The Clare People Archive

OVERCROW DING and hygiene is- sues were highlighted as the main cause of the outbreak of the super bug C-diff at Ennis General Hospi- tal last year, which led to 46 people contacting the highly contagious dis- Creston

According to the “Review of In- creased Identification of Clostridium difficile at Ennis General Hospital 2007” the female medical ward was identified as an area of particular concern.

The bedpan washer leaked, broke down and required maintenance callouts during the early part of 2007, and at times bedpans were hand washed. This problem was not KON UECerOMENNLBD ERLE Elon

Occupancy levels on the Female Medical Ward ranged from a high of 105.9 per cent in February to a low of 99 per cent in May.

“There has been ongoing concerns re hygiene levels at the hospital,’ said the report.

While admitting that infection con- trol nurses raised ongoing concerns about the level of background C diff in the hospital, the report said ad- herence to many of these had been patchy with practical difficulties in implementing appropriate patient isolation, adherence to antibiotic prescription guidelines and poor at- tendance by support staff at infection control training sessions.

There was no hospital Infection Prevention and Control Committee in place from September 2006, and

although one was set up in December 2007 it still does not have input from a consultant medical microbiologist or an infectious disease consultant.

While there was some awareness of an increased level of C diff in the hospital in early 2007, the extent of the problem was not appreciated 1in1- tially by either management or clini- cal staff at the hospital, many of who considered MRSA or Norovirus a bigger threat.

The report stated that the absence of the Director of Nursing on special assignment from March until Oc- tober, the absence on sick leave of the Female Medical Ward Manager April 2006 to April 2007 and the ab- sence on annual leave of the Infec- tion Control Nurse from April 9 to April 23 may have contributed to the delay in taking definitive action in relation to the increase in cases. The situation was not declared as an out- break and an Outbreak Control Team was not convened.

“A range of actions were taken which are likely to have contribut- ed to curtailing the level of C. dif- ficile in the hospital,” according to the report. “These included: raising awareness with consultant and nurs- ing staff verbally and in writing, ad- ditional intensive cleaning, improved hand hygiene facilities, increased ed- ucation and training on hand hygiene and infection control, renewed focus on appropriate antibiotic prescribing. Disposable curtains were introduced in one area of the hospital and their use extended subsequently to other areas of the hospital.”

NURSES at Ennis General Hospi- tal, where an unprecedented spike in cases of Clostridium Difficile was detected in early 2007, have criti- cised hospital management for fail- ing to act on concerns expressed over a number of years regarding over- crowding and understaffing at the hospital.

An investigation was launched last October after a surge in the inci- dence of C diff was picked up during

routine laboratory surveillance. The matter was investigated by two sen- ior HSE doctors who published their findings on Thursday.

The report confirmed that 46 pa- tients were diagnosed with the po- tentially fatal bug during the first six months of 2007. Of those, 15 died within 30 days of being diagnosed while another six are now known to have died up to the end of 2007.

The Irish Nurses Organisation (INO) has welcomed publication of the report but expressed disappoint-

ment that issues raised by frontline staff had not been communicated to the senior doctors who carried out the investigation.

INO industrial relations officer Mary Fogarty said, “Members of the Irish Nurses Organisation at Ennis General Hospital had, in the last number of years, consistently highlighted to hospital management many of the critical contributing factors which caused a high level of Clostridium Difficile at the hospital from January to May 2007.

On a regular basis, when meetings were held with management, nurses advised that putting extra beds in front of sinks was causing the spread of infection as hand washing by staff was prohibited; overcrowding on the two medical wards was leading to very high risk of cross infection between patients and that a chronic shortage of nursing staff on two medical wards was detrimental to patient care.”

Ms Fogarty added, “A report, un- dertaken by nurses at the hospital

and Leeds University in April 2007, identified the need for 26 additional nurses and health care assistants. The additional staff have not been appointed and the INO has referred this matter to the Labour Court for implementation.”

