An inspection report by the Health Information and Quality Authority (HIQA) of Tallaght University Hospital in Dublin has indicated that 30% of Covid-19 cases in the first phase of the pandemic were associated with the hospital.
The report by the health watchdog found that the hospital experienced 19 outbreaks of the virus between March and December of last year.
The unannounced inspection took place in December 2020.
Overall, the report found that this inspection identified that Tallaght University Hospital was substantially compliant with two of the six of the National Standards for the Prevention and Control of Healthcare-Associated Infections in Acute Healthcare Services assessed.
A judgement of partially compliant was made against three standards and a judgement of non-compliant was made against one standard.
The report says inspectors identified numerous weaknesses in infection prevention and control measures implemented at the hospital to protect staff and patients against Covid-19.
It says inspectors found that screening of patients for exposure risk to Covid-19 on arrival at the emergency department did not take place until registration.
It says this was not in line with Health Service Executive guidelines and presented a potential weakness to the rapid identification and streaming of patients into Covid-19 and non-Covid-19 pathways.
It also says that controls in place in the emergency department to limit entry points, reduce entry to accompanying adults, ensure adequate cleaning resources, and reduce risks associated with staff crossover were insufficient.
It found that measures to prevent crossover of staff between Covid-19 and non-Covid-19 streams was not in place in the emergency department.
It says that designated Covid-19 resuscitation bays were not functionally separated from non-Covid-19 resuscitation bays, which potentially increased the risk of transmission of infection due to aerosol generating procedures undertaken there.
It also found that insufficient cleaning resources were allocated in the emergency department to maintain appropriate levels of cleanliness and decontamination, particularly in patient waiting areas.
The report says that from 29 February 2020 to 14 June 2020, 373 patients and 291 staff members at the hospital tested positive for the virus.
It says documentation indicated that during phase one of the pandemic, 30% of the cases were hospital-associated linked to 10 wards.
It says that between 20 March and 14 June 2020, the hospital experienced 11 Covid-19 outbreaks in 10 wards.
It says that contributing factors from these outbreaks indicated that greater adherence to infection prevention and control practices were required.
The report says that pre-symptomatic and asymptomatic presentations of Covid-19 also potentially contributed to onward transmission.
According to the report, the hospital developed a quality improvement plan following the first phase of the pandemic, which identified 34 areas of improvement.
On review of this plan, it says inspectors found that the majority of actionable items were completed.
It says it was was clear to inspectors that the infection prevention and control team were actively managing outbreaks in very challenging circumstances.
The report says that there was strong evidence to show that the hospital had taken steps to identify contributory factors and collate learnings from each outbreak.
But it says that despite numerous measures implemented by the hospital, several Covid-19 outbreaks continued to occur.
The report says that traffic control into the hospital and the mingling of some patients from outbreak wards in the smoking hut were identified by staff as contributing factors in onward transmission.
It cites ongoing lack of isolation facilities as an added challenge. It also says that breaches in personal protective equipment and physical distancing between staff members during breaks was a reported recurring issue.
In its response, the report says that management at the hospital indicated that it had taken action to address the findings identified.
Hospital management said that additional medical resources would be needed to facilitate a dedicated medical team to the Covid-19 pathway.
The report says that a request for these resources would have to be approved at hospital group level.
In the meantime, the report says hospital management said every effort would be made, where possible, to dedicate teams to Covid and non-Covid pathways.
Limited space in the emergency department was cited as a barrier to the implementation of pre-triage assessment of patients.
It said that ways in which this could be implemented, such as the utilisation of the Rapid Assessment Treatment Unit, were under review.
The hospital also said that it aimed to increase patient waiting areas in the department through the installation of pods.
The hospital had increased security levels and the importance of limiting accompanying adults to the emergency department was emphasised to security staff.
A risk assessment was also performed on 15 December 2020 in response to issues identified in relation to compliance with hospital personal protective equipment policy.