A lack of hand hygiene by healthcare staff, dusty and dirty medical equipment, broken and soiled toilets and mould in the shower rooms - welcome to your local hospital.

The Health Information and Quality Authority (HIQA) has just released the results of unannounced monitoring assessments at five hospitals around the country and many of the findings are not pretty.

In fact, the cleaning, or lack thereof, led the HIQA inspectors to conclude that some hospitals were not doing enough ‘to protect patients and reduce the spread of healthcare associated infections (HCAIs)'.

Just last month, the results of unannounced visits in five hospitals, including Beaumont Hospital in Dublin and the Mid Western Regional Maternity Hospital in Limerick, revealed a number of issues, including poor hand hygiene, dirty equipment and potential access by patients to dangerous chemicals, medication and syringes.

The five hospitals in this series of unannounced visits are the Mater, St Vincent's University Hospital and Tallaght Hospital in Dublin, Nenagh Hospital in Tipperary and Ennis General in Clare.

While some small issues were found in Ennis General, HIQA inspectors concluded that ‘the physical environment was effectively managed and maintained to protect service-user dignity and privacy and to reduce the risk of the spread of HCAIs'.

While some opportunities for hand hygiene were ‘missed', the inspectors said that overall, the areas assessed in this hospital were ‘very clean with few exceptions'.

However, the remaining four hospitals did not fare so well.

Nenagh Hospital

In Nenagh Hospital, while some good practices were observed, issues of concern included:
-A ward corridor cluttered with equipment
-Patient toilet areas that were soiled and in disrepair
-Poor lighting in a shower area, which posed a health and safety risk to patients
-No door fitted on the entrance to the dirty utility room in one of the medical wards. This is a temporary holding area for soiled/contaminated equipment, materials or waste prior to their disposal or cleaning. As there was no door, access by unauthorised persons, such as patients, was possible. Hazardous waste was stored here
-Floors in patient areas were unclean
-A sticky residue was found in a number of places, including on the exterior surface of a resuscitation trolley.

Meanwhile, the HIQA inspectors noted that 22 out of 25 hand hygiene opportunities were taken by staff, however, they felt that a ‘culture of hand hygiene practice is not totally embedded among all staff'.

The Mater

In the Mater Hospital, again while some good practices were observed, issues included:
-A ‘black substance' was found in some shower areas
-Access to areas containing hazardous waste/chemicals was not adequately controlled
-Bedpans were found to be stained on the inside and outside
-In one ward, ‘unlabelled syringes containing unknown solutions with attached and unattached uncapped needles' were found stored in two kidney dishes on a worktop in a utility room. This presented a risk of sharps injury
-In the same ward, the door to a utility room was ‘held ajar by a waste glass disposal bin which was overfilled'.

Meanwhile, out of 17 staff handwashing opportunities observed by HIQA inspectors, nine were taken. This, they said, posed a risk to patients of contracting a HCAI.

St Vincent's University Hospital

In St Vincent's University Hospital, while good practices were observed, some of the issues included:
-Unclean bathroom areas
-Unclean equipment, including an ECG machine, which is used to record the electrical tracing of the heart
-In one ward, two electrical plus sockets were broken but were still being used
-One stock room was unlocked and it contained items such as intravenous needles
-In the Emergency Department (ED), a mould-like substance and staining was found in the shower and toilet area
-Dust was found on two of three resuscitation trolleys assessed.

In relation to hand washing, 14 out of 24 hand hygiene opportunities were taken by staff. This posed a risk to patients, HIQA said.

Tallaght Hospital

Finally, in Tallaght Hospital, while some good practices were observed, issues of concern included:
-Patient bedside tables were broken and worn
-A black mould-like substance was found in some shower rooms
-Access to the dirty utility room was not controlled and potentially hazardous cleaning chemicals were stored in an unlocked cupboard and on a worktop
-In one ward, a medication fridge and a large medicine cupboard storing multiple medications was not secured

When it came to hand hygiene, HIQA inspectors were made aware that on one ward, water was not thermostatically regulated at a safe temperature, placing patients at risk of scald injuries.

Meanwhile just 14 out of 23 hand hygiene opportunities were taken by staff, posing a risk to patients.

According to HIQA, these hospitals 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'.

The hospitals will continue to be monitored and follow-up assessments will take place.