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Hospital

HIQA: Poor hand-washing in Irish hospitals potentially putting patients at risk

The HIQA hygiene reports also found wide variations in hospital cleanliness.

NEW REPORTS FROM the Health Information and Quality Authority (HIQA) suggest that poor hand-washing in Irish hospitals is potentially putting patients at risk.

The reports also found wide variations in regard to hospital cleanliness. According to Phelim Quinn, Director of Regulation with HIQA, their assessments found that hand hygiene actions were not always undertaken or carried out in the right way.

The reports on 12 different hospitals showed in some there was dust and dirt on surfaces, signage not in the right areas, and blood and other substances visible on items.

A number of hospitals have now been asked by HIQA to evaluate their level of hand hygiene compliance, in the context of infection rates, in order to assess the impact on patients.

Quinn said that during the assessments, some immediate serious risks to patients were also identified. “To date, one facility has been asked to conduct a hospital-wide review of its compliance with the National Standards for the Prevention and Control of Healthcare Associated Infections,” he said.

The full inspection reports can be found on the HIQA website.

The Authority’s findings during its unannounced assessments included:

Portiuncula Hospital, Ballinasloe

Hand hygiene practices observed were inconsistent with the standards and suggest that a culture of hand hygiene best practice is not operationally embedded at all levels. This poses a clear and serious risk to patients.

One out of the three clinical areas assessed was unclean. The two other clinical areas assessed were generally clean, but there were opportunities for improvement.

South Tipperary General Hospital

The Authority identified an immediate serious risk to the health and welfare of patients. Patients with communicable diseases were on the main corridor adjacent to the Emergency Department (ED) which is used as a main thoroughfare.

It observed a lack of cleanliness of both the physical environment and equipment, such as visible dirt in patient and non-patient areas. It said the culture of hand hygiene practices is not operationally embedded at all levels.

At Luke’s Hospital Kilkenny

Three clinical areas assessed were clean but there were many opportunities for improvement. Hand hygiene practices observed to be inconsistent with national standards, suggesting that a culture of hand hygiene best practice is not embedded at all levels.

This poses a clear and serious risk to patients of contracting an infection.

Mayo General Hospital

All clinical areas observed were generally clean. Overall, with a few exceptions, the cleanliness of the physical environment was well managed according to relevant national guidelines.

Hand hygiene practices observed  would suggest that a culture of hand hygiene best practice is not operationally embedded at all levels.

Our Lady’s Hospital for Sick Children

All clinical areas observed were generally unclean, with the exception of  the ED. Lack of cleanliness observed would suggest that the physical environment was not effectively managed and maintained to protect patients and reduce the spread of infections, posing a clear and serious risk to patients.

The hand hygiene practices observed would suggest that a culture of hand hygiene best practice is not operationally embedded at all levels. This also poses a serious risk.

Midland Regional Hospital Portlaoise

The Authority found that the cleanliness of the environments assessed, and equipment within these areas, to be generally clean

The level of cleanliness observed would suggest that the physical environment was being effectively managed and maintained to protect service users and reduce the risk of the spread of infections.

Connolly Hospital, Blanchardstown, Dublin

A number of specific issues may have presented immediate serious risks to the health and welfare of patients. A patient with a transmissible disease was being cared for in a cubicle in the ED for over 30 hours; the cubicle opened directly to a corridor where other patients were being cared for.

The persons accountable for the services formally reported back with a comprehensive action plan to reduce and manage the risk in December 2012.

A culture of hand hygiene practice is not yet embedded at every level. The cleanliness of the environments and the equipment for patient use was generally clean. Best practice was not followed in relation to maintaining the cleanliness of the physical environment.

Mercy University Hospital, Cork

It was reported that curtains were changed on a weekly basis in St Anne’s Ward as standard and also following management of an infectious patient. However, documented records observed by the Authorised Persons from HIQA did not concur with this.

In a clinical area the management of an infectious patient was not in line with best practice, where the external door to an occupied isolation room was not closed. The overall findings found a moderate risk to patients.

Observations suggested that a culture of hand hygiene practice was not embedded at all levels.

Midland Regional Hospital, Mullingar

The high level of cleanliness observed would suggest that the physical environment and equipment was effectively managed and maintained to protect patients and reduce the risk of spread of infections.

Suggestion a culture of hand hygiene practice was not embedded at all levels and it a concern that this poses a risk to patients.

Cavan General Hospital

The general environment was clean and free from visible dirt. However, there were opportunities for improvement identified in the ED.

Observations suggested that a culture of hand hygiene practice was not embedded at all levels and there concerns this posed a risk to patients.

The healthcare waste was not managed in line with the HSE national guidance for healthcare risk waste management, which poses a moderate risk.

Mid Western Regional Maternity Hospital, Limerick

The main entrance, stairs, stairwells, both clinical areas assessed and the areas immediately external to the wards were observed to be clean. However, there were opportunities for improvement identified. Healthcare waste was not managed in line with the HSE national guidance and this poses a moderate risk.

Suggestion that a culture of hand hygiene practices was not embedded at all levels, posing a risk to patients.

Roscommon County Hospital

Hospital entrance, stairs, stairwells, corridors and patient waiting areas observed to be clean and free from visible dust and dirt. There were opportunities for improvement in the cleanliness of the environment and equipment in both areas assessed.

Concern a culture of hand hygiene practice was not embedded at all levels posed a risk to patients. Sticky residue from adhesive tape was observed on surfaces in the resuscitation room and a tray was splashed with a substance that appeared to be blood, in the Urgent Care Unit.

Coombe Women’s University Hospital

The main entrance, stairs, stairwells, corridors and areas immediately external to the wards observed to be visibly clean and tidy. However, Our Lady’s and St Monica’s wards were unclean and there were opportunities for improvement.

Management of clean and used/contaminated linen and healthcare waste was not managed in line with the HSE national guidance.

Some non-compliance with best practice hand hygiene technique was observed. This suggests that a culture of best practice hand hygiene practice was not embedded at all levels, leading to a concern this poses a risk to patients.

Read: HIQA publishes data quality guide for healthcare staff>

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