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Published Reports - Bugwatch Report Tyrone and Erne Hospitals October 2007

Western Health and Social Services Council

Bugwatch Survey

Summary of Findings

16 October 2007

CONTENTS

Summary of Findings

Surveyors

Questionnaire

Bugwatch Survey Summary of Findings

The WHSS Council carried out a Bugwatch Survey in the Erne and Tyrone County Hospitals on 16 October 2007.

TYRONE COUNTY HOSPTIAL: 2 members carried out the survey in Tyrone County Hospital in the following wards:

Ward 1 & 2 (ENT)

ERNE HOSPITAL: 5 members and the Chief Officer carried out the survey in the Erne Hospital in the following wards:

Maternity Ward

Ward 9 (Elderly Medical)

Ward 10 (Medical)

TYRONE COUNTY HOSPITAL

ENT Wards – TCH

• Sanitizers were available and seen to be used by staff

• Staff questioned had received training in infection control

• The ward, bathrooms, toilets, and sluice room were visibly clean

• No problems were identified with waste disposal, linen or sharps boxes

ERNE HOSPITAL

Maternity Ward – Erne Hospital:

Cleaners:

• Observed going into patient toilets with no gloves on. Only one had gloves on but they were not of the disposable type. After use these were put on top of a cleaning trolley. This raised the question if these same gloves were to be used for the next cleaning job?
  

• Observed cleaner who was not wearing gloves coming from side ward carrying a urine sample .
  

Use of gloves and aprons:

• Auxiliary staff observed changing and disposing of gloves.
  

General:

• Staff who were asked, identified midwife responsible for Infection Control, but said she was not on duty as she is currently on night duty;
  

• Infection Control training appears to be through reading literature and referral to manual;
  

• Staff in the Nursery use a padded, flat changing mat and cover it with a new towel for each child.
  

Ward environment:

• Old and shabby curtains;

• Permanent staining on carpeted area; in general carpeted areas were not clean;
  

• Section of carpet in dayroom stained and dirty;

• Area around patient toilet/shower very mouldy did not appear to be properly cleaned;
  

• Patients’ bathroom had paint falling off walls with possible damp stains;
  

• Lino on floor around a number of beds was damaged (possibly caused by wheels on the beds);
  

• No evidence of cleaning material for bath;

• No evident bathroom/toilet cleaning rota or information to patients to alert staff if area is dirty.
  

Waste disposal:

• Observed yellow bags and linen bags ok;

• General waste was in a cardboard box lined with a black bag.
  

Sharps:

• Drug room/treatment room had used needles in open sharps box container on counter and 2 boxes on floor.
  

• Unused needles very accessible on Emergency trolley

Sluice Room:

• Sluice room side door held permanently open with linen bin;

• Sharps box in this room placed at low level and open.
  

Dust:

• Bed frames and window sills were dust free.
  

Visitor and Patient Information on Healthcare Acquired Infection (HCAI):

• Staff advised that information and advice for visitors who may be in contact with patients with HCAIs is communicated verbally to the relevant visitors;
  

• Visitors’ hand cleaning gel/foam dispenser is not easily noticed on wall at entrance to ward. It is relatively small and ‘lost’ amongst leaflets/notices.
  

Other observations:

• Foetal assessment room is in good condition and clean. This room has the cleanest shower on the ward but the shower area appears to be used for storage and is very cluttered with boxes;
  

• Tested urine sample was observed sitting in bathroom in open tub container and placed under notice asking for samples to be disposed of;
  

• There were 5 Hand sanitizers - the one on entry to the ward had a notice and leaflets however the remaining 4 sanitizers on the main ward had no accompanying notices. There were notices on hand washing techniques in several rooms;
  

• Staff were observed using the correct hand washing technique;
  

• Student nurse didn’t know who Infection Control Nurse was but had Infection Control training on-line when she was in Omagh;
  

• Women attending as out patients for clinics on the ward walk right through the main ward to the back of the ward (clinical rooms) even though there appears to be a rear access point. This area also appears to take the overflow of mothers and babies when the main ward is full.
  

Patient Comment:

• One patient commented that she was very happy with the hygiene on the ward.
  

Staff Comment:

• There is a big problem with visitors sitting on patient beds.
  

Ward 9 - Elderly Medical - Erne Hospital

Hand-washing:

• No mixer taps or elbow controls at sinks;

• No one was observed hand-washing therefore we cannot comment on their hand-washing technique;
  

• One toilet was without hand-washing facilities;

• Side toilets did not have on display posters about hand washing.
  

General:

• Unable to comment about the use of staff aprons and gloves when handling body fluids as this activity was not observed during the survey;
  

• Auxiliary staff did not know the name of the infection control nurse. Ward was observed as dirty in places with floors partly soiled;
  

• Shower plug-hole blocked and full of ‘sludge’;

• Windows both inside and outside were dirty;
  

• One of the toilet areas had a cracked mirror and was rusty around the edges;
  

• One of the toilets had a chipped seat;

• There was soiling around the wash-hand basin in one of the 4-bedded bays.
  

Linen:

• Some linen and bedspreads lying on floor of store room.
  

Sharps Box:

• Did not see sharps box

Patient/Visitor Information on Healthcare Acquired Infection:

• Staff said information is only given to patients who have an infection;
  

• Members carrying out the survey were made aware that the side wards currently had patients with MRSA;
  

• Members were informed that there was one suspected MRSA case waiting to be confirmed. They observed that the patient was still being nursed on the main ward.
  

Sluice Room:

• Sluice room was very dirty and cluttered with linen and bed bottles lying about;
  

• Water from the waste pipe was observed to be overflowing onto the sluice room floor and a member of staff was immediately notified;
  

• Staff member indicated that this must have just happened but immediately identified the cause as a ‘blocked sewer’!

