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- Published Reports - Bugwatch Report Tyrone and Erne Hospitals February 2008

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Published Reports - Bugwatch Report Tyrone and Erne Hospitals February 2008

Western Health and Social Services Council

Bugwatch Survey

Summary of Findings

13 February 2008

CONTENTS

Background

Summary of Findings

Surveyors

Questionnaire

Background

In October 2007 the WHSS Council carried out a ‘Bugwatch’ survey in the Erne and Tyrone County hospitals. Using a specially designed toolkit, those carrying out the survey checked against a number of key indicators on hospital wards including handwashing,ward environment and storage.

Following the survey a report was produced which identified a number of concerns about practices in the Erne hospital and these were brought to the attention of the Trust’s Chief Executive and Director with responsibility for infection control. The Trust responded immediately and put in place an Action Plan to address these concerns. It was agreed that the WHSS Council would carry out a repeat ‘Bugwatch’ exercise in the New Year.

The repeat ‘Bugwatch’ exercise was carried out on 13 February 2008 in the same wards as previously surveyed in the Erne Hospital.

In the previous survey Wards 1 & 2 (ENT) were surveyed in the Tyrone County Hospital. These wards were chosen as they are the last remaining surgical wards in TCH. No concerns were raised during the survey of these wards – therefore a repeat survey was not deemed necessary.

However, as concerns had been raised in the survey of elderly care wards in the Erne, it was decided to carry out a ‘Bugwatch’ survey of the elderly care wards in TCH (Ward 12 SRU) and one additional ward - the Day Procedure Unit.

For ease of reference, previous concerns identified in the October 2007 report have been highlighted at the beginning of each section followed by the findings during the repeat survey.

Bugwatch Survey Summary of Findings

The WHSS Council carried out a repeat Bugwatch Survey in the Erne and surveyed additional wards in the Tyrone County Hospital on 13 February 2008.

TYRONE COUNTY HOSPITAL: 3 members and the Business Support Manager carried out the survey in Tyrone County Hospital in the following wards:

Ward 12 SRU (Stroke/Rehabilitation Unit) - Elderly

Day Procedure Unit

ERNE HOSPITAL: 5 members and the Chief Officer carried out the survey in the Erne Hospital in the following wards. This was a re-survey of wards previously surveyed in October 2007.

Maternity Ward

Ward 9 (Elderly Medical)

Ward 10 (Medical)

TYRONE COUNTY HOSPITAL (TCH)

Ward 12 Stroke/Rehabilitation Unit (Elderly):

Hand washing

Sanitisers were available and seen to be used by staff.

Mixer taps were available at some sinks.

Elbow control taps were not available at all sinks.

Ward environment

Furniture was clean and in a good state of repair

The ward was visibly clean and free from dust and dirt

Bath was clean

Bathroom/showers were clean and clutter-free

Toilets were clean

Sink in treatment room stained but not found to be dirty

Curtains were visibly clean and in good repair

A notice was displayed in toilet for patients with diarrhoea/vomiting to inform staff to ensure toilets are cleaned properly

Waste disposal

Information on waste disposal policy was on display

Waste bags were not over-filled

There were foot operated bins in working order for clinical waste

Bags were on the ward floor on arrival at the ward but these were collected shortly afterwards.

Linen

Linen was segregated into colour-coded bags

Bags were not over-filled

Sharps

Sharps box was sitting on trolley in treatment room with aperture open. Door to treatment room was observed to be open throughout the survey period.

Staff training

Staff confirmed they:

• Had received training on infection control

• Could name the infection control nurse

• were able to identify where the ward’s infection control manual was held

General comments

The ward was busy during the survey with various groups of people entering and leaving – not everyone used the sanitisers.

In general the ward was clean and staff were aware of infection control. Staff were pleasant and helpful.

Laundry procedure - soiled clothes are sent home daily – members did not question staff but wondered whether there are different arrangements for dealing with laundry for patients infected with MRSA or C difficile?

There was a sanitiser available at the entrance to the ward. There was no poster displayed inviting visitors to the ward to use the sanitiser before entry.

Nursing staff informed those carrying out the survey that 2 patients with infections were being nursed in side wards. Gloves and aprons and sanitising gel were available outside one of the side wards where a patient with MRSA was being nursed but no notice was displayed to warn visitors to use them.

DAY PROCEDURE UNIT – TCH:

Hand washing

Sanitisers were available and seen to be used by staff

Mixer taps were not available at all sinks

Elbow control taps were not available at all sinks

Male toilet – no mixer taps.