“We are disappointed that the con- cerns of nursing staff, which were raised consistently with local man- agement over the last 3 or 4 years, were not made available by hospital management to Dr Hynes and Dr Kelleher’, Mary Fogarty added.

AMONG the recommendation made by the HSE in its attempt to ensure the outbreak of C diff last year is not repeated is the development of Ennis General Hospital.

The health authority made this statement just day after it admitted that the €39 million development project was shelved for at least 12 peepee else

In total 46 patients mainly elderly females were infected during the first

half of 2007 with the disease.

Many of those were diagnosed with a particularly virulent and highly transmissible strain PCR _ ribotypr O27 of the disease.

The damming report into the out- break recommended that the Execu- tive Management Team (EMT) of the hospital must regularly receive information about incidence and trends in healthcare associated infec- tions in the hospital as has already been agreed.

The EMT must ensure rapid identi-

fication and notification of outbreaks, and the re-established Infection Prevention and Control Committee should meet on a regular basis as had already been agreed previously.

The hospital should designate a senior executive with responsibility for infection control and a named in- dividual should be identified in each ward or clinical area with responsi- bility for implementing recommen- dations on hygiene and infection control and prevention.

Dedicated sessions of a consultant

microbiologist should be identified for the hospital and the planned pro- eramme of upgrading hand-washing facilities should proceed as a matter of urgency.

There should be an intensive pro- eramme of hand hygiene education and training of all staff followed by audits of compliance with good prac- tice and there should be a systematic programme of infection control edu- cation.

“Guidelines on appropriate an- tibiotic prescribing need to be re-

inforced and their implementation monitored,” it said.

‘The hospital needs to ensure effec- tive isolation for those patients who pose a potential or actual high risk of infection to others. The practice of ‘cohort nursing’ of infected patients on open wards must be reviewed and should be stopped for patients with undiagnosed diarrhoea. Accuracy of death certification – where ever ap- propriate the death certificate should include HCAIs (Health Care associ- ated infection).

PLANS have been lodged for a fur- ther 226 homes in the eastern out- skirts of Ennis, bringing the poten- tial number of new homes in the area to almost one thousand.

One of the country’s biggest home builders, McInerney Homes Ltd, has lodged plans for a €56 million devel- opment at Knockaderry, Roslevan.

The McInerney Homes application joins that of Crystal Partners for al- most 700 homes at Gaurus.

The first phase of the Crystal appli- cation is for 471 homes in a site that takes up 75 per cent of the Gaurus townland.

The McInerney Homes application consists of 136 semi-detached, 24 detached and 66 terraced homes.

Yesterday, Cllr Brian Meaney (GP) said that the applications were pre- mature when the current infrastruc- ture deficit in Ennis was taken into account.

“I believe that these applications are premature and I wonder if they are just kite flying exercises by the developers.”

Cllr Meaney said that the environ- ment minister, John Gormley, was to shortly introduce a new green paper

on local government to ensure that unsustainable development would not be permitted.

A site nearby to that of McInerney Homes was, last year, the subject of a Finn Properties application for 100 homes. The town council re- fused planning permission to due limitations of the town’s sewerage system. The council partly granted Finn Properties permission to extend Oakleigh Woods by 51 homes. Per- mission for 115 others was refused because of the sewerage constraints.

In an internal memo recommend- ing refusal, Town Engineer, Tom Tiernan said, “While I have no ob- jection in principle to the overall pro- posal it is impossible to approve it in its entirety at this stage.

“With a view to being in a position to accommodate development to a very limited degree at various loca- tions throughout the town, it won’t be possible to consider approval for this CCAVoaleyeyentooelmpes limo) 11N0Ko A Ae

has learned that plans to have the project finished be- fore the 2007 tourist summer season have now been scrapped.

Instead the developments’ will continue on the Lahinch lifeguard centre, which is due for completion in mid-June, with all other majors works to be suspended until after the tourism season.

“A number of brand new designs have now been shown to the council- lors and among those there are two or three realistic possibilities.

