National Public Health Emergency Team on...

National Public Health Emergency Team

on Carbapenemase Producing Enterobacteriaceae (CPE)

Situational Analysis

National Public Health Emergency Team on CPE Situational Analysis

21 December 2017 1

Table of Contents

List of Tables ........................................................................................................................................... 2

List of Figures .......................................................................................................................................... 2

1. NPHET Chair’s Commentary ............................................................................................................ 3

2. Purpose of the situational analysis ................................................................................................. 4

3. Key NPHET Outputs to Date ............................................................................................................ 4

4. What is CPE ..................................................................................................................................... 4

5. Background to activation of the Public Health Emergency Plan ..................................................... 5

6. National Public Health Emergency Team (NPHET) .......................................................................... 5

7. Expert Group ................................................................................................................................... 6

8. CPE data sources and surveillance figures ...................................................................................... 6

Data sources ........................................................................................................................................ 6

Surveillance ......................................................................................................................................... 7

9. HSE Governance Structures ............................................................................................................ 8

10. HSE Policies, Procedures, Protocols and Guidelines (PPPGs) ......................................................... 9

11. Communications ........................................................................................................................... 10

12. Gaps and Next Steps ..................................................................................................................... 11

Key concepts ......................................................................................................................................... 12

Appendix 1: National Public Health Emergency Team Terms of Reference, Membership and Schedule

of 2017 Meetings .................................................................................................................................. 14

National Public Health Emergency Team Terms of Reference ......................................................... 14

National Public Health Emergency Team Membership .................................................................... 14

Schedule of meetings in 2017 ........................................................................................................... 15

Appendix 2: Hospital Groups (estimated population#) and Hospitals. ................................................. 16

Appendix 3: Community Health Organisations (CHOs) ........................................................................ 18


21 December 2017 2

List of Tables Table 1: Key NPHET Outputs to Date ...................................................................................................... 4

HSE Business Intelligence Unit ................................................................................................................ 6

Table 2: Hospital Groups. Newly detected patients with CPE. Numbers. 2016 and 2017 Jan-Nov. ...... 7

Table 3: Hospital Groups. Screening for CPE and newly detected patients with CPE. Numbers.

October 2017 .......................................................................................................................................... 8

Table 4: Hospital Groups and CHOs. Status of IPC and IPC and Antimicrobial Stewardship Committee

9

Table 5: HSE CPE related PPPGs and Target Audience. ........................................................................ 10

Table 6: Gaps and Next steps ................................................................................................................ 11

List of Figures Figure 1: Total number of newly detected patients with CPE 2012-2017 (Jan-Nov).............................. 7


21 December 2017 3

1. NPHET Chair’s Commentary

The National Public Health Emergency Plan was activated on 25 October 2017 as response to the

increase and spread of Carbapenemase Producing Enterobacteriaceae (CPE) in Ireland. As a result a

National Public Health Emergency Team was convened and they have been meeting on a weekly

basis since 02 November.

The initial focus of the group has been to gather information to identify current practice in relation

to the surveillance and management of CPE in Ireland. In order to understand the scale of CPE in

Ireland and the HSE’s response capacity, the HSE have been asked to provide information on

governance arrangements, response capacity, surveillance, flows of information and levels of

implementation of action plans and national requirements.

The information gathering process has been slower than anticipated and we are not at a stage yet to

understand the true scale of the problem and the response capacity within the HSE. While some

hospital groups have made progress in 2017 on a number of CPE related issues, including more

screening, this progress has been variable. The HSE have reviewed and strengthened their

governance and implementation oversight arrangements since the National Public Health

Emergency Team was convened. However, quantification of gaps in surveillance and provision of

business cases to respond to these gaps are awaited.

Given the time sensitive nature of this issue, it is of concern to note that we are not in a position to

have a more comprehensive picture of the current situation. In particular, this applies to the actions

the HSE has taken, the impact of those actions, and the plans put in place by the HSE to date in

response to this issue.

- Dr Tony Holohan, Chair of the CPE - National Public Health Emergency Team


21 December 2017 4

2. Purpose of the situational analysis The purpose of this situational analysis is to provide an overview of the information gathered via the

National Public Health Emergency Team process to date. It includes the key outputs achieved, the

current CPE figures, governance arrangements, gaps identified and resulting next steps.

