Hand hygiene practices are generally improving in many Irish public acute hospitals, but unclean hospital equipment, and poor hand hygiene practice among some healthcare staff continues to place patients at unnecessary risk of acquiring a Healthcare Associated Infection, according to a new report published today by the Health Information and Quality Authority (HIQA).

An overview report of HIQA unannounced hygiene inspections in almost all public acute hospitals over a 12-month period shows that whileprogress in working to meet national Infection Prevention and Control Standardshas occurred in many hospitals, including the introduction of many innovative practices, all hospitals could do more to improve hand hygiene and environmental cleanliness.

Between February 2014 and January 2015, HIQA carried out 54 inspections of 49 out of the 50 public acute hospitals in Ireland. Inspections focused in particular on hospital cleanliness and hand hygiene. HIQA carried out unannounced follow-up re-inspections in five of the hospitals due to particularly poor compliance with standards and in order to promote rapid improvement between unannounced inspections.

Serious risks to patient safety were identified in a number of inspections, with HIQA issuing immediate high-risk letters to seven out of the 49 hospitals inspected. Five of these hospitals were inspected a second time. The main high-risk issues identified by the inspectors related to environment and facilities management, hand hygiene, communicable and or transmissible disease control and microbiological services.

Areas covering almost 20% of the overall bed complement in Irish public acute hospitals were inspected, totalling over 80 clinical areas, including for the first time specialist areas treating patients at higher risk of infection such as neonatal intensive care, renal dialysis and operating theatres. HIQA also continued to look at other areas treating especially vulnerable patients at higher risk of infection such as intensive care units, high dependency units and coronary care units. Other areas inspected included surgical, medical, orthopaedic, trauma and oncology services.

Inspectors regularly found poor access to hand hygiene gel dispensers for staff and hand-wash sinks that didn’t meet specifications. Basic patient equipment shared between patients was unclean in many hospitals. Commodes (a type of portable toilet for mobility restricted patients), mattresses, mattress covers, blood glucose monitoring kits (used to monitor patient blood sugar levels) and temperature probe holders were all found to be commonly unclean in many of the hospital areas inspected. In the case of unclean commodes, this constitutes an increased risk of transmission of serious Healthcare Associated Infections such as Clostridium difficile. In addition, in just under a quarter of hospitals it was observed that blood glucose monitoring kits (monitors or holders) were unclean. Unclean blood glucose monitoring equipment has likewise been implicated in Healthcare Associated Infection outbreaks in numerous healthcare settings, and is a concern to the Authority.

Inspectors also saw examples of good local hand hygiene initiatives and equipment cleaning practice.

HIQA’s Acting Director of Regulation Mary Dunnion said: “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. Some hospitals have implemented effective processes to ensure that this is the case but HIQA would recommend that all hospitals should work together to better facilitate the sharing of good practice in addressing common problems for the benefit of all patients nationally.

“Patients too can play an important role in improving hand hygiene. We are recommending that patients and relatives 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.”

HIQA’s report identified the need for improved internal checking procedures for hand hygiene practice in some hospitals, and highlighted the potential for greater awareness among some staff about the difference between the ‘patient zone’ (the area immediately surrounding the patient) and the related ‘healthcare area’ (areas other than the patient zone in the clinical area), and the need for a better understanding of when hand hygiene is required when entering and leaving each area.

Throughout 2015, HIQA will be expanding the scope of its inspections to promote further compliance with the Infection Prevention and Control Standards. This will include a focus on how hospitals use antibiotics, and how hospitals implement infection prevention care bundles – a structured collection of evidence-based best practice interventions that when performed collectively, reliably and continuouslycan result in measurably reduced infection rates for patients. 

Ends.

Further Information: 

Please contact: Marty Whelan, Head of Communications and Stakeholder Engagement 01 814 7480 / 086 2447 623 mwhelan@hiqa.ie.

Notes to the Editor: 

• Healthcare Associated Infections (HCAIs) are a significant patient safety issue and represent one of the most frequent adverse events experienced by patients receiving healthcare services. A one-day survey to determine Healthcare Associated Infection rates across European hospitals in 2012 identified that just over one in 20 patients on the day in question in Irish hospitals had a Healthcare Associated Infection (a rate broadly similar to other European Hospitals). Research shows that HCAIs can result in patient mortality, prolonged hospital stays, long-term disability, increased resistance of microorganisms to antimicrobial drugs and high costs for patients and their families. The World Health Organization reports an estimated annual cost of approximately €7 billion due to HCAIsin Europe, including direct costs only and reflecting 16 million extra days of hospital stay.+It is estimated that up to 30% of Healthcare Associated Infections are currently potentially avoidable if best practice is adhered to, especially in relation to hand hygiene.
• HIQA has the national statutory role for developing standards for the quality and safety of healthcare services. The National Standards for the Prevention and Control of Healthcare Associated Infections (the Infection Prevention and Control Standards) were approved by the Minister for Health and Children in May 2009, and published by the Authority. The Authority has the statutory responsibility for monitoring compliance with National Standards and advising the Minister for Health as to the level of compliance.
• The aim of these Standards, together with the Authority’s monitoring programme to assess compliance with them in public acute hospitals, is to contribute to the reduction and prevention of HCAIs in order to improve the quality and safety of these healthcare services. The Standards also aim to drive a culture of responsibility and accountability among all staff involved in the management and delivery of health and social care services – all of whom must play their part in preventing and controlling HCAIs.

+World Health Organization, Health care-associated infections FACT SHEET.