“The developers must now consult with private stake holders such as Lahinch Golf Club, Seaworld and

the Lahinch Playground committee,” said local councillor Martin Conway GnGoF

“We can’t at this point go public on the specifics of the options but what we saw was totally new.

“The councillors made observa- tions but we reserved any judgement until after the developer spoke with the interested local parties.”

It was, however, confirmed that some minor works would be carried out on the much delayed project over the summer.

“We felt that significant progress had been made in the last number of weeks. We are now three weeks into the building work on the lifeguard centre which is expected to take three months, so that should be completed before the height of the summer sea- son,’ continued Cllr Conway.

“Some minor works will be car- ried out throughout the summer and I would hope for major developments to start this autumn.

CLARE County Council has disre- garded the objections of the Sister of Mercy and other Lahinch residents and granted planning permission for a €25 million housing development in the seaside resort.

Last year, Brendan O’Doherty, Patrick Montgomery, Paul Mont- gomery and John McInerney lodged plans to develop 114 residential units with a number of them to be holiday homes. The development was on a

9.5 acre site on Station Road.

Their application attracted wide- spread opposition in Lahinch. The nearby Sisters of Mercy described the plan as a “concrete jungle” pro- posal.

The nuns asked the council “to look at this development in light of the se- rious issues of anti-social behaviour on Station Road and the fact that the services to Lahinch, including sew- age, water supply and electricity, are seriously over-stretched.

In her oleyassiry leven Marie

O’Donoghue reflected much _ local sentiment when she claimed that “the character of the village is destroyed by the construction of too many holi- day homes which, in turn, is a threat to the tourism on which the village ele ores ake hae

Ms O’Donoghue quoted figures from the Census showing that the population of Lahinch dropped by 2.9 per cent between 2002 and 2006.

Michael and Maria Vaughan of Vaughan Lodge Hotel also expressed their opposition against the plan.

However, the proposed develop- ment site was zoned “residential” meaning it was always going to be difficult for the objectors to prevent the development from going ahead.

Imposing 44 conditions attached to the permission, the council has re- duced the number of residential units to 96, including 28 four bedroom homes and 21 two bedroom units.

As part of its continuing policy not to grant permission to any holiday homes, the council has placed as a condition that the homes be used as

the principal place of residence of the home-owners and that the condi- tion be included in the sales agree- ment of each dwelling.

As part of the permission, the devel- Opers are required to pay the council almost €1 million in developer con- tributions.

However, it 1s likely that the deci- sion will be appealed to An Bord Pleanala

A final decision will be made on the proposal before the end of the year.

CLARE BASED writer Nuala O Faolain revealed over the weekend that she has cancer and will soon die. In an emotionally charged interview, the Lahinch based journalist and author revealed that she learned of the diagnosed six weeks ago in New York.

The cancer, which began in her lungs but has now spread to her brain and liver, is incurable and Ms O Faolain has turned down the option OMe Toate

Ms O Faolain owns a house in Bar- tra outside Lahinch and has lived between Clare and New York for the last two decades. ;

During those years, Ms O Faolain spent much of her time in Lahinch

with fellow journalist Nell McCaf- ferty and was a regular contributor to the Merriman Summer School in Lisdoonvarna.

“T lived for years with Nell McCaf- ferty and lets say 12 of those were the greatest fun and I owe so much to them and in fact, as far as I am con- cerned, Irish women owe so much to Nell and I was dead lucky to live with her. But then again it ended up not so hot, but now it is my great pleasure to be in email contact with Nell and to thank her,’ she told RTE radio.

“Let poor human beings believe what they want, but to me its (the af- terlife) meaningless. I waited on the radio the other day to hear poor John O’ Donoghue, knowing that he is very important to many people, but to me it is utterly meaningless.

“And yet I want to mention one thing that you might play at the end, particularly for dying people, some- thing I picked up little bits here and there about Ireland, largely at the Merriman Summer School, which is one of the great things in my life.

