A hygiene audit of our acute hospitals makes for depressing - even if predictable - reading. Not only are the policies and procedures currently in place inadequate to ensure a high standard of cleanliness, there is a lack of accountability and responsibility for hygiene and waste management within hospitals along with a shortage of training in best practices.
Nearly half of the 54 hospitals surveyed during the summer months were found to operate to poor hygienic standards. Fewer than one in ten was rated as good.
What is particularly shocking about these results is that hospital managements and their staff knew for months in advance that inspections would take place. While the precise inspection dates were not notified to the hospital authorities, they were afforded plenty of time to change their ways. And perhaps they did. If that was the case, then the levels of hygiene prevailing before this audit was announced must have been horrendous.
A handful of hospitals performed well. And they were not all large, modern institutions. The quality of management, medical professionalism and staff morale within some older hospitals helped to lift their performance above that of their modern counterparts. In general, however, the older, more run-down and poorly managed institutions struggled to meet minimum compliant standards, set at 75 per cent of optimum cleanliness.
The prevalence of the antibiotic-resistant MRSA superbug and the threat it poses to hospital patients is what prompted this survey. More than 500 cases of infection were reported last year, making Ireland one of Europe's blackspots. Earlier, a North/South study found that good hospital cleaning practices, the correct use of antibiotics and better infection control programmes were the most effective ways of combating infection. The major mode of transmission, however, was through a failure by healthcare personnel to wash their hands.
In spite of the extensive publicity given to hand-washing as a basic infection-prevention measure, many of the staff surveyed still performed badly. This laxity in personal hygiene was frequently accompanied within the institutions by inadequate washing facilities, dirty toilets and grimy kitchens. On the face of it, leadership, professionalism, training and discipline will be required to address the situation.
The Health Service Executive (HSE) has undertaken to invest €20 million implementing the recommendations of the report. This will involve the introduction of national standards, training programmes, hospital refurbishments and the appointment of senior hospital managers with specific responsibility for hygiene. The HSE accepted the need for "significant improvements in a majority of hospitals" and undertook to introduce national infection control and cleaning standards. Two further hygiene audits will follow. It is a start. But it will take time and a lot of hard work within those hospitals that performed badly to restore public confidence.