Watchdog warns hospitals on hygiene

MOST IRISH hospitals have "poor" or "fair" hygiene standards and six have received formal warnings about specific hygiene risks, according to a report by the health service watchdog.

The Health Information and Quality Authority says overall standards have improved slightly, but the national review of hygiene levels in hospitals it published yesterday points to major variations in standards between different hospitals.

Individual reports on 50 hospitals include instances of dirty, dusty and mouldy facilities, poor cleaning techniques and bad practice, such as a failure to wear protective clothing or wash hands properly. The review gave a "very good" rating to just one out of 50 hospitals, Cappagh National Orthopaedic Hospital in Finglas, Dublin. Cappagh also made the biggest improvement, having scored only "fair" in the first review last year.

Nine hospitals, most of them smaller hospitals in rural towns, scored "poor", and a further 29 hospitals were rated "fair". Eleven hospitals were awarded a "good" rating.

Standards improved at 13 hospitals but in eight others, hygiene standards actually fell.

The six hospitals that have been sent risk letters by the authority are: St Columcille's in Loughlinstown, Dublin, which has featured at a number of inquests into the deaths of patients from MRSA and clostridium difficile; Letterkenny General Hospital; Our Lady of Lourdes Hospital, Drogheda; St Luke's Hospital in Rathgar, Dublin; the Mid-West Regional Hospital, Ennis, where an outbreak of clostridium difficile in the first half of 2007 contributed to 13 patient deaths; and St Mary's Orthopaedic Hospital, Cork.

The authority said hygiene had improved in a number of areas since the first review was published over a year ago. These include hand hygiene, the management of bed linen and waste and the structure of hygiene services in hospitals. Among the areas it says are in need of improvement are the reporting and evaluation of information, the monitoring of staff satisfaction and health, and evaluation of staff.

Minister for Health Mary Harney, while describing the findings as encouraging, said there was still too wide a gap between those doing well and the "underperformers". She promised targeted initiatives next year to ensure best practice is replicated across the system.

The HSE said the review provided clear, independent evidence that it was providing care to patients in hospitals that were cleaner, year on year. The number of hospitals receiving a "good" or "very good" award from the authority rose from seven in 2007 to 12 in 2008, it pointed out.

However, Fine Gael health spokesman Dr James Reilly said the dearth of "very good" ratings showed progress on hygiene was painfully slow. He noted that 24 hospitals that had rated either "fair" or "poor" last year had achieved the same rating this year, while the rating of eight hospitals had disimproved.

"The reality is that this is nothing like the kind of impact we would have hoped for after two audits and two HSE hygiene reports. How can we expect this situation to improve in the coming year with massive health cutbacks promised by the Government?"

The authority's chief executive, Dr Tracey Cooper, said high-quality hygiene systems were essential to driving down the rates of infections. The hospitals awarded a "poor" rating include those in Bantry, Letterkenny, Mullingar, Roscommon, Ennis, as well as the Mercy Hospital in Cork, Our Lady of Lourdes in Drogheda, St Mary's Orthopaedic Hospital in Cork, and St Columcille's, Loughlinstown.

In Dublin, St James's, Beaumont, Tallaght and the Rotunda hospitals were all ranked "good".

In a survey of patient perceptions, recurring concerns were expressed about the toilet facilities in hospital wards. Patients said these were inadequate for the size of ward, resulting in over-use and a failure to clean them as regularly as necessary. The survey also revealed many patients do not feel comfortable asking doctors and nurses to wash their hands before examining them. Less than 10 per cent had actually done so.

St Mary's Orthopaedic Hospital, Cork

"Windows were observed to be in need of cleaning."

"Equipment was found to be dusty in all areas, with the exception of the outpatient department."

"On-site laundry was in a very poor condition. The environment is not managed appropriately, with evidence of lack of cleaning methods, mould on walls, substances dripping from the ceiling, and malfunctioning washing machines resulting in washing cycles that could not be relied upon to ensure satisfactory cleaning of linen. Therefore, there is a risk of cross contamination/infection."

St Columcille's Hospital, Loughlinstown, Co Dublin

"There was evidence of visible dirt in the shower room on Lourdes ward; this was the only shower available to patients in this area.

"It was observed that records of cleaning the toilet and washing areas was not up to date in any of the areas visited.

"Ward areas were noted to be poorly ventilated.

"Staff were observed not to be wearing personal protective clothing in all instances while transporting waste. Thus there was a serious risk to patients identified."

Mid-Western Regional Hospital

(St Joseph's General), Nenagh

"Clutter was observed. Therefore cleaning was difficult. There was evidence that bedpan washers needed cleaning."

"Storage of urinals/wash basins needed attention."

"Most bins appeared to be new, however many of the bin interiors were not clean."

"Hand-hygiene techniques were observed not to be in line with best practice."

"There was evidence observed of a wristwatch being worn by laundry staff when hand-hygiene was being demonstrated."

Mid-Western Regional Hospital, Ennis

"There was evidence of dust.The bed-pan washer was not working in the surgical ward. The cleaning equipment observed did not appear clean in all areas visited.

"In general the hygiene in the kitchens visited was not to a very high standard."

Mid-Western Regional Maternity Hospital, Limerick

"It was observed that a number of bedpans were not clean. It was demonstrated that a number of wash-hand basins were not in line with best practice."

"There was evidence that not all waste bins were hands free."