A ‘significant' number of public hospitals inspected in 2014 were found to be using unclean patient equipment, a new report has revealed.

Hand hygiene practices among some staff members were also called into question.

The report has just been published by the Health Information and Quality Authority (HIQA). It provides an overview of hygiene inspections carried out in 49 of the country's 50 public acute hospitals between February 2014 and January 2015.

Serious risks to patients were identified following a number of these inspections. In fact, seven of the hospitals were issued with immediate high-risk letters and five of these hospitals were re-inspected within six weeks.

High-risk issues identified by HIQA included management of the environment, hand hygiene and communicable disease control.

While hand hygiene practices were found to be ‘generally improving', this was still found to be an issue of major concern. Inspectors regularly found poor access to hand hygiene gel dispensers for staff, and sinks for washing hands that did not meet specifications.

"In several hospitals, there were insufficient numbers of alcohol hand-rub dispensers in clinical areas, while alcohol hand-rub was completely absent in some instances," the report noted.

It also noted that the inspection team ‘observed some staff failing to perform hand hygiene when there was an indication to do so, especially before touching a patient after entering the patient zone (the area directly surrounding each individual patient)'.

The inspection teams also focused on environmental hygiene and found that while most hospitals were ‘generally clean', a significant number required improvements.

"There was poor compliance with keeping patient equipment clean and in areas of high activity such as patient areas and sanitary facilities used by patients. Poor environmental hygiene in these areas increases the potential risk of the spread of healthcare associated infections (HAIs)," the report said.

Areas that achieved the greatest level of compliance included isolation rooms and waste disposal. However, ‘areas of high activity, such as patient areas and bathrooms, had considerably lower compliance across the 49 hospitals inspected'.

"Patient equipment was commonly unclean. The inspection team was concerned to find that a significant number of hospitals inspected in 2014 were using items of reusable patient equipment which was unclean," the report stated.

For example, 37 out of the 49 hospitals (75%) were using unclean commodes. Unclean commodes are known to increase the spread of Clostridium difficile (C.diff), a bug that causes diarrhoea, abdominal pain, inflammation of the colon, fever, vomiting and dehydration.

It can be particularly dangerous for vulnerable groups, such as elderly hospital patients, and up to 30% of patients diagnosed with hospital-acquired C.diff infection die within 30 days.

Meanwhile, the report also noted that in almost one in four hospitals, blood glucose monitoring kits were also found to be unclean and this has also been implicated in HAI outbreaks in ‘numerous healthcare settings'.

Other pieces of equipment found to be unclean included mattresses, mattress covers and temperature probes.

The inspectors also found incomplete cleaning records for frequently used equipment in a ‘significant' number of hospitals, while some hospitals had no cleaning checklists at all.

"In a few cases, inspectors found that checklists had been completed on the day of the inspection or the day before the inspection indicating that equipment had been cleaned, but this was not always what was observed by inspectors. For example, levels of dust or staining suggested that checklists were completed without the equipment having been adequately cleaned," the report stated.

Commenting on the findings, HIQA's Acting Director of Regulation, Mary Dunnion, insisted that patients ‘have the right to expect that equipment used as part of their care is clean in the first instance and cleaned after use when it is shared with other patients'.

"Hospital management need to tackle the problems head on by prioritising environmental cleaning and maintenance in patient areas, and by supporting and ensuring staff compliance with hand hygiene training and implementation," she said.

She added that patients also have a major role to play when it comes to hand hygiene and they should be made aware by hospitals of how to keep their hands clean as a matter of routine.

"Patients should be educated to clean their hands at appropriate times and in turn should be empowered and encouraged by hospitals to challenge staff to clean their hands.

"Some hospitals have already introduced measures to encourage patients to ask staff if they have washed their hands, for example, through poster campaigns or prompting badges on uniforms. This is worthy of more widespread exploration across Irish acute hospitals," Ms Dunnion added.