‘Immediate risk’ to Waterford hospital patients

Immediate and serious risks to the health and welfare of patients at Waterford Regional Hospital have been identified by the Health, Information and Quality Authority.

The risks, which relate to the transmission of infections, must be seriously addressed within six weeks, the authority has said.

Among the risks identified were serious breaches of hand-hygiene standards, a toilet area “heavily stained with a mould-like substance”, an unlocked medication fridge, used surgical instruments and a used tracheotomy tube stored on top of a tray containing disinfectant fluid; a designated hand-wash sink containing pieces of equipment soaking in solution, a patient with a suspected communicable disease not in a room but in an open bay, and a commode not being washed after use.

The Hiqa inspectors, who made an unannounced visit to the 549-bed hospital on June 25th, found the environment to be “generally unclean”.

The report on the hospital is published today. The hospital was assessed for compliance with environment and facilities management standards and with hand hygiene standards. They looked at the emergency department, a surgical ward and a medical ward.

In the emergency department, they found the hand-hygiene of staff “was not in line with best practice guidelines.

“The authority observed 23 hand-hygiene opportunities throughout the monitoring assessment, comprising 11 before touching a patient [AND]12 after touching a patient. Five of the 23 hand hygiene opportunities were taken and were observed to comply with best practice hand hygiene technique. Non-compliance related to failure of nursing and medical staff to take hygiene opportunities. Some staff wore sleeves to their wrists and wrist watches, which is not best practice as it prevents adequate hand-washing.”

Hand-hygiene, says the report, is “the single most important preventative measure” in the transmission of health-care acquired infections.

The inspectors said there was evidence of good practice in environment and facilities management. However they also found a “heavy sticky residue” on the exterior of a patient’s wardrobe, chipped lockers, chipped paintwork, dust , radiators being used for patients’ personal towels which sometimes touched other patients’ towels.

In the medical ward they found: “The floor directly around the toilet and the base of a toilet cistern for patient use was heavily stained with a mould-like substance”. In the same ward “a disposable kidney dish containing used surgical instruments and a used tracheotomy tube were stored on top of one of two large trays containing disinfectant”.

Also in this ward, “Hiqa observed that the surfaces of two commodes assessed were stained [AND]a member of staff was observed ... failing to clean a used commode after use.” Another commode had “visible soiling on the seat” and the lids of two others were “unclean”.

In the drugs/utility rooms the inspectors “found that a medication fridge on medical ward 2 containing, for example, insulin and antibiotic solutions and a cupboard containing medicated sprays, were unlocked and as such accessible to unauthorised persons”.

In the surgical ward, “the designated hand-wash sink contained a tray with pieces of equipment soaking in a solution. Hand washing was carried out without removing the tray from the sink”.

There was also evidence of non-compliance with National Standards for the Prevention and Control of Healthcare Associated Infections. Although isolation rooms were available, says the report, “a patient with a suspected communicable infection was accommodated in a bay in the main area of the Emergency Department.

“During the course of the monitoring assessment the [INSPECTORS]identified immediate serious risks to the health and welfare of patients.” These risks were brought to the immediate attention of the hospital’s general manager and the HS.

“Waterford Regional Hospital must now develop a quality improvement plan (QIP) that prioritises the improvements necessary to fully comply with the National Standards for the Prevention and Control of Healthcare Associated Infections...This QIP must be published by the Hospital on its website within six weeks.”

A spokeswoman for Waterford Regional Hospital said a plan was being drawn up to address the concerns highlighted by Hiqa.

“WRH wishes to reassure the public that all systems and processes are in place for managing the cleanliness of the clinical environment.”

Among the measures being taken were a review of hand hygiene education including separate sessions for clinical and clinical staff; specific induction sessions for all new-intake junior doctors on hygiene standards and a review of the environmental issues raised.