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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.
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.
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While I am advocate of proper hand washing especially when out and about, it all seems totally pointless when you use a public toilet wash your hands and then have to grab the door handle on the way out, where no doubt other people have not done so
you can get away with using your elbow unless its one of those twisty door knobs…
I usually pull my sleeve down over my hand to pull the handle!
It shouldn’t be necessary to touch hospital bathroom door handles with your hand. Same with taps. You should be able to use your elbows. Also, there should be several hand washing stations on every hospital ward that aren’t in bathrooms.
In the maternity where I work there are special handles on all doors operated by forearm pressure thus avoiding hand contact
Other doors are opened by foot pedals
In France hand washing and usage of alcoholic gels are rigorously enforced.
James Reilly is putting hospitals and patients at risk. The government should wash their hands of Him!
Patients should insist on their Doctor washing their hands in front if them and if they’re unable to, then the person with them should insist on it. The days of the Doctor always being right and unquestionable are well and truly gone.
How about insisting that the system doesn’t treat NCHDs as slaves and work them to the point of collapse. Frankly a patient insisting on a doctor washing their hands in front of them is an unnecessary insult to someone who could be working a 36 hr shift. Everyone has a role to play re proper hand washing from porters to doctors and there’s little reason castigating doctors if the place is being contaminated by everyone else. Doctors are easy cape goats, has the most responsiblity and the system employs far more nurses and ancillary staff in comparison
Doctors hygiene is impeccable.
What is required is a personal sink at every bed, a Hitler style masochist at every entrance to ensure that every person (regardless of their reason of being there) washes their hands properly.
The repercussions of a HAI for frontline staff are quite severe, they’re the least of your worries.
Also, what Alan said x1000.
I have insisted that doctors wash their hands and they have gotten quite peeved. I have seen them move from one person to the next (and then to my father) without washing their hands. My father was a dialysis patient and so had an open line into his body. He did get an infection and he died eventually. Would hand washing have helped? Probably.
I wouldn’t be admitted into an Irish hospital for a million euros after what I have seen. I live abroad now and for the duration of my last pregnancy I did not return to Ireland for fear I might end up in the hands of the healthcare system.
Its important for average healthy person to wash hands…but in a healthcare situ its critical….we all know we dont wash our hands properly most days…but in a hospital or nursing home its sooo important
The curtains around beds in hospitals are only cleaned a few times a year. This is a source of infection that is not taken seriously. MRSA, Nora virus can live on these curtains.
“Frankly a patient insisting on a doctor washing their hands in front of them is an unnecessary insult to someone who could be working a 36 hr shift.”
A patient is entitled to know they are being handled by someone with clean hands. Any doctor who objects should have his/her backside booted along the ward. The days of “trust me I’m a doctor” are long gone!
Not much point in us washing our hands if the patient has just returned from sitting on another bed to have a chat, or if the bins are overflowing and filthy, or if the visitors have just pawed everything in the room, or if management refuse to sanction cash for a sink less than 50m from the bed.
Anyone who thinks hospital hygiene can be fixed by this sort of “tell docs to wash” nonsense is an idiot, simple as.
I seen cleaning staff use the same cloth to wipe a counter as they’d used in the bathroom before! (I think the hospital had a contract with a private company – who trains and regulates their hygiene standards and work practices?!) Notoriously unhealthy food, the overworked, understaffed staff it all contributes. My aunt had keyhole heart surgery and was placed on a trolley in the corridor the next day, she became very ill from MRSA. Another man i know had a toe removed and ended up dying from MRSA. And all this not even including the complete lack of facilities for cystic fibrosis patients, even the new rooms in Vincent’s aren’t nearly enough and many have to treat themselves at home for fear of infections which may be fatal. Those with CF who live in The north have a longer life expectancy than those in the south – all thanks to our lack of facilities. But when we had money this country only cared about profit. Now we have ghost estates AND shit healthcare.
As usual the Government is wasting money with reports and not dealing with the problem in question. Get rid of a few quangos and the money saved will fund the necessary cleaning products and education for the hospitals
The corridor was never ment to be a hospital ward if we look at the reports on a daily report we see the corridores been used as wards in many of our hospitals while wards in the hospitals remain closed due to cuts in budgets.
When my son was in Harcourt St Childrens hospital for a week staff cleaned the entire ward at least twice during that week -pulling beds out and washing and disinfecting the floors and walls. This seemed to be the standard operating procedure 15 years ago or so.
When my dad was in Tallaght hospital a few years ago, the only cleaning I saw done was a disinterested contract cleaner sweeping the bits of the floor she could see. There was a bloodied bandage and other bits of rubbish under his bed for at least three days.
I was on a Cruise last year and everywhere you go they have that alchohol spray. I Know its Profit driven as they dont want any down days or weeks due to any illness etc but the HSE should take a leaf out of thier book.
Alcohol spray is no use against the likes of norovirus.
I wonder how many of the hospitals have hot rather than just warm water. That would be more important.
Cheap hand dryers tend to just circulate bad dirty air as well.
There are alcohol hand washs at the entrance of every room and at the end of every bed but the alcohol washs aren’t 100% effective
Norovirus isn’t a bacteria, so alcohol won’t work at all for that.
Good handwashing, bleach and specific foam anti-viral hand sprays are the only things of any use.
Anti-viral hand sprays are very hard to find in the shops though. You really have to order online.
They had a question about the importance of the temperature of the water on QI, apparently it’s not necessary for the water to be hot- it’s more about how vigorously you wash your hands with a soap containing an anti bacterial agent. Personally I still prefer the hot water, but if this is true it means you can still do a decent job if the water is just warm.
There’s a hand washing routine that most hospitals / nursing homes display in their toilets, designed to ensure that you get everything. It’s worth doing it properly anyway.. Especially if you’re around people who have impaired immunity.
Does James Riley doing a great Pontius Pilate impression count as poor hand washing?
I have spent a significant amount if time over the past four month on st Johns cancer ward in Crumlin with my son. Hygiene is a huge problem and is extremely important for kids undergoing chemotherapy as they have no resistance to infection and any infection can have very serious results. While there are sinks in every room I have observed the handwashing culture is not embedded in staff. I have had to ask nurses to wash hands. The nursing staff are very busy and it doesn’t seem to be a habit with all of them. Some are fantastic and wash hands every time they enter the room. This is how it should be for all staff. We cannot allow any risk with these very sick kids. The rate of infection of hospital bugs is very high in Ireland compared to other countries and can be significantly reduced by hand washing. Hand washing is free. We can’t blame lack of resources for this failure. In the USA patients are encouraged to remind everyone who enters their room to wash their hands. This would be a good trend to start in Ireland. All visitors – whether they are nurses, doctors or therapists or mums and dads and brothers and sisters should be reminded to wash hands properly. This should create 1 positive change.
In fairness this is not just down to hand washing. Did hand washing cause the mould on the tiles? The blood stains? The filthy surfaces? The is a huge sign outside Waterford Regional which proclaims a “smoke free campus”. At Christmas I saw someone smoking next to it – unchallenged.
Who supervises the cleaning companies? The HSE’s own staff or the companies themselves? If it’s the latter then herein lies the problem.
It comes down to simple hygiene or lack of , the unions have a lot to answer for in this they have ruined the health service every body wants more money to do their jobs , for instance the cleaners won’t move the beds to clean under them because they say its not in the contract. Someone will need to be firm with the unions in order to clean up the hse.
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