‘Moderate risk’ of infection at maternity hospital

EXPECTANT mothers in Clare, Limerick and North Tipperary were exposed to “a moderate risk” of healthcare-associated infections, according to a “snapshot of the hygiene levels” at the region’s maternity hospital.
The Health Information and Quality Authority (HIQA) carried out the unannounced inspection at the Mid-Western Regional Maternity Hospital, Limerick on November 7 last but the results were only made public on Wednesday.
The report shows that while healthcare risk waste was managed effectively at ward level, it was not managed centrally in line with HSE guidelines, posing “a moderate risk to service users of healthcare-associated infections”.
It also revealed that in the hand hygiene instances observed by HIQA inspectors at the hospital, just one-quarter complied with best practice.
Speaking after HIQA published 12 reports on unannounced inspections at Irish hospitals, the organisation’s director of regulation, Phelim Quinn, commented, “A good hand hygiene practice is the single most important measure to protect patients from healthcare associated infections. Staff at all levels within our hospitals deserve credit for their awareness of the importance of, and the good examples of, hand hygiene practice found by the authority. This reflects their commitment to patient safety.
“In many cases, however, we found hand hygiene actions were not always undertaken, or carried out in the right way, despite the efforts of the staff involved. A number of hospitals have now been asked by HIQA to evaluate their level of hand hygiene compliance, in the context of infection rates, in order to assess the impact on patients.”
The report stated that HIQA inspectors saw “20 hand hygiene opportunities during the monitoring assessment. Of those 20 hand hygiene opportunities, 13 were taken.” However, it added that of those 13, “only five were observed to comply with best practice hand hygiene techniques for hand washing or use of alcohol gel”.
“The authority’s observations suggested that a culture of hand hygiene practice was not embedded at all levels. This poses a risk to patients of healthcare-associated infections,” it concluded.
Following the inspection of Limerick’s maternity hospital, which serves Clare, Limerick and Tipperary, a spokesperson for HSE West said, “We are disappointed that we were observed to have suboptimal levels of hand hygiene compliance on the day in question”. But the spokesperson also said, “Much of the audit was extremely positive and complimentary of the service and the staff involved in its delivery”.
It noted that the “main entrance, stairs, stairwells, both clinical areas assessed and the areas immediately external to the wards were observed to be clean. However, there were opportunities for improvement identified in both clinical areas and the outpatient department.”
The authority found that healthcare waste “was not managed in line with the HSE national guidance for healthcare risk waste management and this poses a moderate risk to service users of healthcare-associated infections”.
Inspectors also observed “an accessible stocked cleaning trolley with chemicals and dirty water in both buckets on a corridor leading to the outpatient department”.
“Light to moderate dust was observed on medical equipment such as cardiac monitors and a resuscitation trolley.”
In maternity ward 2, “electric fans were observed to be very dusty” and “a number of dressing trolleys were stained and had rusty wheels”.
The report also recorded “in the outpatient department, there was a high level of dust visible on low surfaces”.
According to the HSE West, “Since our audit, all staff trained in the delivery of hand hygiene training have had refresher and update training and an updated training plan is now in place for 2013. A technical assessment of all our clinical handwash sinks is being undertaken with a view to prioritising non-compliant sinks for immediate replacement.
“A similar assessment of all associated taps is also being done. This enhanced training will be further strengthened in February when it is planned to ‘blitz’ hand hygiene compliance throughout the hospital.
“Senior midwifery management have long been involved in the ongoing promotion of hand hygiene compliance and this involvement is being approached with a new vigour from the perspective of patient advocacy to facilitate consistent, continuous oversight of compliance across all disciplines, not just midwifery/nursing.
“Our recently appointed clinical director, Dr Roy K Philip, is now actively pursuing compliance amongst our cohort of clinicians at all levels and we’re also confident that the level of senior involvement in this area will see the necessary culture shift so that compliance with hand hygiene becomes absolutely embedded throughout the Maternal and Child Health Directorate,” a spokesperson for the HSE West said.
“We acknowledge that significant improvement in this area is required and we are fully committed to ensuring that we achieve the necessary improvement,” he went on.
There were 5,135 live births in the Mid-Western Regional Maternity Hospital in 2011 and 3,559 new and 14,816 review outpatient attendances.
Based on the findings of the November assessment, HIQA will carry out a follow-up assessment within the next six months.