Further analysis will be carried out at hospital level to inform the work of NPHET. A situational

analysis report will be published on a monthly basis.

3. Key NPHET Outputs to Date Table 1: Key NPHET Outputs to Date

Key Outputs of NPHET to Date

1 Increased measurement and collation of various data collection bodies related to screening and identification of CPE patients

2 Increased focus on securing timely data from all clinical laboratories on the number of CPE colonised or infected patients

3 Increased communication from HSE to service providers regarding the current national Policies, Procedures, Protocols and Guidance (PPPG)

4 Initial measurement of the implementation of some of those national guidance documents/PPPGs

5 Increased clarity and strengthening of HSE governance arrangements for HCAI/AMR

4. What is CPE Carbapenemase-producing Enterobacteriaceae (CPE) is the newest in a long line of ‘superbugs’ or

bacteria that are hard to kill with antibiotics and are a particular problem in hospital settings. Of all

the superbugs, CPE is the most difficult to kill with antibiotics.

The World Health Organisation (WHO), Centre for Disease Control and the European Centre for

Disease Prevention and Control (ECDC) all identify that infections with CPE are a serious threat to

patient safety due to their resistance to multiple antimicrobials, meaning that there are very few

treatment options for infected patients. Patients infected with CPE experience poorer patient

outcomes, increased morbidity, mortality and have higher associated hospital costs.

The HSE’s National CPE Action Plan (HSE, 2017) identifies several factors that are contributing to the

rise in CPE in Irish health care settings including:

1. Inappropriate antibiotic prescribing in hospitals, primary care, and nursing homes

2. Understaffing and overcrowding in hospitals and other healthcare settings

3. Lack of adherence to standard infection prevention and control practices by healthcare workers in

hospitals, nursing homes and primary care

4. Lack of availability of suitable isolation facilities at ward level and in Emergency Departments

5. Poor infrastructure and design in hospitals


21 December 2017 5

6. Suboptimal screening, surveillance and information/IT systems to support timely communication

tracking and flagging of patients with CRE, their contacts and other Multidrug resistant organisms

(MDROs)

7. Shortage of infection control specialists (medical, nursing, pharmacists, medical scientists) at

community, hospital, and national levels

8. Inadequate environmental hygiene and decontamination of patient care equipment

9. Lack of active screening for CPE in a number of hospitals

10. Undefined clarity around indications for screening in non-acute healthcare facilities

11. Lack of awareness in general public and healthcare workers

5. Background to activation of the Public Health Emergency Plan Cases of CPE have been reported throughout the world in recent years. Ireland has seen an increase

in the number of cases year on year. The number of cases almost doubled in 2016 to 282 cases and

is estimated to increase by a third in 2017, (401 in the period from January to November). The

spread of this superbug in hospitals can lead to the closure of beds, wards and units removing

thereby, essential capacity to provide services, to admit patients from Emergency Departments and

to address waiting lists effectively.

International experience indicates that CPE and antimicrobial resistance (AMR) need to be tackled at

a national level. In March 2017, the HSE Leadership Team decided to escalate the increasing CPE risk

and to put in place a national management plan in response. In May, a National Clinical Lead was

appointed and a National Response Team was established and the Director General wrote to

National Directors, Hospital Group CEOs and Community Healthcare Organisation Chief Officers

setting out the national and local response required across the health service. Implementation of

governance and screening requirements commenced with screening levels increasing since then,

however implementation varied nationally.

In October, there was further escalation of the issue from the Director General to the Minister for

Health, Mr Simon Harris, T.D., and from the Health Information and Quality Authority (HIQA) to the

Chief Medical Officer, Dr Tony Holohan. On the advice of the Chief Medical Officer, Dr Tony

Holohan, and in consultation with the National Patient Safety Office the Minister activated the

National Public Health Emergency Plan on 25 October 2017 in response to CPE in Ireland and a

National Public Health Emergency Team was convened as a result.

6. National Public Health Emergency Team (NPHET) The NPHET was convened on 02 November 2017 and have met on a weekly basis. Their role is to

provide advice, guidance, support and direction on the surveillance and management of CPE at

national level; the development and implementation of a strategy to contain CPE and provide

oversight. Membership of the team includes key stakeholders from the Department of Health, the

Health Service Executive (HSE) management with responsibility for public health, surveillance,

operations and quality assurance and patient representatives. Appendix 1 includes their Terms of

Reference, membership and schedule of meetings in 2017.


