Patients in Waterford hospital at ‘serious risk’ - Hiqa

Hospital drawing up plan to address risks indentified during unannounced visit

Waterford Regional Hospital. Photograph: PJ Browne

Waterford Regional Hospital. Photograph: PJ Browne

Sat, Aug 17, 2013, 01:00

Waterford Regional Hospital has said a plan is being drawn up to address the serious concerns highlighted in an inspection by the Health Information and Quality Authority (Hiqa).

Immediate risks to the health and welfare of patients were identified by Hiqa during an unannounced visit to the 549-bed hospital on June 25th.

The risks, which relate to the transmission of infections, must be seriously addressed within six weeks, the authority said.

“During the course of the assessment the [inspectors] identified immediate serious risks to the health and welfare of patients,” Hiqa said in a report published yesterday.

Six-week deadline
The hospital “must now develop a quality improvement plan (QIP) that prioritises the improvements necessary to fully comply with the National Standards for the Prevention and Control of Healthcare Associated Infections . . . This QIP must be published by the hospital on its website within six weeks.”

Among the risks identified were serious breaches of hand hygiene standards, a toilet area “heavily stained with a mould-like substance”, a commode not being washed after use, an unlocked medication fridge, used surgical instruments and a used tracheotomy tube stored on top of a tray; a designated hand-wash sink containing pieces of equipment and a patient with a suspected communicable disease in an open bay.

The Hiqa inspectors found the environment at the hospital to be “generally unclean”.

The hospital’s emergency department, a surgical ward and a medical ward were assessed for compliance with environment and facilities management standards and with hand hygiene standards.

The authority observed 23 hand hygiene opportunities throughout the monitoring assessment, 11 before and 12 after touching patients. Five of the 23 opportunities were taken and were observed to comply with best practice.

Sticky residue
The inspectors found a “heavy sticky residue” on the exterior of a patient’s wardrobe, chipped lockers, chipped paintwork, dust and radiators being used for several patients’ personal towels.

In the medical ward they found that “the floor directly around the toilet and the base of a toilet cistern for patient use was heavily stained with a mould-like substance”. In the same ward “a disposable kidney dish containing used surgical instruments and a used tracheotomy tube were stored on top of one of two large trays containing disinfectant”.

Also in this ward, “Hiqa observed that the surfaces of two commodes assessed were stained [and] a member of staff was observed . . . failing to clean a used commode after use.” Another commode had “soiling on the seat” and the lids of two others were “unclean”.

In the drugs/utility rooms “a medication fridge . . . containing, for example, insulin and antibiotic solutions and a cupboard containing medicated sprays, were unlocked and accessible ”.

Portiuncula Hospital, Co Galway
Portiuncula Hospital in Co Galway has again been found to be putting patients’ health and welfare at risk, following a highly critical Hiqa report of its hygiene standards in January.

Improvements have been achieved, the inspectors said, but waste management, the physical environment and the cleanliness of patient equipment “were not effectively managed and maintained”. The hospital was inspected on July 9th.

Wards, corridors and a storeroom were “heavily cluttered”. The doors to the storeroom for waste and used equipment were unlocked and the doors of two isolation rooms were open. Hand-hygiene opportunities were not taken while members of staff wearing theatre scrubs entered patient areas and returned to theatre without changing.

Opportunities for improvements in hand-hygiene practices of some staff “indicate a culture of hand-hygiene is not fully embedded at operational level within some of the hospital staff grades”, the report said.

Dundalk County Hospital
Moderate risks to the health and welfare of patients were identified during a Hiqa inspection of Dundalk County Hospital on July 1st.

The emergency department, a minor injuries unit and a step-down ward were inspected during the unannounced visit. In the step-down ward bed-frames were “unclean”, varnished surfaces were damaged, paintwork was chipped, a bath interior was stained and the area beneath a shower seat was soiled.

“Two patients with known transmissible infection were being cared for in rooms where the doors were open . . . to where other patients were being cared for.”

Hand hygiene of staff entering and leaving the isolation rooms in the step-down ward “was not in line with best practice”. “The physical environment and equipment were generally unclean . . . and therefore were not effectively managed and maintained to protect patients and reduce the spread of healthcare associated infections.”

St Michael’s Hospital, Dún Laoghaire
An unannounced Hiqa inspection of a male ward and the emergency department at St Michael’s Hospital, Dún Laoghaire on June 19th found a “blood-like substance” on the exterior of a portable urinal, an unlocked store of cleaning products and inadequate hand hygiene.

The male ward was “generally unclean”, and paintwork throughout needed attention. The ward’s holding area for soiled equipment was cluttered with waste. A clinical waste bin was placed on the sink used for cleaning patient equipment and the “lockable storage unit for cleaning chemicals . . . was not locked”.

Also, “while urinals were inverted when being stored, one was visibly unclean. The urinal had a blood-like substance visible on the outer surface”.

In one patient toilet area “there was a mould-like substance visible on the low shelf edging alongside the toilet”.

The inspectors said: “A culture of hand hygiene is not yet operationally embedded within all staff specialities”.

Our Lady’s Hospital, Navan, Co Meath
It was “essential that a culture of hand hygiene” be embedded in every service level of Our Lady’s Hospital in Navan, the Hiqa inspectors found.

“The environment in the emergency department (ED) was generally unclean, with exceptions,” their report stated. The hospital’s emergency department and female ward were inspected on 4th July. “Overall the Authority found that improvements were required in the cleanliness of the environment and of equipment in both areas assessed with some exceptions.”

They found the patient toilet in the ED was unclean and wooden casing located at the back of the toilet bowl was “heavily stained”. Walls were stained. Access to the storage room on the female ward, which contained syringes and needles, was “uncontrolled”.

The report found the ED and the ward “were not effectively managed and maintained to protect patients and reduce the spread of healthcare-associated infections”.