"Up to 40 patients per day use this toilet, and on occasion up to 50," the report said. "Being bowel flora, VRE carries a high risk of environmental contamination in such areas as toilets."
The report also identified an exposed sewer pipe in a sterile store that had previously leaked; a lack of isolation facilities for infectious patients; an inadequate sluice area; an insufficient number of handwash basins; inadequate cleaning hours, with cleaning occurring while patients were undergoing dialysis; and a small, cluttered servicing room that became too hot, meaning the back door to the car park was wedged open to allow ventilation.
Hospital chief executive Geraint Martin said issues such as the leaking pipe did not directly relate to the VRE crisis. "We acknowledge there are a number of shortcomings in the dialysis unit," he said.
"These relate to space constraints as patient volumes have grown significantly since the unit was established."
In further correspondence with the hospital, services director Phillip Balmer said there were, in fact, 10 toilets available to patients in the area.
None of the patients identified as carrying the bacteria had developed a VRE-related illness.
Of the 14 cases, three patients had died from unrelated health conditions; two had been cleared of VRE; and nine continued to be colonised with VRE.
The hospital had 5473 dialysis sessions scheduled each month, a 6 per cent increase in demand year on year. That was due to factors including increasing levels of obesity, diabetes, cardiovascular disease and renal disease.
Martin said planning had progressed for expansion of the dialysis facilities and in the interim it was meeting the growth in demand through outsourcing patients to other facilities.
The hospital had implemented effective control measures to prevent further outbreaks of VRE, including active surveillance, toilet cleaning twice daily and ongoing hand hygiene and infection control education and audit. Improvements had been made in the unit since the report.
Auckland University associate professor of infectious diseases Mark Thomas said it was likely VRE was spread through the overused toilet.
"Unless you have an intensive approach to cleaning that toilet then potentially you have problems, particularly if one or more of them has diarrhoea," he said.
He said VRE most commonly caused kidney or bladder infections, but for people in hospital who already had health problems, it could cause serious infections and potentially death.
People on dialysis were more at risk because they tended to have weaker immune systems, he said.
