Hospital patients at risk from bad hand hygiene, report finds

Hand hygiene practices are generally improving in many Irish public acute hospitals, but unclean hospital equipment and poor hand hygiene practice among some healthcare staff is still putting patients at risk, according to a new report.

An overview report of Health Information and Quality Authority (Hiqa)unannounced hygiene inspections in almost all public acute hospitals over a 12-month period shows while many hospitals meet national infection prevention and control standards, all hospitals could do more to improve hand hygiene and environmental cleanliness.

Between February 2014 and January 2015, Hiqa carried out 54 inspections of 49 out of the 50 public acute hospitals with a focus on hospital cleanliness and hand hygiene.

Hiqa carried out unannounced follow-up re-inspections in five of the hospitals due to particularly poor compliance with standards and to promote rapid improvement between unannounced inspections.

Serious risks to patient safety were identified in a number of inspections, with Hiqa issuing immediate high-risk letters to seven out of the 49 hospitals inspected.

The main high-risk issues identified by the inspectors related to environment and facilities management, hand hygiene, communicable and or transmissible disease control and microbiological services.

Specialist areas treating patients at higher risk of infection such as neonatal intensive care, renal dialysis and operating theatres were inspected for the first time last year

Other areas inspected included surgical, medical, orthopaedic, trauma and oncology services.

Inspectors regularly found poor access to hand hygiene gel dispensers for staff and hand-wash sinks that didn’t meet specifications.

Basic patient equipment shared between patients was unclean in many hospitals.

Commodes, mattresses, mattress covers, blood glucose monitoring kits and temperature probe holders were all found to be commonly unclean in many of the hospital areas inspected.

Infections

In the case of unclean commodes, this constitutes an increased risk of transmission of serious healthcare associated infections such as clostridium difficile which causes debilitating diarrhoea.

The inspection team observed various examples in hospitals whereby efforts were made to promote hand hygiene and improve compliance amongst staff.

For example, one hospital would withhold parking permits if staff had not completed their training, and another hospital would prevent staff from applying for further study if they had not been trained.

Junior doctors in one hospital were prevented from moving onto their next rotation if they had not completed hand hygiene training.

A group SMS text was sent to non-consultant hospital doctors in one hospital, informing them of the ‘bare below the elbow’ policy and the fact that handbags were not allowed to be worn in clinical areas.

One hospital had taken a zero tolerance approach to hand hygiene compliance amongst staff.

A penalty point system was in place whereby staff would receive a penalty point for hand hygiene non-compliances. Staff who received five points would be required to re-attend hand hygiene training.

Hiqa’s acting director of regulation Mary Dunnion said patients have the right to expect equipment used as part of their care is clean.

“We are recommending that patients and relatives should be made aware by hospitals of how to keep their hands clean as a matter of routine. Some hospitals have already introduced measures to encourage patients to ask staff if they have washed their hands, for example, through poster campaigns or prompting badges on uniforms.

“This is worthy of more widespread exploration across Irish acute hospitals.”