A deadly cluster of resistant staphylococcus bacteria. Credit:Science Photo Library An analysis obtained by Fairfax Media shows Royal North Shore Hospital doctors issued more than 9,000 doses of powerful restricted antibiotics to patients without approval between January and May last year. A separate document reveals compliance with the Northern Sydney Local Health District's system through which approval to prescribe the powerful antibiotics is sought, called eASY, was at just 35 per cent. The system underpins the hospital's so-called antimicrobial stewardship (AMS) program, which is designed to reduce inappropriate antibiotic use to improve patient outcomes and reduce superbug resistance and costs. The same document shows senior hospital staff in charge of infection control at the hospital were concerned Royal North Shore might not meet accreditation standards due to a lack of electronic surveillance system to detect superbug outbreaks.

Royal North Shore Hospital hosted the highest number of drug company-funded events, compared to its Sydney counterparts. Credit:Bob Pearce At present hospital staff enter the results of swabs taken from patients into a database manually. Fairfax Media has been told Royal North Shore is required to carry out the swabbing procedure in all of the hospital's surgical wards once a month. NSW Health Minister Jillian Skinner. However, due to "resourcing issues" it fell to just one ward every quarter, according to a well-placed source.

Leaked figures reveal compliance rates for swabbing on admission and discharge of only 59 per cent to 76 per cent were recorded between January and May last year. A high-level meeting of the Clinical Governance Unit was held at Royal North Shore in April last year to discuss the lack of an electronic system for Infection Prevention and Control (IPAC) and AMS. "Lack of an electronic platform for IPAC & AMS surveillance for a hospital of RNS size was commented on at the last accreditation," a meeting record says. "If this is not improved we risk getting a NOT MET. (If a hospital fails any element it fails accreditation)." It says the lack of an electronic system for infection prevention and control means there is no real-time data, early detection is hampered and a risk of missing cases altogether.

The revelations follow a horror few weeks for the NSW Health system and minister Jillian Skinner, who has been under pressure due to the under-dosing of chemotherapy patients and the death of a newborn baby who was given nitrous oxide instead of oxygen. Peter Collignon​, professor of infectious diseases at the Australian National University medical school, said the data is "very likely to be reflected in other places". "Doctors are trying to do the best for their patients [but] they believe this is another level of bureaucracy interfering with their decision-making," he said. "Not agreeing with reasonable rules is throwing fire on the superbug problem. It's bad enough as it is. But it's worse if people give too many broad-spectrum antibiotics for longer than they need to be". Professor Collignon said Royal North Shore should be congratulated for conducting the analysis because "it should be done in every hospital in Australia" but the key was how it addresses the problem.

A spokeswoman for Mrs Skinner said none of these issues had been brought to her attention. She refused to comment and referred questions to the hospital. A Northern Sydney Local Health District spokesman said Royal North Shore "performs very well in appropriate use of antibiotics according to the national benchmarks under the National Antibiotic Utilisation Surveillance Program". The hospital's AMS system "was awarded a Met with a Merit rating and surveyor commendation following a rigorous National Safety and Quality HealthCare Standards accreditation survey in November 2015". He said between 450 and 550 prescriptions are issued by doctors each month, but only about half of those are run through the eASY system. "Infection rates at the hospital are better than benchmark with the My Hospitals report showing Staph bloodstream infections is the lowest in peer group," he said. The hospital is tendering for an electronic surveillance system.

NSW hospitals in crisis St Vincent's Hospital In February it was revealed 70 head and neck cancer patients had been given off-protocol doses of the chemotherapy drug carboplatin by senior oncologist Dr John Grygiel​. The number of affected patients was later revised to 103. The flat doses dipped between half and a third of the recommended levels and were unsupported by clinical evidence. Hospital staff were aware of the dosage error for at least six months before contacting patients.

The incident prompted an inquiry led by NSW Chief Cancer Officer Professor David Currow​ that found the hospital had misled the public and government on the scandal. A senior hospital staff member lost their job over the errors. The NSW upper house agreed on Thursday to initiate a select committee to inquire into the treatment of patients of Dr Grygiel and that of another Sydney oncologist, operating at Sutherland and St George Hospitals. Sutherland and St George Hospitals Oncologist and haematologist Dr Kiran Phadke​ was suspended from both hospitals in June after it was revealed he had been under-treating cancer patients for more than a decade.



An investigation into his treatments was commenced after concerns were raised by a nurse in April, following the flat-dosing scandal at St Vincent's Hospital.

Three of Dr Phadke's patients were found to be affected; two have since died. The records of another 14 patients are being examined.

Bankstown-Lidcombe Hospital A newborn baby died and a second was left in a critical condition in June and July, after they were given nitrous oxide, or "happy gas", instead of oxygen. The babies were given nitrous oxide that was incorrectly dispensed from an oxygen outlet in the hospital's neonatal resuscitation unit. The oxygen outlet in one of the hospital's theatres had been incorrectly installed and certified by BOC Ltd in July 2015.

The incident prompted an urgent review of the state's 15 Local Health Districts and two specialty networks, to ensure media gas outlets had been installed correctly. On the same day news broke of the incorrectly administered gas, a 46-year-old female Iraqi refugee took her own life at the hospital, while in the care of Banks House mental health inpatient unit. The death was not treated as suspicious and a post-mortem examination was arranged to officially determine how the woman died. Lucy Cormack