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Unannounced inspections at children's hospital found 'high-risk' uncleanliness

“Multiple surfaces within the wards inspected were dusty and these included bed undercarriages, chairs and examination couches.”

A RECENT INSPECTION of Temple Street Children’s University Hospital has found that environment and patient equipment hygiene were at critically low levels and needed to be addressed urgently.

The first unannounced inspection was carried out by the Health Information and Quality Authority (HIQA) at Temple Street hospital on 27 July 2016.

A re-inspection six weeks later examined the level of progress which had been made regarding environmental and patient equipment hygiene in the areas inspected.

The report based on these two visits found that the environmental hygiene in both St Patrick’s Ward and St Bridget’s Ward was poor overall and “was not in line with current national standards and guidelines for hospital cleaning”.

First visit

“Cot frames, bedside storage units and recliner chairs in vacant bed spaces in St Patrick’s Ward that had been cleaned following patient discharge were stained.”

Multiple surfaces within the wards inspected were dusty and these included bed undercarriages, chairs, examination couches, floors, over-bed lights, wall surfaces, radiators, ventilation grilles, staff workstations, a games table and horizontal ledges.
Other unclean surfaces, including the interiors of waste bins, cupboards, storage units and fridges, did not appear to have been included in ward cleaning specifications. Poor finishes around radiators in St Bridget’s Ward facilitated dust collection.

It was also reported that toilets were cleaned once a day and that a janitorial service was available to staff if required during the day, which was not in line with recommended national minimum cleaning frequencies.

Other factors which contributed to poor environmental hygiene in the wards inspected included an outdated hospital infrastructure, poor maintenance, very limited space in patient care and ancillary areas, lack of storage space, the design and positioning of beds and cots and bedside storage units which did not facilitate effective cleaning.

Second visit

During the second inspection on 6 September, “significant improvements” were made to clean both St Patrick’s Ward and St Bridget’s Ward.

Both ward environments were found to be clean. It was evident that enhanced cleaning had been performed in both areas

New flooring had been installed, painting and woodwork repairs had been carried out, and surfaces had been upgraded. Although “deep cleaning and improvement works” had been carried out since the first inspection, and the report finding the hospital “98% compliance with standards”, there were incidents of a lack of hygiene upon the re-inspection.

“Overall patient equipment in St Bridget’s Ward was clean with few exceptions. A
stained commode was stored in a locked cupboard on a corridor outside the ward.”

The commode was stored in this manner because there was not enough floor space within the ‘dirty’ utility room, which was the appropriate storage area for this item.

“In addition, bedside suction catheter holders were unclean.”

In St Michael’s C Ward:

Heavy dust was present under pull-out beds for parents in two patient rooms and behind a fixed cupboard in the open plan renal dialysis area. The design and manner in which these items were fitted did not facilitate effective cleaning.

The report recommended that more soap dispensers should be provided, that regular hygiene training be provided to staff, and that a hygiene audit be conducted.

Temple Street must also publish its Quality Improvement Plan (QIP) on its website within six weeks of today, and provide HIQA with the web link.

The aim of unannounced HIQA inspections is to assess hygiene in the hospital as observed by the inspection team and experienced by patients at any given time.

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