21 December 2017 6

The work of the NPHET to date has been focused on gathering information to inform a situational

analysis including information on levels of screening and number of patients with CPE, policies and

procedures and governance arrangements at national, regional (Hospital Group and Community

Health Organisation) level and in individual facilities. This report provides the current situational

analysis.

7. Expert Group On the direction of NPHET an Expert Group has been convened. This group will monitor and review

national and international research and developments in relation to CPE and provide expert advice

to the NPHET team. This group held their first meeting on 04 December and as a priority they are

assuring the HSE’s screening policy and CPE outbreak management procedure are in line with

current international best practice.

8. CPE data sources and surveillance figures

Data sources

Health Protection Surveillance Centre (HPSC): The HPSC produces a quarterly report which gives

information on the number patients (based on 1st isolate) infected with CPE in Ireland each quarter.

Hospitals are currently not mandated to submit data to the HPSC on their CPE patients. This report

gives specifics as to the organism type of CPE found.

HPSC submits information to the European EARS-Net system biannually. This system collects

laboratory antimicrobial resistance data on the number of blood stream infection from a number of

pathogens including E. coli and Klebsiella pneumoniae (two organisms that in which antimicrobial

resistance, including carbapenem resistance, is of concern). The EARS-Net system was designed to

monitor overall antimicrobial resistance in key pathogens to monitor major trends over time. It was

not designed to collect data in a time frame intended for performance management or to guide

immediate public health action.

CPE Reference Laboratory Service (CPEaRLS): The Reference Laboratory, based at University

Hospital Galway, was established in 2012. CPEaRLS receives isolates from clinical laboratories for

confirmation as CPE and for further typing. The submitted isolates arrive with additional information

on the patient’s clinical details and the patient’s location (long term care facility, hospital, other,

etc). Submitting isolates to CPEaRLS is voluntary but all clinical laboratories submit isolates and

almost all do so in a timely manner. At present the CPE reference laboratory provides monthly

report on the number of new patients (and isolates, including microbiological information on the

type of bacteria).

HSE Business Intelligence Unit: As of August 2017, the BIU collects data relating to CPE in public

hospitals from hospital managers. This includes information on the number of CPE screening tests

done, number of confirmed CPE patients (either infected or colonised), the management/isolation of

CPE patients and the amount of one specific antibiotic (meropenem) used. Hospitals return data on


21 December 2017 7

a monthly basis. As this information is at the beginning stages of collection, the quality and

frequency of the data collection from all hospitals is still improving.

This information is helpful to compare to CPEaRLS data, as one gives information on the number of

screening tests done and the other gives information on the number of patients confirmed to have

CPE for the same time periods/frequencies.

Surveillance

Figure 1 shows the number of newly detected patients with CPE from 2012 to 2017 (January to

November). It also provides a breakdown of the different types of CPE identified. OXA-48, KPC and

NDM-1 have been the most frequent type of CPE detected. There has been a year-on-year increase

from five patients in 2012 (October to December only) to 401 in 2017 (January to November only).

This increase is partly attributable to an increase in screening.

Figure 1: Total number of newly detected patients with CPE 2012-2017 (Jan-Nov)

Source: CPE Reference Laboratory Data

Table 2 shows the total number of newly detected patients with CPE in each Hospital Group in 2016

and in 2017 (January to November). Variation across hospital groups may be partly attributable to

the size and type of hospitals in the hospital group, the patient cohort and levels of screening across

the hospitals. See Appendix 2 for a list of all hospitals by Hospital Group.

Table 2: Hospital Groups. Newly detected patients with CPE. Numbers. 2016 and 2017 Jan-Nov.

