The number of staff at Limerick's hospital group who are now off work or self-isolating as a result of a Covid-19 infection outbreak has risen to 221, up from 161 last week.
The group has confirmed that most of those affected work at University Hospital Limerick, the region's acute hospital.
Further cases emerged as testing and tracing continued at the hospital last week.
One staff member tested positive and then contact tracing affected further members of various hospital teams.
Those affected include staff who tested positive for Covid-19 through workplace and community transmission, close contacts of those cases, as well as any staff who are showing symptoms and who are staying off work in line with health guidelines.
Up to six wards now have beds blocked, as these wards remain closed to new admissions in an effort to curb the outbreak.
Most elective and outpatient appointments and endoscopy procedures at UHL and at Ennis hospitals have been cancelled since last Thursday.
A decision will be taken tomorrow or Friday if further appointments need to be cancelled next week.
All patients in all wards at University Hospital Limerick are being swabbed.
An enhanced temperature monitoring temperature programme is now in place for all staff to have their temperature checked before their shift as part of the infection control response across the hospital.
The outbreak among staff is being blamed for a spike in Covid-19 infection numbers in Limerick, which registered 88 cases on Monday, down to 44 yesterday.
Separately, Regional Hospital Mullingar has implemented its Full Capacity Protocol as it deals with a "lot of seriously ill patients with a variety of complex healthcare needs".
In a statement, the hospital apologised for "the distress or inconvenience caused to patients or their loved ones who are experiencing long wait times".