Unannounced visits by health officials to a number of hospitals around the country have uncovered a range of serious hygiene issues.

Officials from the Health Information and Quality Authority (HIQA) recently carried out ‘unannounced monitoring assessments' on five hospitals. While Beaumont Hospital in Dublin was severely criticised for hygiene standards (see more here), problems were also found in the other hospitals.

Limerick Regional Maternity

The Mid Western Regional Maternity Hospital in Limerick was assessed on July 10. Just over 4,900 babies were born in this hospital in 2012.

The HIQA officials found that a number of hygiene issues that had been identified in an assessment in November of last year, had been rectified. However some issues had not. For example, dust still remained inside the drawers of a foetal heart monitoring unit and on a portable suction machine.

The officials also found that dust and grime was present in the corners of floors in some patient areas, some patients' lockers were chipped, ‘hindering effective surface cleaning' and the paint on some walls and radiators in patient areas was ‘stained, chipped and peeling'.

"In Maternity 1 and 2 wards, encrusted solidified matter was found at the corners of the frame and base tray and on wheel units of all baby cots with labels on them indicating decontamination had been completed," they stated.

HIQA said that while the findings suggest that some improvement had been achieved, ‘the physical environment, waste management and cleanliness of patient equipment were still not effectively managed and maintained to protect service users and reduce the spread of healthcare associated infections'.

Lourdes Otrhopaedic

The Lourdes Orthopaedic Hospital in Kilcreene was also assessed on July 19. It is the regional elective orthopedic hospital for the south east and has a bed capacity of 31 beds. One ward - St Briget's Ward - was looked at.

While there was evidence of good practice there, such as clean surfaces, mattresses and chairs, a number of issues were found:
-Paintwork throughout the ward, including walls and radiators, ‘required attention'
-Dust was found on some patient equipment, such as the resuscitation trolley and oxygen equipment
-A shower chair in the shower room had dust and grime in the joints and under the base

The HIQA officials did find good hand hygiene practices among staff at the hospital. Of 14 hand hygiene opportunities observed by the officials, 12 of these opportunities were taken. They concluded that a ‘culture of hand hygiene is operationally embedded throughout the hospital'.

Merlin Park Galway

Merlin Park University Hospital in Galway was assessed on July 9. This hospital provides a range of elective medical and surgical inpatient services, as well as outpatient services. It has 59 inpatient beds and dealt with over 2,600 admissions last year.

Two wards were assessed - the Orthopaedic Ward, which is an elective ward and Ward 4, which is a rehabilitation ward.

Evidence of good practice included clean floors, beds and patient equipment. However problems included chipped and cracked paint on some walls, skirting boards and radiators.

"There was a pool of yellow fluid on the floor of one toilet assessed and spillage on another toilet floor in Unit 4 ward. Although an up-to-date cleaning checklist was displayed in the ensuite in the ‘Day Hall' area of the Orthopaedic Ward with three hourly signatures confirming the area was clean, staining was observed by the authority on the floor around the base of a toilet bowl," HIQA said.

Meanwhile, the doors to two clinical equipment storerooms were unlocked on the Orthopaedic Ward.

"While one door was closed, the other was wide open. There was a potential risk of access by unauthorised persons to syringes, needles and intravenous fluids...A sharps waste disposal container attached to a phlebotomy trolley stored in the large clinical storeroom was overfilled with hazardous waste protruding over the top," HIQA pointed out.

It noted noted that the seat of a commode assessed in Unit 4 ‘was stained with a brown coloured substance'.

HIQA also found a number of issues in relation to isolation rooms. For example, doors to isolation rooms were left open, which increases the risk of healthcare associated infections.

Furthermore, isolation procedures were not controlled, ‘as visitors to isolated patients did not remove personal protective equipment on exiting the isolation rooms and were observed to continue wearing contaminated apron and gloves
outside the isolation room for the duration of their visits'.

"Isolated patients with confirmed communicable infections were observed by the authority to leave the isolation facilities to use a communal bathroom and to sit outdoors," HIQA added.

It concluded that some key areas ‘were not effectively managed and maintained to protect patients and reduce the spread of healthcare associated infections'.

Tullamore Regional

The final hospital to be assessed was the Midland Regional Hospital in Tullamore in Offaly, which is one of the few purpose-built, standalone hospital buildings outside of Dublin. It opened on a phased basis in 2007 and 2008. This hospital was visited on May 20, with the emergency department (ED) and Orthopaedic (trauma) Ward being assessed.

Problems noted by HIQA included dust throughout the ED, such as on the undercarriage of patient trolleys, curtain rails and on the surfaces of resuscitation trolleys.

A sanitary waste disposal bin was overflowing in one of the ED's patient toilets.

"A glucometer (glucose testing machine) assessed in the Orthopaedic Ward and an ECG machine and temperature probes assessed in the ED were not in a clean state," HIQA noted.

Meanwhile dressing trolleys in the ED were unclean - the doors of these were found to be ‘heavily stained'.

"The authority assessed a ‘see and treat' room in the ED. The fabric cover of the examination couch was stained. A dressing trolley was dusty. A sink designated for hand hygiene was obstructed by a non-clinical waste disposal bin located in front of it," HIQA said.

In one case, a patient with a suspected transmissible disease was being cared for in a room without handwashing facilities and the door to the room was left open leading directly to where other patients were being cared for.

HIQA concluded that ‘the physical environment and equipment were unclean in the ED and therefore were not effectively managed and maintained to protect patients and reduce the spread of healthcare associated infections'.

The officials observed 24 handwashing opportunities during their visit, 19 of which were taken. They said that this suggests that ‘a culture of hand hygiene practice is not embedded at all levels'.