TWO UNANNOUNCED INSPECTIONS of Tallaght Hospital found a number of deficiencies that are putting patients at risk.

The inspections were carried out by the Health Information Quality Authority (Hiqa) in July and August this year. The July inspection found that there were insufficient Clinical Microbiology resources in place to enable a timely response when needed in the treatment of patients with serious infections in the hospital.

Hiqa said that efforts to prevent and control healthcare associated infections at the hospital were severely restricted as a result, and this represented a “high risk to patients”.

During the same inspection, it was noted that in one unit several items of frequently used patient equipment such as glucose meters, a commode, hoists, an oxygen saturation probe, a temperature probe holder and vital sign monitors were “unclean”. The report said this equipment ‘poses a potential risk of inter-patient transmission of infective material’.

The authority was informed that there were reduced resources for cleaning patient equipment on the ward immediately prior to the inspection.

Daily cleaning checklists for equipment were found to be incomplete and inspectors were told that healthcare assistants in charge of this job were frequently required to help with direct patient care. This ‘impacted’ on the time they had to clean.

The report read:

It was explained to the Authority that healthcare resources on the unit are likely to be further reduced for a period in the immediate future due to an overall reduction in the number of healthcare assistants available to the unit.

In addition, it was found that the switch to control pressure levels in an isolation room on one ward was accessible to unauthorised persons. This had the “potential to cause a high risk of transmission of airborne infections”. Other issues included:

• A procedure, policy or maintenance records for this room were not available;
• There was no system in place to monitor the pressure in the room when used for the isolation of patients requiring airborne precautions;
• The door of another room isolating a patient requiring contact precautions was not closed.

August follow-up inspection

The authority was told in August that a previous recruitment drive for an additional locum consult support to the microbiology service had been unsuccessful but a new microbiologist has since been recruited and was due to start this month.

As for the unclean equipment in one of the units, though daily checklists were not available to view at the time of the re-inspection, the cleanliness of the equipment “had improved considerably”. However the authority said that in view of the resources issues highlighted by the July inspection, it recommends that the impact of further reducing resources needs to be examined by the hospital.

Hiqa was told that an audit of commodes, dressing trolleys and drug trolleys was carried out in September 2013. The hospital has secured funding to replace these items throughout the hospital however; the replacement of commodes or drug trolleys was not evidenced at the time of the re-inspection in either of the two areas inspected.

The hospital addressed concerns about the isolation room by issuing a memo encouraging increased vigilance amongst staff. The authority found that the doors of two single rooms on Franks Ward occupied by patients who required isolation were open but this decision was based on a risk assessment of the patient needs. However, the Authority was informed that the risk assessments were not routinely documented.

Mark Stedman / Photocall Ireland Mark Stedman / Photocall Ireland / Photocall Ireland

The keys to isolation rooms with engineering controls have been removed from the control switch and given to a designated person on the ward.

However, Hiqa said concerns remain relating to the monitoring of this room when used for the isolation of patients requiring positive or negative pressure as there is no alarm system which can alert staff if the doors are left open or the pressure is not maintained at the required level. On top of this, staff at the ward said they were not educated on the ventilation systems in the room and were unsure of what the required optimal levels were.

The authority recommended that the hospital review the systems, procedures and processes in place to ensure that the risk of transmission of infection is prevented, managed and controlled.

Hygiene

Inspectors also said maintenance tof the patient environment on both wards was also a concern.

• A blood stain was visible on the floor beside a patient’s bed along with a tourniquet in a six bedded unit.
• “Unacceptable levels of dust” were present on bed frames, the undercarriages of beds, floor edges, behind lockers and casements over patients beds on some of the areas
• The floor covering in patient areas in Franks Ward – particularly under hand hygiene sinks – was damaged and beginning to lift
• A significant area of floor covering was missing beside a patient bed leaving exposed concrete.
• There was damage to plasterwork and paintwork on walls, door frames and radiators.

The follow-up inspection found a number of rooms had been refurbished, though the same is needed in the other rooms.

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