Hiqa critical of hygiene standards at Tipperary hospital

The standard of environmental hygiene at South Tipperary General Hospital is "sub-optimal" with "unacceptable" levels of dust an ongoing issue, Health Information and Quality Authority (Hiqa) inspectors have said.

The findings were contained in a report on an unannounced inspection of the 193- bed hospital in Clonmel last month, which also noted that just 54 per cent of doctors had attended hand-hygiene training during the previous year.

The HSE “welcomed” the report and said management noted the hospital was compliant with “many” Hiqa guidelines, including that its intensive care unit and other areas were “clean” overall and staff displayed a “strong awareness” of required standards.

Management at the hospital “have said that hygiene is a key priority and a plan, agreed with Hiqa, is already being implemented to address areas that require improvement”, the HSE said in a statement.

An audit of three units in the hospital found visible bloodstains on a blood gas machine in the hospital’s intensive care unit, while red stains were visible on a mattress cover and a pillow.

Hiqa inspectors also found “unacceptable dust levels” in a number of areas and, while this was referred to the hospital’s household manager by the ward managers in the coronary care unit and one of the wards, it remains “an ongoing issue”.

Coronary care

The cleanliness of patient environments in the coronary care unit and medical one ward was “of concern to the authority”, the inspectors said.

“On the coronary care unit, unacceptable levels of dust were present on floor edges and corners, on skirting boards, high surfaces such as curtain rails and bed frames.

“On medical one, dust was observed on the under-surfaces of beds, on the casements above beds, on skirting boards, floors, window ledges and curtain rails.”

The patient sanitary facilities in both areas were also “unclean”, the report said, with an “unclean” shower basin and a “stained” toilet brush. “A hospital environment should be visibly clean and free from dust and dirt and acceptable to patients, visitors and staff.”

The Hiqa report said adherence to standard precautions and “fundamental” infection- control principles “such as the safe management of sharps and waste, effective cleaning of equipment, hand hygiene and education are essential in preventing transmission of blood-borne pathogens such as hepatitis B virus and hepatitis C virus”.

Other equipment including thermometer probes, blood pressure cuffs, a commode and glucometer holders were found to be “unclean” in the coronary care unit.

“In accordance with national and evidence-based guidelines, direct contact patient equipment should be clean and equipment which is shared by patients should be cleaned and decontaminated between each use,” Hiqa said.

The unannounced inspection took place on July 10th and focused on three areas – the intensive care unit, the medical one ward and the coronary care unit.

Separate functions

Support staff at the hospital work on both cleaning and catering, in spite of Hiqa’s standard that these areas of work should be kept separate.

“The authority is concerned that the lack of a dedicated cleaning staff on the coronary care unit and medical one may have contributed to the findings on the day of the inspection,” its report said.

On the day of the inspection, hand-hygiene compliance among staff was just 36 per cent, although this was based on a small sample size.

While all staff at the hospital are required to attend hand hygiene training every year, just 54 per cent of doctors had done so between July 2013 and July 10th last, while 55 per cent of healthcare assistants and 46 per cent of administration staff had received training in that period. The figure for all staff was 80 per cent.

Hospital general manager Grace Rothwell said it welcomed the report "and can assure the public that the hospital has a solid record as a safe provider of healthcare to the people of south Tipperary".