Hospital Group 2016 Jan-Nov 2017

University Limerick Hospital Group 29 50

Children's Hospital Group 3 4

South/Southwest Hospital Group 22 33

Saolta Hospital Group 41 48

RCSI Hospital Group 9 34

0

50

100

150

200

250

300

350

400

450

2012 2013 2014 2015 2016 2017 (Nov)

IMI

OXA-48

NDM-1

VIM

IMP

KPC


21 December 2017 8

Hospital Group 2016 Jan-Nov 2017

Ireland East Hospital Group 28 56

Dublin Midlands Hospital Group 138 143

Other Healthcare Facilities (primarily private hospitals) 13 33

National Total 283 401 Source: CPE Reference Laboratory Data

Table 3 shows the total number of CPE screenings that were reported to the HSE’s Business

Intelligence Unit in October (November data was not available at the time of writing this report) and

the total number of newly detected patients with CPE confirmed by the CPE Reference Laboratory

across each of the hospital groups. Variation across hospital groups may be partly attributable to the

size and type of hospitals in the hospital group, the patient cohort and implementation of screening

guidelines across the hospitals within a hospital group.

Table 3: Hospital Groups. Screening for CPE and newly detected patients with CPE. Numbers. October 2017

Hospital Group Reported CPE screening ~

Newly detected patients #

University Limerick Hospital Group 1043 4

The Children’s Hospital Group 383 0

South/South West Hospital Group 381 1

Saolta Hospital Group 1395 6

Royal College of Surgeons Ireland Hospital Group 1078 9

Ireland East Hospital Group 1967 3

Dublin Midlands Hospital Group 3574 13

Total 9821 36 ~ Source: Reported screening HSE Business Intelligence Unit (BIU) data.

# Source: Newly detected patients CPE Reference Laboratory data.

9. HSE Governance Structures The NPHET has been seeking assurances from the HSE in relation to the governance and oversight

for managing CPE.

At a national level, the HSE’s HCAI/AMR National Taskforce was established in 2016, they developed

a CPE Action Plan which was approved by HSE Leadership in March 2017. As a result, a National CPE

Response Team, led by a HCAI/AMR Clinical Lead, was established in May. This group was

responsible for implementation of the CPE Action Plan. In December, the HSE advised the NPHET of

their plans to strengthen this structure to ensure an operational focus. The National Response Team

will be subsumed into an Implementation Team which will include both a Clinical Lead and an

Operational Lead.

At a regional level, the HSE’s HCAI/AMR Clinical Lead has recommended that an Infection Prevention

and Control (IPC) and Antimicrobial Stewardship Committee should be established at Hospital Group

and CHO level to ensure robust governance in relation to CPE and wider healthcare acquired


21 December 2017 9

infections (HCAIs) and antimicrobial resistance (AMR). On the direction of NPHET, information was

initially gathered from all Hospital Groups and CHOs on the status of these committees. Table 4

provides an overview of responses from Hospital Groups and CHOs (see Appendix 3 for areas

covered by each CHO). The HSE are in the process of preparing an operational response to the

current governance arrangements.

The next phase of data collection will be focused on governance structures at local level within

individual hospitals. The group will then examine the feasibility of gathering data from long-term

care facilities.

Table 4: Hospital Groups and CHOs. Status of IPC and IPC and Antimicrobial Stewardship Committee

Hospital Group/CHO IPC and Antimicrobial Stewardship Committee currently in place

Dublin Midlands Hospital Group Yes

Ireland East Hospital Group Yes

Royal College of Surgeons Ireland Hospital Group

No (Quality and Patient Safety Committee at group level and IPC Committee at hospital level)

Saolta Hospital Group Yes

South/South West Hospital Group No (plan to establish and first meeting in January 2018)

The Children’s Hospital Group No (Committees at hospital level)

University Limerick Hospital Group Yes

Dublin Midlands Hospital Group Yes

CHO 1 Yes

CHO 2 Yes

CHO 3 No (CHO wide Quality and Patient Safety committee)

CHO 4 Yes

CHO 5 Yes

CHO 6 No (did previously exist, priority to re-establish)

CHO 7 Yes

CHO 8 Yes

CHO 9 Yes

10. HSE Policies, Procedures, Protocols and Guidelines (PPPGs) The HSE have developed a number of CPE related PPPGs in 2017. These documents have been

disseminated within the HSE and published on the HSE’s website. Table 5 includes the CPE related

PPPG documents provided by the HSE to the NPHET.

Screening is required in order to detect, manage and control CPE in a healthcare setting. The HSE

have reported to NPHET that, based on current figures been reported to the HSE’s Business

Intelligence Unit, there is variation in the implementation of the National CPE Screening Policy

across hospital groups and individual hospitals.


