discussed "the transmission of MRSA in St Patrick's ward from a patient known to have MRSA in his bloodstream, bones, soft tissue abscesses and extensively on his skin to other patients in the high- dependency unit.
"This high-secreter patient with MRSA was housed with four other people who were not known to have it [and] at least two of them certainly acquired MRSA from this patient.
"I think it also would be of public alarm and alarm to our patients if they thought that coming into Beaumont they are possibly going to be housed next door to somebody with MRSA who is shedding it extensively from their skin."
The practice and attitude of staff towards personal hygiene was also found to be lacking in all hospitals, particularly in the area of hand-washing.
At Beaumont, an audit of staff in 2005 found that nearly 80% did not decontaminate their hands with alcohol-based gels before entering isolation rooms.
A quarter chose not to wear protective equipment such as gowns and 44% did not disinfect after leaving isolation units.
The Mater claims considerable inroads have been made in cleaning and hygiene audits over the last three years.
Files on the hospital illustrate that this was clearly needed. Beds were in urgent need of "power washing", methods of cleaning behind radiators had to be identified and a revision of glove-changing and hand- washing policy was only undertaken in 2006.
As with all hospitals, isolation was also identified as a significant problem. In 2005, a survey of 87 rooms found that none were compliant with infection-control standards.
Legal concerns were expressed in a letter from a senior doctor in 2006. "Frequently, patients who are MRSA-positive are nursed alongside patients who are MRSA-negative, which is completely unacceptable," the doctor said.
"The situation continues to cause considerable concern among patients and relatives and could have future legal repercussions for the hospital."
In the meantime, the hospital has introduced mandatory attendance at hygiene education sessions and claims that this has "developed a culture of importance", something which had been lacking in hospitals generally.
Between 2007 and 2008, it said the number of patients acquiring MRSA was reduced from 314 to 307, while clinical-infection rates, specifically, were down by 21% for the same period.
Basic hygiene was a principal concern to infection-control teams and the files at MUH paint a grisly picture.
Files show that in 2002 the Southern Health Board contacted the hospital over the catering department and in particular the pastry area, which it felt posed a physical and microbiological hazard.
Blood-stained sheets were not going straight to the laundry, cleaners were unaware of special requirements for cleaning MRSA-infected areas while a waste-collection agency complained that when collecting cardboard it came across medical waste.
Bed frames were found to be blood-stained, air vents clogged and dirty.
Linen in the laundry room was also found to have syringes, scissors and surgical swabs.
MUH says it has since been "proactive in ensuring a safe environment for our patients".
There has been extensive training in and auditing of hand-washing, increased isolation of MRSA- infected patients, a review of antibiotic use and the use of alert systems on files.
"As a result, the number of newly diagnosed MRSA cases has dropped to less than half the rate in 2008 and is continuing to reduce," it says.
"Hospital-acquired cases are less than 30% of that total and this proportion is also falling."
In the last three years, the hospital has undertaken the impressive task of screening every patient admitted, but previous conditions were disturbing.
In 2007, the situation was said to be getting worse. The policy was not to isolate patients with MRSA as there was not enough capacity to do so.
There were concerns over the re-use of single-use syringes while just 8% of student nurses and 17% of consultants were found, in an independent audit, to be compliant with hand-hygiene.
In a bizarre insight into priorities at the hospital, a memo in 2005 noted: "Currently we are not complying with national guidelines and place ourselves at considerable risk given the current media and legal issues pertaining to hospital-acquired infection."
There were concerns that many patients were not being told of their infection; there were numerous public complaints over hygiene and in 2007, a letter stated that "efforts to control MRSA so far have largely been a failure despite the great efforts made recently with improving hygiene."
Now, all patients are screened and a janitor has been hired to clean isolation areas, four more isolation rooms have been added and infection-prevention guidelines are given to all staff members.
Hand-hygiene audits are carried out and facilities have been upgraded.
In 2004, an "education day" on hand-cleaning was attended by just eight members of staff, illustrating the prevalent hygiene culture.
As with all hospitals, Waterford insists it has come a long way, but the files from the last decade are damning.
In 2004, nine patients died with a principal diagnosis of MRSA, 41 with a secondary diagnosis.
Again, substantial shortfalls in isolation units were highlighted. While technical services insisted they had been cleaned, half of the ventilation units on site were found to be dirty.
In 2005, cups were washed in the same sink used to wash down blood and it was found that there was just one sink to every five to 10 beds. In 2004 alone, there were 342 new cases of MRSA infection.
Between 2006 and 2009, the hospital said there was a reduction in infections from 47.1% to 24.5%.
Several measures were introduced including senior management "walkabouts", robust management of contract cleaning, training programmes and an increased focus on hand-hygiene.
According to the most recent national hygiene audits, Waterford Regional was one of the top three performing hospitals in the country.
Beaumont Hospital, citing a drop of over 30%, said the level of bloodstream infections had been dramatically reduced over the last four years.
This position is in keeping with the fact that the majority of concerns relate to the 2005/2006 era, when screening and isolation were the central problems and the mixing of patients was described as "unacceptable".
Concerns were outlined over routine screening not being carried out, staff not washing hands, and the possibility of suspending infection-prevention services due to a lack of resources.
At one stage, the hospital spent €775,000 replacing all of its sinks while in 2006 the committee noted that infection rates were twice the national average. One- third of MRSA-infected patients were not isolated.
In a 2004 letter to the chief executive, concerns were expressed over the resignation of a surgeon due to recurring MRSA problems. But the hospital said its improvement rate was ahead of the national average and "further progress is constantly being sought".
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