HIQA inspections find poor hygiene in four hospitals

HIQA reports into hygiene standards in five hospitals published this morning have found evidence of inadequate hand hygiene leading to risk of infection to patients while wards in two hospitals were deemed "generally unclean".

Unannounced inspections of the Mater, Nenagh, St Vincent’s, Tallaght and Ennis hospitals were carried out by Hiqa inspectors between August and September and focused on environmental cleanliness and hand hygiene.

Four of the five hospitals, with Ennis being the only exception, were found to breach hand hygiene standards to the point where the practice posed a risk to patients of healthcare associated infections.

In the Mater Misericordiae hospital in Dublin HIQA inspectors found “much evidence of practice that was not compliant” with national standards.

It found that the two wards inspected - St Teresa’s, which is a medical ward and St Joseph’s - were “generally unclean” although patient equipment was “mostly clean”.

Inspectors in the Mater reported:

- unlabelled syringes containing unknown solutions found in two kidney dishes on a worktop in the utility room in St Teresa’s Ward while unclean intravenous stands were also found in the ward

- inappropriate storage of hazardous chemicals in a “dirty” utility room which contained multiple wire catheter holders, some of which were rusted.

- that hand hygiene practices were not embedded at all levels, especially among staff practices observed on St Joseph’s ward

- eight patient washbowls and bed urinals stored incorrectly in the St Joseph’s ward where some bedpans were also observed to be stained

In a statement released this afternoon the Mater said improving hygiene compliance was a “top priority” for the hospital. It said it was disappointed with some findings as outlined in HIQA’s report: “We would like to take this opportunity to reassure patients that our hospital is clean and that we will continue to work hard to achieve best practice in National Hygiene Standards.”

In Nenagh Hospital inspectors found that the environment and equipment in two wards, Medical 1, a male ward and Medical 2 ward, a female ward were "generally unclean" with a subsequent risk of to patients of hospital-based infections.

Inspectors in Nenagh also reported:

- an unlocked storage unit in Medical 2 contained needles, syringes and oral medications

- that a culture of hand hygiene practice was not embedded among all staff; some sinks designated for hand washing were unclean with a black “mould-like substance” on one sink

- damaged coverings in Medical 1 hindered effective cleaning while the ward had wall surfaces with large areas of paint missing and a sink located beside an exposed, crumbling wall surface beside a patient’s bed

- the surface of a patient temperature monitoring device was unclean and there was a piece of soiled dressing tape on the surface of the device

- a sticky residue the surface of an intravenous pump in the nurses’ station; and grit and rust around the area over the wheels of dressing trolleys

In St Vincent’s University Hospital in Dublin inspectors found that environmental hygiene was not effectively managed and that a culture of hand hygiene was not embedded among all staff.

It found that some of the hand wash sinks were unclean and that non-compliance of hand-wash practices posed a risk of the spread of hospital-based infections.

Inspectors in St Vincent’s also reported:

- a mould-like substance on a surface between a sink and a wall in the Emergency Department

- unclean wall and floor coverings in a bathroom on St Patrick’s Ward

- a “dirty” utility room which was not fit for purpose on St Patrick’s Ward where cupboard doors were falling off.

In a statement released this afternoon St Vincent’s University hospital said it considers hand hygiene compliance “one of the single most important factors in reducing and eliminating healthcare associated infections”.

“The hospital continually monitors its progress in this area and these recent HIQA hand hygiene findings are below what St Vincent’s normally achieves,” it said, adding that a national hand hygiene audit undertaken earlier this year showed 91 per cent compliance.

In the Adelaide and Meath Hospital in Tallaght Hiqa inspectors found that the Lane and Osborne wards were "generally clean" with a number of exceptions.

Inspectors in Tallaght reported that:

- 38 per cent of nursing and healthcare assistant staff on the Lane ward had not completed hand hygiene training in the year up to the end of June and that a culture of hand hygiene practice was not embedded at all levels or among all grades of staff

- a step-ladder in a treatment room was heavily soiled

- broken and worn edges of some patient bedside tables; cracked, peeling or missing paint; and a black mould-like substance on the edges of some protective wall borders and wall joints

- the treatment room was non-compliant with national standards including dust, access issues, damaged equipment and a mould-like substance

In a statement released this afernoon Tallaght Hospital acknowledged the findings of HIQA report, adding that the incidences of non-compliances identified in the report were unacceptable.

It said that, in line with the HIQA report recommendations, a Quality Improvement Programme had been initiated by the hospital.

“Tallaght Hospital will continue to ensure that the above measures aimed at ensuring the highest level of hand hygiene are fully implemented and enforced at all grades and that a culture of hand hygiene becomes fully embedded at all levels within the organisation,” the statement said.

In Ennis Hospital, where inspections were undertaken in the Fergus and Burren wards, inspectors found both to be very clean with "very few" exceptions.

It found that hand hygiene training is mandatory and regular hand hygiene audits are undertaken although some opportunities for hand hygiene were missed.

However, inspectors found three boxes of intravenous fluids stored on the floor of the drugs room.