21 December 2017 10

Table 5: HSE CPE related PPPGs and Target Audience.

Target Audience

PPPG type/name Hospitals Long Term Care Facilities

GPs Public/ Patients

Requirements for screening of Patients for Carbapenemase Producing Enterobacteriaceae (CPE) in the Acute Hospital Sector

●

Out-Patient and Day Care and Hospital Visiting for People Colonised with Antimicrobial Resistant Organisms (AMRO) Including Carbapenemase Producing Enterobacteriaceae (CPE)

● ●

Provisional Guidance relating to Interfacility Transfer of Patients Colonised or Infected with Antimicrobial Resistant Organisms (AMRO) Including Carbapenemase Producing Enterobacteriaceae (CPE)

● ●

Provisional Guidance relating to Healthcare Workers Colonised with CPE

● ●

Response to Requests for Advice on use of Hydrogen Peroxide Vapour and similar technologies for environmental decontamination in the context of Carbapenemase Producing Enterobacteriaceae

● ●

Provisional Guidance relating to CPE for General Practice

●

Provisional Guidance relating to CPE for Long Term Care Facilities (Residential Non Acute Care Settings)

●

You have questions about CPE and CRE? ●

11. Communications The Department of Health have a dedicated webpage on their website where minutes of NPHET

meetings and related documents are published. A press release has been issued after each meeting

to communicate the items discussed and actions agreed. The Department of Health has briefed the

Government Task Force on Emergency Planning and the National Health Threats Coordination Group

on the work of NPHET.

http://health.gov.ie/national-patient-safety-office/patient-safety-surveillance/antimicrobial-

resistance-amr-2/public-health-emergency-plan-to-tackle-cpe/

The HSE have a dedicated HCAI webpage which includes a section on CPE on their website. An

updated version was published on 08 December 2017. The HSE have appointed a HCAI/AMR

Communications Lead.

http://hse.ie/eng/about/Who/healthwellbeing/Our-Priority-Programmes/hcai/resources/cpe/

http://health.gov.ie/national-patient-safety-office/patient-safety-surveillance/antimicrobial-resistance-amr-2/public-health-emergency-plan-to-tackle-cpe/

http://health.gov.ie/national-patient-safety-office/patient-safety-surveillance/antimicrobial-resistance-amr-2/public-health-emergency-plan-to-tackle-cpe/

http://hse.ie/eng/about/Who/healthwellbeing/Our-Priority-Programmes/hcai/resources/cpe/


21 December 2017 11

12. Gaps and Next Steps Table 5 provides an overview of the gaps identified to date and the next steps planned.

Table 6: Gaps and Next steps

Gaps Next steps

CPE is not on the list of notifiable diseases therefore reporting in not currently mandatory. This has an impact on the completeness and timeliness of current data.

The Department of Health are preparing an Statutory Instrument to provide for the addition of CPE colonisation to the list of notifiable diseases. The background preparatory work is currently underway by the Health Protection Surveillance Centre.

Variance in implementation of national requirements including national screening policy.

Map requirements, standards and key activities in the various action plans to focus on implementation of interventions. These include:

Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP)

HSE CPE Action Plan

HSE HCAI/AMR Action Plan

HIQA hygiene standards and recommendations in the review of antimicrobial stewardship

Gather data on implementation of requirements from hospitals and CHOs.

Expert Group to assure national screening policy and outbreak management are in line with current international best practice.

Operational response from the HSE.

There is no national IT surveillance system in place. ICNET is not in all hospital. There have been delays in the roll out of MedLIS.

Identify gaps in IT surveillance systems to develop a business case.

Issues in relation to data completeness and timeliness including:

Limited CPE data from long-term care

facilities

Gaps in data on use of resources in hospitals and CHO settings

Multiple data collection streams including the National CPE Reference Laboratory, the Health Protection Surveillance system and HSE’s Business Intelligence Unit.

Gather data from hospitals, Community Health Organisations (CHOs) and long term care facilities (LTCFs) on IPC governance arrangements, use of resources and implementation of requirements.

CPE KPI included in the HSE’s 2018 Service Plan and Scorecard.

Further analysis will be carried out at hospital level to inform the work of NPHET. A situational

analysis report will be published on a monthly basis.


21 December 2017 12

Key concepts

What is a public health emergency?

