Conditions at the National Liver Transplant Unit at St Vincent's University Hospital in Dublin have been criticised following an inspection by the Health Information and Quality Authority.
The health watchdog has also warned of high risks with infection, in particular, concerns about a serious bacterial infection resistant to antibiotics, called VRE, at the hospital.
The unannounced inspection took place on 30 March and says that St Vincent's has not acted on what was learned from a 2014 outbreak, to reduce risks to patients.
The inspection report, published today, says that the poor infrastructure and facilities in the St Brigid's Ward, the National Liver Transplant Unit, do not aid effective infection and prevention control.
HIQA also found poor compliance with transmission based precautions and wrote to the hospital's chief executive to seek assurances on the issue.
In the 21-bed National Liver Transplant Unit, inspectors found insufficient en suite isolation rooms for patients; that not all single rooms used for isolation had en suite shower or toilet facilities; patients colonised with resistant bacteria were sharing with patients not colonised with resistant bacteria; and there was limited space between patients in multi-bed rooms.
The inspection also noted an increased incidence of VRE infection seen at the hospital in 2014 and 2015.
In 2014, the hospital reported the first outbreak in Ireland of Linezolid-resistant VRE infection in the National Liver Transplant Unit.
HIQA said this was a concern as it limits the treatment options for seriously ill patients.
The hospital said that the outbreak was likely facilitated by the practice of putting patients in multi-occupancy rooms, with shared toilet facilities.
St Vincent's told HIQA that it recognised the incidence of VRE and the infrastructure of St Brigid's Ward were significant issues.
It also said it was working to deal with the issues within the confines of its budget allocation and the pressures arising from a lack of beds in the face of increasing clinical demands.
The hospital said that it had taken measures to deal with VRE including increased screening, single room isolation, or grouping patients colonised with the infection.
In a statement, St Vincent's added: "It is our policy to maintain the highest possible standards of hygiene in all our clinical activities at all times, and in that spirit we accept all the findings of the HIQA Report, which we will use to further improve the delivery of our services for our patients.
"It is gratifying that the HIQA inspectors found that 'overall the patient environment and patient equipment was generally clean at the time of inspection'."
The Chief Executive of the Irish Kidney Association said the unit is not fit for purpose.
Mark Murphy said the HIQA report was welcome, given that all of the other transplant units at Beaumont Hospital and the Mater Misericordiae University Hospital have the facilities which are missing at St Vincent's, such as single rooms and air control systems.
He said St Vincent's had performed almost 1,000 liver transplants, so despite the facilities it was a very successful unit.
