South Tipperary General Hospital criticised over hygiene

HIQA inspectors have said the standard of environmental hygiene at South Tipperary General Hospital is "sub-optimal" while "unacceptable" levels of dust are an ongoing issue.

The findings were contained in a report on an unannounced inspection of the 193-bed hospital in Clonmel which took place last month and which also noted that just 54 per cent of doctors had attended hand-hygiene training during the previous three months.

An audit of three units in the hospital found visible blood stains on a blood gas machine in the hospital’s intensive care unit while red stains were visible on a mattress cover and a pillow.

HIQA inspectors also found “unacceptable dust levels” in a number of areas of the 193-bed hospital and said that, while this was referred to the hospital’s household manager by the ward managers in the coronary care unit and one of the wards, it remains “an ongoing issue”.

The cleanliness of patient environments in the hospital’s coronary care unit and medical one ward was “of concern to the Authority,” the inspectors said.

“On the coronary care unit, unacceptable levels of dust were present on floor edges and corners, on skirting boards, high surfaces such as curtain rails and bed frames. On medical one, dust was observed on the under surfaces of beds, on the casements above beds, on skirting boards, floors, window ledges and curtain rails.”

The patient sanitary facilities in both areas were also “unclean,” the report said, with an “unclean” shower basin and a “stained” toilet brush. “A hospital environment should be visibly clean and free from dust and dirt and acceptable to patients, visitors and staff. The findings of the inspection indicate that environmental hygiene is suboptimal and dust has been highlighted through internal hygiene audits as an ongoing issue.”

The HIQA report said adherence to standard precautions and “fundamental” infection-control principles “such as the safe management of sharps and waste, effective cleaning of equipment, hand hygiene and education are essential in preventing transmission of blood borne pathogens such as hepatitis B virus and hepatitis C virus.”

Meanwhile, other equipment including thermometer probes, blood pressure cuffs, a commode and glucometer holders were found to be “unclean” in the coronary care unit. “In accordance with national and evidence-based guidelines, direct contact patient equipment should be clean and equipment which is shared by patients should be cleaned and decontaminated between each use,” HIQA said.

The unannounced inspection took place at the hospital on July 10th and focussed on three areas: the intensive care unit (ICU), the medical one ward (St Monica’s Ward) and the coronary care unit, including the step-down section.

The hospital’s catchment population is 134,000 across south Tipperary, west Waterford and part of north Tipperary.

Support staff at the hospital work on both cleaning and catering, in spite of HIQA’s standard that these areas of work should be kept separate. “The Authority is concerned that the lack of a dedicated cleaning staff on the coronary care unit and medical one may have contributed to the findings on the day of the inspection.”

On the day of the inspection, hand hygiene compliance among staff was just 36 per cent although this was based on a small sample size.

While all staff at the hospital are required to attend hand hygiene training every year, just 54 per cent of doctors had done so between July of 2013 and July 10th last, while 55 per cent of health care assistants and 46 per cent of administration staff had received training during that period. The overall figure for all staff was 80 per cent.

During the inspection, 18 “hand hygiene opportunities” were noted but just seven of these were taken. The 11 opportunities not taken included five before touching a patient, two after touching a patient, three after touching patient surroundings, and one after touching one patient and before touching the next patient.