Scabies, which is highly infectious and causes intense itching, infected several residents and staff at the Kilkenny Care Centre, Newpark, Kilkenny.
Inspectors from the Health Information and Quality Authority (Hiqa) who visited the centre in July this year found a significant number of residents and staff had shown signs of the skin infection since September 2024.
Scabies can cause intense itching. Photo: Getty
Today’s News in 90 Seconds – September 25th
“A clinical diagnosis of scabies was made by the GP, and a dermatologist review of one case confirmed crusted scabies, which is a severe and more contagious progression of scabies infestation,” they said.
The inspectors found management of the the scabies outbreak was fragmented and lacked co-ordination and oversight, which likely contributed to the persistent infection.
The owners, Mowlam Healthcare, were required to take urgent action following this inspection to ensure there was local oversight, supervision and assurance mechanisms in place to see that the outbreak was effectively managed.
The report said the ongoing scabies outbreak in the centre was likely exacerbated by several infection prevention and control failures, including the lack of resident isolation when symptomatic, unclear guidance among staff, improper management of laundry and non-washable items and potential errors in the application and administration of treatments.
These gaps contributed to “continued transmission and highlighted the need for improved staff training, standardised procedures and improved oversight of infection prevention and control procedures”.
Additional infection prevention and control training and supervision was required. There was ambiguity among staff regarding specific infection prevention and control measures required during the ongoing outbreak, said the inspectors.
Residents showing signs of infestation were not immediately isolated pending clinical diagnosis and for 24 hours after initial treatment
The report pointed out that inconsistent practices can lead to cross-contamination.
A review of documentation indicated that residents showing signs of infestation were not immediately isolated pending clinical diagnosis and for 24 hours after initial treatment. This may have allowed the infestation to spread between residents, staff and possible visitors.
Two residents had completed their initial course of treatment on the morning of the inspection. However, staff were unclear regarding the required duration of isolation following the initial course of treatment.
Documentation indicated that scabies treatments were not properly applied or administered as per public health recommendations. Incomplete or ineffective treatment allows the infection to persist and spread.
Items that could not be laundered, such as slippers, shoes and soft toys, were not appropriately managed when residents were treated
Clothing and bedding were mismanaged after residents received treatment for confirmed or suspected scabies.
Additionally, items that could not be laundered, such as slippers, shoes and soft toys, were not appropriately managed when residents were treated. These items could have reintroduced mites to the environment or to other residents.
Bedrooms were not routinely deep cleaned when residents were treated for scabies. This may contribute to re-infestation post treatment.
Appropriate infection prevention and control care plans were not in place to guide the care of several residents with confirmed or suspected scabies.
Where care plans did detail the confirmed or suspected diagnosis of scabies, sufficient detail was not recorded to effectively guide care.
The owners of the home agreed to an action plan to address the issues.
In a separate inspection last June of another home, Beechfield Manor on the Shanganagh Rd in Shankill, Dublin, inspectors found that some residents spoken to referred to staffing levels being ”a little short”, with two residents referring to long waiting periods for assistance after ringing the call bell.
Similar resident feedback regarding inadequate staffing levels to support them, including with timely access to the toilet, was noted in the records of the residents’ meetings.
On the first evening of the inspection, the inspectors found that the temperature within the centre did not ensure the comfort of the residents.
Multiple residents, visitors and staff reported that the temperature in the centre, including some of the bedrooms and communal areas, was excessively warm. This continued to be a significant issue on the second day.
The inspectors were informed that the central heating could not be switched off nor could the settings be adjusted to account for the outdoor temperature.
The inspectors observed that fire doors to bedrooms were equipped with a device that allowed the resident to keep their door open, but would automatically close the door upon activation of the fire alarm to prevent the spread of fire and smoke.
These devices were acoustically operated and powered by batteries. The inspectors saw two instances where these devices were emitting a noise indicating that the batteries needed to be changed.
“This continuous noise negatively impacted the residents’ peaceful enjoyment of their environment and also highlighted the risk that the device would soon not be functioning once the batteries expired. Staff had not responded to this noise and arranged for the batteries to be replaced,” they said.
The inspectors noted fire safety concerns as they walked the premises, including fire doors observed to be held open with chairs in resident bedrooms, locked fire doors, including an emergency escape route door, and hoist batteries charging on bedroom corridors.
Inspectors saw a number of instances where residents were not adequately supervised
Inspectors saw a number of instances where residents were not adequately supervised. For example, on the lower ground floor, the inspectors observed a resident standing on a chair with no staff present.
This resident had been assessed as being at a high risk of falls.
Three residents in the first-floor sitting room were seen sitting for 20 minutes without staff supervision and without access to a call-bell to summon assistance if required.
On the second inspection day, the inspectors noted that the activities listed in the daily activity schedule such as arts and crafts, board games and knitting, were not occurring.
Instead, residents were observed sitting for lengthy periods in the ground floor and first-floor sitting rooms, with the television on but without any other meaningful activity.
The owners of the nursing home have agreed to an action plan set out by Hiqa.