Documents obtained by the Sunday Independent show that staff at one public hospital in Limerick complained that space is so tight patients have to eat by their bedsides, while 44 elderly residents shared six toilets between them in another hospital.

The documents emerge amid bitter recriminations over a damning report that blamed weak patient care for the infection of 46 patients with the potentially fatal hospital infection, C difficile, at Ennis General Hospital last year. Fifteen elderly patients who contracted the superbug died within 30 days.

The damning report published by the Health Services Executive (HSE) showed how major weaknesses in patient care left them vulnerable to the infection.

It found the hospital had no effective system for surveillance of the superbug and was consequently unaware it had an outbreak.

It cited problems ranging from overcrowding, staff absenteeism at critical periods, poor hygiene and faulty equipment as contributory factors in the spread of the bacterium.

However, internal documents from the country's public hospitals for the elderly show that vulnerable patients remain at serious risk from infections.

The documents revealed an alarming shortage of washing facilities at St Joseph's Hospital for the elderly in Ennis. In one unit of the hospital, 44 patients had to share between them just six toilets, four wash hand basins and two showers.

One elderly patient was moved to complain to the HSE about the lack of adequate facilities last year.

In the handwritten note, released under the Freedom of Information Act, the patient asked: "Do you consider two toilets and one hand basin enough for the needs of 32 patients? Or two showers for 30 or more patients?

"In the morning from 8am to 9am, you have to wait for a free toilet or try to control your bowel function, a hard act to achieve. The hand basin is in use, so hands are not washed. All these things lead to serious infection," it said. "We are a very wealthy country, so cannot plead poverty."

In a follow-up letter, the hospital's director of nursing acknowledged that there was an "urgent need" to upgrade current facilities throughout the hospital but said this was dependent on funding.

At St Ita's Community Hospital in Limerick, under staffing led to complaints about patients not being washed or showered properly. A clinical nurse manager wrote to hospital management in December, demonstrating how standards overall were slipping due to low staffing levels.

"Showers are given randomly as opposed to request or need. Mobility levels have decreased as a result of lack of supervision," the nurse wrote. "Wounds are not consistently redressed when due because of time constraints and have to be organised around staff rather than requirements.

"Patients' anxiety levels are increased as they have decreased social interaction with staff. Continence has decreased. Ward cleaning has declined."

A staffing review at St Camillus Hospital for the elderly in Limerick found that the 200-year-old building hindered nursing care.

Ward areas appeared overcrowded and the space available did not always allow for "safe provision of care" to residents. The overcrowding put staff at risk of injury.

It said, in some instances, the quality of life for some residents was impacted upon by the lack of space, by hindering them from being nursed appropriately.

Bathroom facilities were not always sufficient and toilets and bathing facilities were not meeting the requirements of dependent older people.

Margaret Dawson, who co-founded MRSA and Families in protest at the spread of hospital-acquired infections, said the documents showed that patients continue to be at risk of infection as long as hospital services were being cut back.

"Whatever they say, patient care at the end of the day is affected by cutbacks," she said. "There are lots of smaller hospitals like this that care for the elderly, which we never hear much about, and their needs are pushed aside."