A series of serious hygiene lapses have been uncovered at Northern Ireland’s hospitals, despite the continuing drive for basic cleanliness in our major medical facilities.
Equipment splattered with blood, staff not washing their hands after touching patients and walls stained with faeces were all shortfalls identified during a series of recent no-warning inspections.
The Regulation and Quality Improvement Authority has released the findings of its latest unannounced hygiene inspections at hospitals across Northern Ireland which reveal patients are still being put at risk by basic failures.
While it commended staff for improvements made following on from inspections last year, the RQIA teams still found some startling lapses in basic hygiene.
Under the spotlight were acute hospitals, maternity units and acute inpatient psychiatric facilities inspected in 2009 and again in 2010 to determine whether hygiene failures had been addressed.
A number of recurring issues were identified throughout Northern Ireland’s biggest hospitals, with staff failing to wash their hands or wear personal protective equipment such as aprons or gloves — fundamental in the fight to drive down the number of hospital-acquired infections.
Some of the most shocking lapses in basic hygiene levels included dried blood on equipment, out-of-date medication, and a toilet wall in the Erne Hospital was found to have faeces on it.
In some cases the RQIA team discovered no steps had been taken to address failures identified during previous inspections almost a year ago.
At the Royal Belfast Hospital for Sick Children they found the framework of cots still dusty and worn and the tips of forceps still covered in Elastoplast.
There was also evidence that staff at some hospitals had not received infection control training, while cleaners were using the wrong type of disinfectant which was putting patients at risk of infection.
The issue of hospital-acquired infections is high on the public agenda following on from an outbreak of killer superbug C difficile in the Northern Trust area.
Two years on from the outbreak, and despite massive strides by the trust to improve infection control, the RQIA still identified a series of issues at Antrim Area Hospital, including dried blood on a dressing trolley, failure by staff to wash their hands, a failure to lock medication fridges and inconsistent recording of the temperatures of the fridges.
Follow-up inspections of maternity suites across Northern Ireland showed a marked improvement in hygiene levels, but still identified issues that needed to be addressed.
These included old, worn or broken equipment, equipment which should be sterile being left exposed, a failure to ensure blood-stained equipment is cleaned immediately, and the use of unsuitable disinfectant.
Meanwhile, failings were found in acute psychiatric inpatient facilities, such as the absence of soap and hand towel dispensers in communal bathrooms.
Maeve Hully, chief executive of the Patient and Client Council, welcomed the improvements, but said more needs to be done to ensure patient safety in our hospitals.
She said: “We know from our many conversations with patients and their families across Northern Ireland that hospital cleanliness is of great concern to them.
“We will strive to ensure that patients get the best standards of cleanliness on all wards.”
Health Minister Michael McGimpsey said he was encouraged by the findings which he said prove efforts to address hygiene in Northern Ireland’s hospitals are working.
Where the worst cleanliness blunders were found
Some of the most shocking findings from the follow-up inspections this year were:
Royal Victoria Hospital A&E — the undercarriage of some patients’ trolleys were dusty and some had evidence of black residue, and dried blood was noted on a foot pump. Patient washbowls were wet and soiled, staff did not know the correct dilution rates for disinfectants used for blood spillages and decontamination of isolation rooms.
Royal Belfast Hospital for Sick Children Allen Ward — a series of issues had not been addressed from the last inspection 11 months before including the framework of baby cots still worn and dusty and the tips of forceps still covered in Elastoplast tape. Staff also failed to wash their hands after touching patients.
Mater Hospital A&E — staff member did not wear a protective apron resulting in a heavily- stained uniform.
Belfast City Hospital A&E — underside of commodes again stained with faeces and a system to show that commodes have been cleaned and are ready for use had not been used for 10 months; some equipment was dusty and a patient trolley and mattress remained blood-stained after cleaning. Staff did not wear aprons when there was the risk their clothes may be exposed to bodily fluid.
Musgrave Park Hospital Outpatients — member of staff failed to remove personal protective equipment when leaving an isolation ward after changing bed sheets, while in Ward 4 there were stained commodes and items sticking out of bins for needles which were also accessible to the public.
Erne Hospital — walls in toilet cubicles and toilet brush stained with faeces; unused incontinence pad hanging on hand rail; bin for disposing of needles was overflowing and splattered in blood.
Causeway Hospital Ward 2 — public had access to room with drug trolleys, domestic staff did not wear aprons when cleaning, while in the A&E trays for needles were dirty.
Craigavon Area Hospital — staff have not received mandatory training on infection prevention and control or safe handling and disposal of needles.
Downe Hospital — inadequate supply of staff uniforms, dirty trays for needles.
Daisy Hill Hospital — undercarriages of beds, patient trolleys and storage units required cleaning; out-of-date medication was found; alcohol rub unavailable at the entrance of the A&E.
South Tyrone Hospital — patient toilets in minor injuries unit in need of detailed cleaning, toilet brushes were soiled.
Ulster Hospital — needles were resheathed after use; immobile patients not offered hand hygiene facilities after using the commode or prior to meals.
Altnagelvin Hospital Ward 10 — trays for needles were found to be blood-stained.
Tyrone County Hospital — torn mattress covers and internal mattress foam stained.