An unannounced inspection of the National Maternity Hospital last October revealed so many high risk findings, that a re-inspection was necessary within six weeks, the Health Information and Quality Authority (HIQA) has revealed.

According to a report of inspections at the hospital on Dublin's Holles Street, an unannounced inspection was carried out on October 7, 2015, followed by a re-inspection on November 17.

The first inspection involved the delivery ward and neonatal intensive care unit, while the second inspection involved the delivery ward and theatre department.

According to HIQA, during the first inspection of the delivery ward, ‘a number of high risks were identified'. It revealed that overall environmental hygiene in the delivery ward was ‘very poor with evidence of organic contamination on surfaces, insufficient dust control measures and suboptimal cleaning observed in most areas inspected. Inconsistent adherence to standard infection prevention and control precautions was also observed'.

The inspectors noted that multiple surfaces, including flooring underneath beds, skirting boards and radiators, were dusty and adhesive tape residue was also present on a number of surfaces. This presents a risk of contamination of sterile supplies stored within the patient environment, they said.

The inspectors also found that patient equipment had not been cleaned properly, e.g. theatre transport trolleys stored on the ward were dusty, leftover intravenous medication had been left on a tray beside a bed instead of being discarded and ultrasound gel residue was found on a handheld sonogram.

"Red stains were present on the interior surfaces of a trolley used to transport equipment for decontamination. The same finding was made during the 2014 inspection. The trolley was unsecured and stored inappropriately on a communal corridor within the delivery ward. Inspectors were not assured that this trolley was scheduled for regular cleaning," the report stated.

The inspectors also noted that the design of patient beds ‘did not facilitate effective cleaning or inspection of mattress cores' and there were ‘poor processes' in place for bed cleaning. Beds viewed during the inspection ‘had not been effectively cleaned'.

Hospital management informed the inspectors that ‘high levels of activity, particularly in recent months, made it difficult to access delivery rooms for cleaning'.

The inspectors acknowledged that the current site at Holles Street poses a number of challenges, e.g. ‘the number of delivery rooms on the ward is insufficient for the level of activity it caters for', space ‘is very limited' and the layout ‘does not facilitate patients' dignity, confidentiality or privacy'.

"HIQA acknowledges that National Maternity Hospital staff work in a compromised physical environment dealing with a high level of activity, very complex cases and or multiple birth scenarios. Despite these challenges, the hospital reports low perinatal mortality rates and low bloodstream infection rates," the report noted.

Other issues noted by the inspectors included:
-Cleaning equipment was inappropriately stored and managed
-An open plan food and beverage preparation area was located in the centre of the main delivery ward corridor. This was ‘unusual and not suited to a clinical environment'.
-Multiple syringes containing reconstituted intravenous medications were insufficiently labelled and stacked in a refrigerator in a delivery room. Labelling suggested that some of these medications had been drawn up several days ago, however it is recommended that such medications are prepared immediately before administration. The refrigerator was also found to be unclean with an ice build-up, suggesting unmonitored temperature control.

When it came to the neonatal intensive care unit, overcrowding was immediately observed, with 46 babies being cared for in a unit designed for 36.

A fire exit in the unit was also partially blocked by a baby cot at the time of the inspection.

HIQA acknowledged that the unit faces major capacity issues, but insisted that the practice of admitting babies to an overcrowded unit ‘remains a significant risk'.

During the re-inspection on November 17, the inspectors found ‘significant improvement in environmental and patient equipment hygiene'. A deep clean of the delivery ward had taken place after the first inspection, which took three weeks to complete. The ward pantry had also been removed and alternative catering services were being provided.

However, the inspectors did find some ongoing issues, including ‘deficiencies in cleaning resources' and the inappropriate storing of cleaning equipment. They concluded that ‘improvements are required in the management of the cleanliness of the physical environment and in how the quality of the hygiene services are monitored and evaluated'.

While the hospital is supposed to be moving to the grounds of St Vincent's University Hospital in Dublin, the report noted that this ‘will take a number of years to complete' and in the meantime, improvements in the infrastructure in Holles Street are necessary ‘to promote patient dignity and privacy'.