Poor hand hygiene at St James’s Hospital criticised

Hand hygiene of staff at the State’s largest hospital, St James’s in Dublin, is poor and poses and poses a serious risk to patients, according to a new report.

The Health Information and Quality Authority (Hiqa) today published critical reports on hygiene standards at St James’s and four other hospitals.

Hiqa inspectors found that just seven out of 29 hand hygiene opportunities they witnessed in the emergency and plastic surgery departments at St James’s followed best practice. Non-compliance related to a failure to wash hands correctly, the wearing of sleeves to the wrist, the wearing of watches or bracelets and the length of time spent on the action.

The report is also critical of the physical environment in the two areas examined. Inspectors found evidence of an unclean shower tray and a mould-like substance on shower files, unsecured chemicals, and debris and grit on the floor. The emergency department was cluttered due to overcrowding, making cleaning difficult.

The report on the Royal Victoria Eye and Ear Hospital in Dublin found the environment in the emergency department and West Wing was “generally unclean, with some exceptions”.

Hand hygiene practices were not in compliance with national standards and this posed a “clear risk” to patients of contracting infection. The hospital has been told to draw up a quality improvement plan and publish it within six weeks.

Inspectors criticised the level of disinfection of some equipment, including the use of non-sterile gloves for reprocessing fibroscopes. They found evidence of dust and cobwebs under chairs, sticky residue on the walls, dust and grit in the toilets and unclean surfaces on radiators.

Of 17 hand hygiene opportunities, 10 were taken. Many medical staff wore their protective clothing, including disposable caps and gowns, outside the operating theatre, which was not in keeping with best practice.

A report on St Colmcille’s hospital in Loughlinstown found while clinical areas were generally clean, there were opportunities for improvement. Some areas had dust and grit and external contractors were not trained in hand hygiene best practice.

Inspectors observed that 15 out of 24 hand hygiene opportunities were taken and concluded that a culture of hand hygiene is not yet operationally embedded throughout the hospital.

An inspection of Letterkenny General Hospital last June found a considerable improvement in hand hygience standards since a previous inspection in February. Although 23 out of 40 hand hygiene opportunities were taken, Hiqa says an culture of hand hygiene is still not embedded in the maternity and surgical wards it inspected.

Inspectors also found a visible improvement in the cleanliness of the emergency department environment and patient equipment since their previous visit.

Overall, though improvement was needed to ensure cleanliness and the physical environment was not effectively managed to protect patients and reduce the spread of infection. Inspectors rated the risk of infection as moderate.

The Hiqa findings in relation to Letterkenny predate the disastrous flooding which devastated large parts of the hospital later in the summer.

Improvements were also noted at Kerry General Hospital in Tralee but inspectors found that a culture of hand hygiene was not yet operationally embedded among all staff. Just half of the 22 hand hygiene opportunities were taken.

Overall, the surgical and post-natal wards examined were generally clean but inspectors drew attention to instances of dust, clutter and unsecured chemicals, waste and medicines.