Ward 10 - General Medical – Erne Hospital

Hand-washing:

• There were no sanitizers at the end of patients’ beds. There was one wall mounted dispenser on entry to each 4 bedded bay but some very difficult to see. These sanitizers seemed to be aimed at visitors as the notice is targeted at visitors. Sanitizer attached to medical notes cart and observed during the ward round which was on at the time of the survey. Not once during the survey period was any member of staff observed washing their hands or using sanitizer;
  

• One nurse was observed showing a patient how to use soap dispenser at the ward sink;
  

• No obvious ‘stoned’ jewellery observed but a number of staff were wearing wristwatches. One junior doctor observed with his tie tucked into his shirt at mid chest and he had his shirt sleeves folded up to his elbows;
  

• Staff were wearing aprons but were not using gloves at any time although there were boxes of gloves throughout the ward;
  

• One nurse observed working with patient taking blood. She was not wearing an apron or gloves and was moving between patients. She was not observed hand washing or using the sanitizer.
  

Training on infection control:

• The Staff who were questioned knew there was on-going training but had not yet attended;
  

• Could name Infection control Nurse.
  

Cleaners:

• A cleaner said they were not involved in this training but would love to attend;
  

(NB cleaning was brought back in-house having previously been through outside contractors).

• They said they did not have enough time to do proper cleaning to their satisfaction and that they don’t have enough cleaning materials. They are told to use soap and water. Two shop style ‘toilet ducks’ were on the cleaning trolley. It could not be ascertained that this was part of the Trust’s cleaning supply;
  

• Cleaners said they have been told not to use chemicals and only to use micro fibre cloth which is “great for dusting” but “useless for cleaning”.
  

Ward Environment:

• Note: staff had 1 hours notice of Council visit;

• Observed on entry to ward hectic cleaning activity and tidying of one bay. The sweepings collected from this floor seemed to be rather a lot;
  

• Ward furniture observed as clean and generally in good repair. Three damaged chairs were placed outside bays with notices for disposal.
  

Shower areas:

• The plug hole leading to the drain was dirty and clogged with an accumulation of hair;
  

• Female bathroom/toilet had an open shower in fairly large room. This room had a notice; “do not use bathroom as store…” however there was a patient trolley below this notice containing draw sheets, talcum and personal hygiene items (There is a similar notice outside the room);
  

• Blood stained sticking plaster observed at the start of the visit on the floor of toilet/shower room. There was also blood on the floor. The plaster and staining was still there at the end of the visit;
  

• A patient who was asked, said they would notify staff if they felt toilets/ showers were dirty.

Sluice room:

• Good clear notices for staff re contamination etc. Fairly well laid out and tidy room;
  

• Washing machine in sluice room is broken (notice);
  

• Sluice sink obviously washed down but no sign of any abrasive type cleaning. There were very old dirt marks and the waste pipe was sludgy and very dirty.
  

Waste-bags:

• The yellow, black and linen waste bags were all tied off with clips and in a room identified as the ‘soiled-linen room’ however the bags were full to the top and could split when being moved.

Sharps Boxes:

• The full boxes were kept in the soiled-linen room and were closed.
  

Information to patients/visitors on Healthcare Acquired Infections:

• It was observed that patients had received general Infection Control advice leaflets on admission. In the event of infection the ‘relevant’ people were informed.
  

Visitors’ sanitizer dispensers:

• These dispensers are mounted on the left wall on entry to the ward and are not in the line of sight, they are relatively small and close to switches and other notices etc.
  

Other Observations:

• This was a fairly busy ward when the survey was going on with a ward round involving doctors and nurses in progress. Other healthcare professionals who were not involved in the ward round were in and out of the ward. One 4 bedded bay had at least 9 staff in the area at one particular time (cleaners, OTs, nurses and auxiliary’s). They were not ward round staff or WHSSC members.
  

• There is also clearly a big problem because of lack of storage space and the inappropriate use of toilet/shower areas and dayroom etc for general storage.
  

• It is difficult to understand why the infection control nurses are all based in the TCH, Omagh and none are based in the Erne, Enniskillen. The Erne hospital is virtually operating as the acute hospital for the two areas with most of the higher risk patients being admitted there e.g. ICU/HDU, neo-natal babies, children and new-borns in maternity, older people, surgical patients and those who may be regarded as having compromised immune systems.
  

Hospital – General

Public areas and corridors:

• The lino was clean and dust free however the carpeted areas had ground-in dirt and staining which routine hoovering is unlikely to shift.
  

• Just inside the area leading to the main corridor there is a large notice approx 6’ x 1½’ high placed up above the double doors. The notice is referring to infection control. It is to be commended for its size, but is only visible if the person chances to look up.
  

• One suggestion might be to have large colourful message boards at all entrances just inside the hospital. These boards could be fitted with large dispensers of the sanitizing foam/gel. Everyone, whether visitor or staff, should be asked to use the gel before entering the wards or any other part of the hospital.
  

• Much is made of the role visitors have to make in helping staff to control infection. It is concerning therefore that staff appear to have some way to go in giving a lead in the basics such as hand washing.

Bugwatch Survey

16 October 2007

*WHSSC Chief Officer

Infection Control Survey

Any other observations or comments:

Western Health and Social Services Council
‘Hilltop’
Tyrone and Fermanagh Hospital
Omagh
Co Tyrone
BT79 0NS
Freephone: 0800 917 0222
Tel: 028 8225 2555
Fax: 028 8225 2544
Minicom: 028 8224 8389
Email: info@whssc.n-i.nhs.uk
Website: www.whssc.org

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