A public health emergency is described as any serious or unexpected event, due to an infectious

disease, which causes, or threatens to cause, death or serious illness to large sections of the

population, an individual region or a specific cohort of individuals and which will have a major

impact on the normal functioning of the health system and on society in general.

What is the Public Health Emergency Plan?

The Department of Health’s National Health Emergency Plan is a plan for activation in the event of a

national/large-scale public health emergency in the event of an infectious disease outbreak or

similar health issue. The purpose of the plan is to assist all health agencies in the State to respond to

a public health emergency in an integrated and co-ordinated manner.

What are Healthcare Associated Infections (HCAIs)?

A healthcare-associated infection is an infection that is acquired after contact with the healthcare

services. This is most frequently after treatment in a hospital, but can also happen after treatment in

outpatient clinics, nursing homes and other healthcare settings. Healthcare-associated infections

that are picked up in hospital are also known as “hospital-acquired infections”.

The five most common HCAIs are:

Surgical site infection

Pneumonia

Urinary tract infection

Bloodstream infection

Gastroenteritis.

What is Antimicrobial Resistance (AMR)?

Antimicrobials are medicines used to treat infections or disease, and are essential in both human

and animal health. Antimicrobial resistance occurs when an antimicrobial that was previously

effective, is no longer effective to treat an infection or disease caused by a microorganism.

The development of resistance is a natural phenomenon that will inevitably occur when

antimicrobials are used to treat disease. The problem at present is that the sheer volume of

antimicrobials being used globally in humans, animals and in other situations is leading to significant

increases in the rate of development of resistance with the result that common infections are

becoming more difficult to treat and microorganisms that are resistant to many antimicrobials, so

called ‘superbugs’, are emerging.


21 December 2017 13

What is the difference between antibiotic and antimicrobial resistance?

Antibiotic resistance refers specifically to the resistance developed by bacteria to antibiotics.

Antimicrobial resistance is a broader term, encompassing resistance to drugs to treat infections

caused by other microbes, such as mycobacteria (e.g. M. tuberculosis), parasites (e.g. malaria),

viruses (e.g. HIV) and fungi (e.g. Candida spp. and Aspergillus spp.)

What is Antimicrobial stewardship?

Antimicrobial stewardship is a systematic approach to optimising antimicrobial therapy, through a

variety of structures and interventions. Antimicrobial Stewardship includes not only limiting

inappropriate use but also optimising antimicrobial selection, dosing, route, and duration of therapy

to maximise clinical cure, while limiting the unintended consequences, such as the emergence of

resistance, adverse drug events, and cost.

What is the National Action on Antimicrobial Resistance 2017-2020 (iNAP)?

Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 aims to implement policies and

actions to prevent, monitor and combat AMR across the health, agricultural and environmental

sectors. Reducing the inappropriate use of antimicrobial medicines, as well as preventing infections

and disease, is vital to stop the development and spread of resistant microorganisms.

It provides an overview for the health, agricultural and environmental sectors. It presents key

strategic interventions for tackling antimicrobial resistance in line with World Health Organisation

(WHO) requirements across the three sectors. These interventions represent Ireland’s commitment

to the development and implementation of a holistic, cross-sectoral ‘One Health’ approach to the

problem of antimicrobial resistance.


21 December 2017 14

Appendix 1: National Public Health Emergency Team Terms of Reference,

Membership and Schedule of 2017 Meetings

National Public Health Emergency Team Terms of Reference

1. Oversee and provide expert advice, guidance, support and direction for the overall national

response to CRE, including national and regional and other outbreak control arrangements.

2. Direct the collection and analysis of required data and information and the subsequent reports

to NPHET.

3. Conduct an on-going situational analysis and evaluation having regard to reports received,

expert advice, international guidance and assurance regarding optimal use of resources.

4. Liaise with relevant organisations and stakeholders, to include other Government departments,

statutory and voluntary agencies, international bodies and the relevant regulators.

5. Direct and ensure an effective communications system at local, regional and national levels.

6. Evaluate on an on-going basis the readiness of the health service to manage and sustain the

containment of CPE as part of ordinary operations with a view to standing down the NPHET at

the appropriate time.

