QEUH: Senior medic says bird poo infections 'most likely came from hospital'

Dr Teresa Inkster has cast doubt on the conclusion of an independent review that stated Cryptococcus infections of an elderly woman and a 10-year-old boy could not be clearly linked to pigeons in the Queen Elizabeth University Hospital.

Speaking exclusively to The Herald on Sunday, the clinician said information about those infections and problems with the water supply had been withheld from her and colleagues responsible for managing infection control. She has also questioned the conduct of independent review team, which published its report last month.

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Dr Inkster, who has worked at NHS Greater Glasgow and Clyde (NHSGGC) since 2002, was the lead infection control doctor at the QEUH between 2016 and 2019, before stepping down from the role in September last year.

She was responsible for investigating the cryptococcus infections of December 2018, bloodstream infections in 2018 and further infections of children with cancer in 2019.

Dr Inkster explained: “During the cryptococcus incident, the first thing I did with my infection control nurse was walk round the areas these patients were in. We have evidence and we took photos of pigeon poo on windowsills, in courtyards in the vicinity to the wards where these patients were.

“I can’t prove how it got from the pigeons to the patients. There are various hypotheses, one of which is the plant room. We also looked at the windows, but the windows seem to be adequately sealed.

“We do know that there was an issue with pigeons such that pest control said there needed to be an 80% reduction.

“There was extensive pigeon poo. There were dead birds in the pictures from the plant room. That’s enough for me to say the likelihood is that the infections came from the QEUH.”

The independent review’s report stated there was no clear link between Cryptococcus infections found in two cancer patients who died and the presence of pigeons on the campus.

Dr Inkster has raised concerns about this conclusion and disputes their findings.

She said: “In infection control, when something happens, by the time it manifests in a patient and you get the test, you decide you’ve got a problem, weeks have passed. You never know what exactly took place, you can’t go back in time. It’s all about hypothesis and probability. That’s why people struggle with it. From my perspective the probability is that the pigeons are the source.

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“What the review said about people carrying [the Cryptococcus] on clothes, onto wards, that being the source, that’s not the case. If that was the case you would be seeing a lot more infections because you’ve got a lot of immunosuppressed people there. There was an issue with pigeons such that pest control said there needed to be an 80% reduction.”

During each infection outbreak, an incident management team (IMT) meeting was held, where senior members of the health board gathered to discuss the cases and share information.

However Dr Inkster said she discovered several times that information had not been shared relating to the Cryptococcus infections and a spate of bloodstream infections in children at two cancer wards in 2018.

She said: “As recently as spring 2020 new information was coming to me about Cryptococcus, well after the incident was closed.

“A colleague sent me photos of the plant room and a pest control report that, as chair of the IMT, I hadn’t seen. That was just a couple of months ago.”

She said reports also emerged seven months in to an investigation of bloodstream infections in child cancer patients staying at the Royal Hospital for Children, adjacent to the QEUH.

A total of 23 children became infected with 11 different bugs between January and September 2018.

Dr Inkster explained: “One of the defining points for me in this whole thing was in July 2018. I was made aware of reports from 2015 and 2017, about the water and risk assessments.

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“If we had had those reports at the beginning of the incident, in January 2018, we wouldn’t have had to spend so much time debating what to do. Instead we were trying to work out the source of infection, when the answers were all there in that report.”

The doctor said if the findings from previous investigations had been acknowledged by NHS Greater Glasgow and Clyde, and changes implemented at the time, “these infections in children would have been largely preventable.”

She added: “People who were still in the organization knew we were in the middle of a water incident, and they had those reports. Why wouldn’t you share them?”

Dr Inkster and her colleague Dr Christine Peters wrote to the Independent Review chairmen following the publication of their report into the QEUH last month.

They sent a 31-page rebuttal to Dr Andrew Fraser and Dr Brian Montgomery, raising concerns about how it was carried out and its conclusions. On July 15, the day the review officially closed, they received a response informing them that nothing would be amended despite their extensive list of concerns.

Dr Inkster was only interviewed once by the review team, and a second interview was cancelled. The review also said vital information about the IMTs sent by Dr Inkster was not received.

The review also said when they attempted to contact Dr Inkster through her work email, this was returned undelivered. The review told Dr Inkster: “Inquiries were then made…with GG&C to ascertain if there had been a change to your email address; it appears that at some point in early March 2020, [an employee of the Review] had been told you were no longer working at GG&C or alternatively you were off sick; given data protection issues we were unable to progress our inquiries any further.” After contacting Dr Inkster on her personal email address, there continued to be communication problems. The review later said: “It appeared to us that you were indisposed in some way or did not wish to continue to engage with the Review.

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Dr Inkster said: “I do not know why anyone would have told them this. I wasn’t off sick, and I was still working at GGC. I still work here now. I understand mistakes can happen, but this is a series of mistakes which add up.

“I was the lead infection control doctor at the time when many of these incidents took place, and yet I wasn’t asked for specific details. My colleague and I were also not given a right of reply to what was being alleged in the report. I was sent my witness statement on the Friday before the report was published, my colleague got her statement after it was published. It seems like they didn’t want to hear from us, despite the fact we were heavily involved in infection control.”

A spokeswoman for the QEUH Independent Review said: “When the Review team encountered an issue with Dr Inkster’s NHS email address they sourced a personal email contact for her and advised her of the problem so she could continue to engage with the process.

“This was the address used to correspond with Dr Inkster from this point, including the sharing of her witness statement.

“We have concluded our work, and stand by the report.”

An NHSGGC spokesman said: "We are sorry that reports were not shared with Dr. Inkster in 2015 and 2017 as the senior management team were not aware of them. The 2015 and 2017 water risk assessments, the DMA reports, were brought to the attention of our senior managers in the middle of 2018. As soon as they were received by the Chief Executive, these were acted on. Improvements have since been made in the governance of the estates and facilities function.

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"We continue to work with Professor Fiona McQueen and the members of the Oversight Board who have been reviewing the effectiveness of our infection prevention and control procedures, including the concerns Dr. Inkster has raised.

"We had a small administration team who were supporting requests for information from the Independent Review Team; they were not approached and asked about Dr Inkster’s employment status. We are not aware who spoke to the Independent Review Team about this."