“It’s a song I heard a few years ago called Thois I Lar an Glanna. It’s a kind of modern song sung by Albert Fry and other Donegal singers. And the last two lines are two things, ask- ing God up there in the heavens, even though you don’t believe in him, to send you back even though you know it can’t happen. Those two things sum up where I am now.”

NEXT week, Clare will travel to London and will record their fourth league win on the trot. It will bring some clear comparisons to Clare’s league run in 1990/91 when another relatively unknown Connaught man- ager came to the county and em- barked on his first league campaign.

Back then, John Maughan’s Clare began poorly, lost the opening half of their league games, then turned things around in the latter half of the competition. Incidentally, both campaigns included important wins against fancied Wicklow sides. It may be a sign.

On Sunday afternoon, with the warm down over, Frank Doherty was basking in the late afternoon sun gushing onto the Cusack park grass, but was still focused on next week- aKeb

“We’re going to take a professional view about the London game,” he says. “We’re not going away to have a bit of fun, because I want to finish the campaign having won four on the trot. I want to send a shock wave down to Waterford to say we’re not gone away, we’re here and we’re able to do business when they come to Cusack Park [in the championship] in five weeks time.”

The turn about in Clare’s league, he says, can be attributed to two com- ponents — one mental, and the other on the field.

“Confidence and training,’ he says. “I still believe if we beat Carlow we’d have been pushing the latter end of the league. This could have been a league final here today. But we lost our confidence after Carlow and then Antrim came here and gave us a wake up call and there were games

there we could have won.

“Then training was important as well. We didn’t have time to knuckle down and do some championship pace training but when the [one week] break came [just before Clare began to win again] we got back to solid training.”

The return of confidence and the opportunity to train at a pace Do- herty was happy with, provided the springboard for this hat-trick of vic- tories, culminating with Sunday’s defeat of Offaly.

“The big thing for me today was that we showed a lot of bottle and a lot of character at the end. Once they drew level, we stayed going and went down and kicked the winning point. Questions have been asked of this team and today, some of those were answered.’

After 40 minutes, with the score level, there came the odd bellow from the stands, calling on the man- ager to move things about around the centre of the field. Though Doherty didn’t heed any of those cat calls, he says Clare could have gripped mid- field with a stronger hold.

“We can do better at midfield, but we had two young lads there today, Frank [O’Dea] and Garry [Bren- nan]. David [Russell] came out and we moved Garry across, but we were missing [the suspended] Ger [Quin- lan’s] strength and presence in there as well.

“We basically have four competing for two positions. I have to put David on the team because he’s working hard and his effort has been mighty. Ger would have horsed into Ciaran McManus if he was there and that would have freed up either Garry or Frank. In fairness, the lads today are young and we have to compliment

them and drive them on rather than be hitting on them.

He’s asked about his decision to withdraw his captain, Michael O’Shea, before re-introducing him.

“I think it was obvious why he was taken off. Michael will give every- thing, he was winning ball but we were giving away ball too softly. I didn’t want to sit around and wait, so we brought on Sean Collins and he was just on a minute or two and kicked a point.

“T can never doubt Michael’s com- mitment to Clare, but turning ball over and losing it is a cardinal sin. But I put him back in and he kicked a score. I don’t want to be unkind to anybody but at times, you have to do that. You can’t kick a ball into a goalkeeper’s hands after commit- ting playing forward. It allows them re-group and leaves your team ex- posed.”

He goes on to explain that Rory Donnelly had just passed a fitness test on Saturday night and as his hamstring problem re-surfaced, the manager felt it was wiser to take him off than risk further injury. He also says the decision to play Gordon Kel- ly at corner back was a tactical deci- sion, made with the scoring threat of Niall McNamee in mind.

“Gordon did well again, he kept McNamee quiet. You can’t ask for jeeKO)KommM er: DaMAer-limae

London next week before the crunch visit of Waterford on May 25. From here, there’s no reason why Clare can’t string five wins together.

