Report criticises hand hygiene at St James’s Hospital

Minister for Health James Reilly has referred a series of reports critical of hospital hygiene to the Medical Council and An Bord Altranais to see if action needs to be taken over the failure of staff to wash their hands properly.

“I have no doubt that the relevant regulatory bodies will deal appropriately with medical professionals who persist in endangering patients through a lack of hand hygiene. My department will be following up in this regard,” said Dr Reilly.

He was speaking following the publication of the latest hygiene reports by the State's health watchdog, which said patients at St James's Hospital are at serious risk of infection because of the poor hand hygiene of staff.The criticism of standards at the State's largest hospital are contained in one of five reports published yesterday by the Health Information and Quality Authority and follow similar criticisms of Beaumont Hospital and other hospitals in a previous batch of reports published earlier this month.

Spread of infection
Dr Reilly said the HSE would be instructing all hospitals to beef-up measures to prevent the spread of infection. Each hospital must ensure a member of senior management is responsible for hygiene and that a hygiene programme is in place by the end of this year. Hospitals have also been requested to have their entire workforce educated and trained in hand hygiene by June 2014.

St James’s Hospital said the findings of the report from Hiqa are “below what St James’s normally expects and achieves”. However, it pointed out that rates of MRSA and other infections at St James’s are below the national average.

The Irish Patients’ Association said the findings showed the message about hygiene was “not getting through”.

“This seriously calls into question the governance of our acute hospitals and the level of oversight by the HSE,” said its spokesman Stephen McMahon. “If left undermanaged, it will contribute to an erosion of trust by patients and leave them open to infection while in hospital.”

At St James’s, inspectors found that just seven out of 29 hand-hygiene opportunities they witnessed in the emergency and plastic surgery departments followed best practice. Non-compliance related to a failure to wash hands correctly, the wearing of sleeves to the wrist, the wearing of watches or bracelets and the length of time spent on the action.

The report is also critical of the physical environment in the two areas examined. Inspectors found evidence of an unclean shower tray and a mould-like substance on shower files, unsecured chemicals, and debris and grit on the floor. The emergency department was cluttered due to overcrowding, making cleaning difficult.

The report on the Royal Victoria Eye and Ear Hospital in Dublin found the environment in the emergency department and west wing was "generally unclean, with some exceptions".

Hand-hygiene practices were not in compliance with national standards and this posed a “clear risk” to patients of contracting infection. The hospital has been told to draw up a quality improvement plan and publish it within six weeks.

Inspectors criticised the level of disinfection of some equipment, including the use of non-sterile gloves for reprocessing fibrescope. They found evidence of dust and cobwebs under chairs, sticky residue on the walls, dust and grit in the toilets and unclean surfaces on radiators.

Best practice
Of 17 hand-hygiene opportunities, 10 were taken. Many medical staff wore their protective clothing, including disposable caps and gowns, outside the operating theatre, which was not in keeping with best practice.

A report on St Columcille’s hospital in Loughlinstown found that while clinical areas were generally clean, there were opportunities for improvement. Some areas had dust and grit and external contractors were not trained in hand hygiene best practice.

Inspectors observed that 15 out of 24 hand hygiene opportunities were taken and concluded that a culture of hand hygiene is not yet operationally embedded throughout the hospital.

Cleanliness
An inspection of Letterkenny General Hospital last June found a considerable improvement in hand hygiene standards since a previous inspection in February.

Although 23 out of 40 hand hygiene opportunities were taken, the report says an culture of hand hygiene is still not embedded in the maternity and surgical wards it inspected.

Inspectors also found a visible improvement in the cleanliness of the emergency department environment and patient equipment since their previous visit.

Overall though improvement was needed. The findings in relation to Letterkenny predate the disastrous flooding which devastated large parts of the hospital this summer.

Improvements were also noted at Kerry General Hospital in Tralee but inspectors found a culture of hand hygiene was not yet operationally embedded among all staff. Just half of the 22 hand hygiene opportunities were taken.