National Public Health Emergency Team Membership

Name Job Title Organisation

Dr Tony Holohan (Chair) Chief Medical Officer Department of Health

Dr Kathleen Mac Lellan

Director, National Patient Safety Office (NPSO)

Department of Health

Ms Anna Cunniffe Acute Hospitals Policy Division Department of Health

Ms Sandra Walsh Primary Care Division Department of Health

Ms Bernie O’Reilly Patient Representative Patients for Patient Safety

Ms Brigid Doherty Patient Representative Patient Focus

Mr John Connaghan Chief Operations Officer Health Service Executive

Mr Patrick Lynch National Director, Quality Assurance and Verification Division

Health Service Executive

Professor Martin Cormican HCAI National Clinical Lead Health Service Executive

Mr Tom McGuinness Emergency Management & National Ambulance Service


Dr Kevin Kelleher AND Public Health and Director (acting) Health Protection Surveillance Centre (HPSC)


Ms Audrey Lambourn

Client Director HCAI/AMR Clinical Programme



21 December 2017 15

Schedule of meetings in 2017

Meeting number Date of meeting

1. 02 November 2017

2. 09 November 2017

3. 16 November 2017

4. 23 November 2017

5. 30 November 2017

6. 07 December 2017

7. 14 December 2017

8. 21 December 2017


21 December 2017 16

Appendix 2: Hospital Groups (estimated population#) and Hospitals.

Hospital Group Hospital name

Dublin Midlands Hospital Group (800,000) Midlands Regional Hospital Portlaoise

Midlands Regional Hospital Tullamore

Naas General Hospital

St James' Hospital

St Luke’s Radiation Oncology Network

The Adelaide & Meath Hospital Tallaght

The Coombe Women & Infant University Hospital

Ireland East Hospital Group (1,000,000) Cappagh National Orthopaedic Hospital

Mater Misercordiae University Hospital

Midland Regional Hospital Mullingar

National Maternity Hospital

Our Lady's Hospital Navan

Royal Victoria Eye and Ear Hospital

St Columcille's Hospital Loughlinstown

St Luke's General Hospital Kilkenny

St Michael's Hospital Dun Laoghaire

St Vincent's University Hospital

Wexford General Hospital

RCSI Hospitals Group (800,000) Beaumont Hospital

Cavan General Hospital

Connolly Hospital Blanchardstown

Louth County Hospital Dundalk

Monaghan Hospital

Our Lady of Lourdes Hospital Drogheda

Rotunda Hospital

Saolta Hospital Group (700,000) Letterkenny University Hospital

Mayo General Hospital

Portiuncula Hospital

Roscommon County Hospital

Sligo Regional Hospital

University Hospital Galway & Merlin Park University Hospital

South/South West Hospital Group (850,000) Bantry General Hospital

Cork University Hospital/Cork University Maternity Hospital

Lourdes Orthopaedic Hospital Kilcreene

Mallow General Hospital

Mercy University Hospital

South Infirmary Victoria University Hospital


21 December 2017 17

Hospital Group Hospital name

South Tipperary General Hospital

University Hospital Kerry

University Hospital Waterford

The Children's Hospital Group National Children's Hospital Tallaght

Our Lady's Hospital for Sick Children Crumlin

Temple Street Children's University Hospital

University of Limerick Hospital Group (400,000) Croom Hospital

Ennis Hospital

Nenagh Hospital

St John's Hospital Limerick

University Hospital Limerick

University Maternity Hospital Limerick # Source: The Establishment of Hospital Groups as a transition to Independent Hospital Trusts

(Department of Health, 2013)


21 December 2017 18

Appendix 3: Community Health Organisations (CHOs)

CHO name CHO Area

CHO1 Donegal, Sligo/Leitrim/West Cavan and Cavan/Monaghan

CHO2 Galway, Roscommon and Mayo

CHO3 Clare, Limerick and North Tipperary/East Limerick

CHO4 Kerry, North cork, North Lee, South Lee and West Cork

CHO5 South Tipperary, Carlow/Kilkenny, Waterford and Wexford

CHO6 Wicklow, Dun Laoghaire and Dublin South

CHO7 Kildare/West Wicklow, Dublin West, Dublin South City and Dublin South West

CHO8 Laois/Offaly, Longford/Westmeath, Louth and Meath

CHO9 Dublin North, Dublin North Central and Dublin North West

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