A GROUP of locals in Liscannor has warned Clare County Council not to repeat the planning mistakes made in other coastal areas.

The residents, who are opposing plans by Atlantis Developments for a mixed use development on the village’s main street, including the redevelopment of Joseph McHugh’s and Egans’ pubs, state that the coun-

cil needs to draw up a strategic de- velopment plan for the village before any more tourism based development is granted.

“It 1s apparent that over-develop- ment has already taken place in Lis- cannor and the council should be taking steps to stop it from causing irrevocable damage to the village character,” they state.

“It is now at the stage where a small cottage in Liscannor has an asking

price of €1.5 million. How can local people expect to afford a site or home when prices have reached this hugely inflated level?”

The Atlantis Development plan includes a 14-bed hostel, five-two bedroom apartments, four retail units and the two large extensions to McHugh’s and Egans.

Atlantis Development also has ap- plications for park and ride parks in Liscannor and Doolin and decisions

on all three applications are expected later this month.

The local residents state, ““Let us not forget the Holland Park development — directly opposite the site — which included commercial units along the front facade. All but two of these are empty, 1n poor repair and some have been converted to residential units.”

The residents continue, “Liscannor is a small coastal village that caters for both permanent and seasonal residents. However, the excessive fra- tio of seasonal versus permanent ac- commodation is greatly deteriorating the fabric of the community.

‘Apartments, more akin to the re- quirements of towns and cities where space is at a premium, are not justi- fiable is a small village like Liscan- nor. The only reason for apartments in such a small village is to maxim- ise profitability at the expense of the architectural setting of the receiving village.”

The residents state that currently, the ratio of holiday homes to perma- nent residences in approximately 7:1 and this figures is even higher from the church to Knockaderry where it is in excess of 10:1.

They residents claim they have been for far too long subjected to the eradual and saddening deterioration in the fabric in the community. “This has taken place by developers being given free reign to build whatever they wish wherever they wish.”

THE mother of three who suffered a cancer misdiagnosis has issued a heartfelt plea to the HSE’s chief ex- ecutive to ensure no woman is ever put in such a life-threatening situa- tion again.

In an open letter to professor Brendan Drumm, Rebecca O’ Malley launched a damning attack on the Health Services Executive. Rebecca,

from Ballina/Killaloe, was wrongly given the all-clear after tests for breast cancer in 2005 at the Mid- West Regional Hospital in Limerick and Cork University Hospital.

The misdiagnosis led to a potential- ly lethal 14-month delay in starting treatment for her condition. The 42- year-old went public on the mistake, which led to an investigation and re- port by the Health Information Qual- ity Authority (HIQA), the results

of which were published last week. The misdiagnosis was due to an er- ror, but could have been put right if the hospitals had used the recom- mended multi-disciplinary review of her case.

In her letter, Mrs O’Malley chal- lenges the HSE to name the rec- ommendations of the HIQA Which it says have already been implemented. She also calls for the appointment of an official to ensure

that all 15 recommendations are put in place.

Mrs O’Malley asks Dr Drumm to “please learn from the mistake and take us all into your confidence by adopting a new form of communica- tion with your patients”.

After the publication of the report last week, the Tipperary woman said she feels “achingly sad at the breadth and extent of the institution- al deficiencies which let me and my family down so badly and exposed me to such grievous and continu- ing danger. I am now left with vivid mental images of surgeons blindly poking their fine needles into pa- tients’ breasts without always having the obvious and beneficial assistance of ultra-sound equipment to guide their hands.”

The HSE said that it “accepts the report’s 15 recommendations which relate to clinical and process issues, a number of which have already been implemented and others are in the process of being implemented. Their implementation will be overseen by the National Director of the National Hospitals Office working with the Director of the Cancer Control Pro- rea: beeu selon

Commenting on this report and a separate report into procedures for breast treatment at Barringtons, Health Minister Mary Harney said she is “determined that each of these reports will lead to improved stand- ards of patient safety and patient care in all healthcare settings”.