Waste disposal

Information on waste disposal policy was on display

Waste bags were not over-filled

There were foot operated bins in working order for clinical waste

Linen

Linen was segregated into colour-coded bags

Bags were not over-filled

Ward environment

The Unit appeared to be very clean and tidy.

Curtains were visibly clean and in good repair.

Sharps

Small yellow boxes with aperture open were kept on trolley in corridor.

Staff training

Staff confirmed they:

• had received training on infection control

• could name the infection control nurse

• were able to identify where the ward’s infection control manual was held

General comments

Signposting was very good within Day Procedure Unit.

All patients who were asked praised the Unit and said it is very clean.

It was noted that there is no bath or shower for patients on this Unit. It was explained to those carrying out the survey that these facilities are not required in a Day Procedure Unit.

ERNE HOSPITAL

Elderly (Ward 9)

Previous concerns:

• Staff were not observed to wash their hands

• Auxillary staff could not name the infection control nurse

• Ward was observed as dirty in places with floors partly soiled

• Windows both inside and outside were dirty

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

• Sluice room was very dirty and cluttered

• Water from waste pipe was overflowing
  

Repeat survey findings:

• Staff were observed to wash their hands and use the hand sanitiser

• Staff were able to name the infection control nurse and knew where to find the ward’s infection control manual

• The ward was visibly clean

• Windows, curtains were clean

• Showers and toilets were clean - bathrooms were in use and not available for inspection

• Sluice room was clean and clutter free

• Previously reported concerns regarding the waste pipe overflowing have been resolved
  

Members involved in the survey stated that they had observed a significant improvement in the general environment and in infection control practices.

Ward 10 - General Medical

Previous concerns:

• staff and visitors not observed either hand washing or using sanitising gel.

• Staff member was observed not using disposable gloves while taking blood from patient

• Cleaners said they were not involved in infection control training

• Shower plug hole leading to the drain was dirty and clogged with hair

• Female bathroom/toilet was cluttered

• Sluice room – waste pipe was sludgy and very dirty

• Washing machine in sluice room was broken

• Waste bags were full to the top and could split when being moved
  

Repeat survey findings:

• Staff were observed washing their hands and using the sanitising gel.

• There was clearly a significant improvement in hand washing since the last survey.

• It was also noted that there is a sanitising gel dispenser at the end of every patient’s bed.

• Staff were observed using disposable gloves and aprons when providing direct patient care.

• A nurse observed checking patient’s blood sugar (thumb prick) used gloves, washed hands after and changed gloves before carrying out a similar procedure with the next patient.

• Cleaners reported a completely new cleaning regime in place including new cleaning fluids – one for degreasing and one for ‘heavy-duty’ toilet cleaning.

• There is one cleaning cloth for each patient area (bed, locker etc). After use the cloth is put in a laundry bin and is sent for laundering.

• Cleaners report they are now involved in training through their supervisor.

• Toilet Duck has been replaced with heavy duty toilet cleaner.

• A laminated notice was displayed in male/female toilets for patients to “contact staff if the toilet area is unsatisfactory” - this notice is signed by the 2 charge nurses.

• The ward was visibly clean.

• Bathrooms/showers/toilets were clean and clutter free.

• There were new chairs on the ward.

• Information about waste disposal was on display.

• Bags were not over-filled and stored in a closed store room.

• Corridor to bays are not cluttered and storage boxes have gone from the day-room.

• A new washing machine had been installed.

• Sluice drains cleaned and plug holes clean.

• Vastly improved sluice room - not cluttered and very clean.

• Isolation side ward had clear notice to all visitors to report to nursing staff before entering room.
  

General comments:

There has been a transformation in this ward both in the ward management of environment and nursing and cleaning practice.

There was a strong sense of ward leadership.

The ward was very busy with 3 ward rounds going on at the same time. Doctors were observed using the sanitising gel after direct contact with patients.

Painters were observed working in a number of bays within the ward. The bathroom and shower rooms had been repainted.

Maternity Ward – Erne Hospital:

Previous concerns:

• Infection control training appears to be through reading, literature and referral to manual

• Staining on carpeted area; in general carpeted areas were not clean

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

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

• Unused needles very accessible on emergency trolley

• Sluice room door held permanently open with linen bin

• Sharps box placed at low level and open

• Shower room cluttered with boxes

• Urine sample in bathroom in open tub container

• Some sanitisers on the main ward had no accompanying notices
  

Repeat survey findings:

• Hand sanitising agents - clearly visible and with sanitiser in them – and observed to be used by staff.

• Staff questioned have received training on infection control. Training is ongoing with classes held on site and further literature available.

• The ward, bathrooms and showers were observed to be clean and clutter free. Cleaning materials were available for cleaning the bath.

• Toilets and showers were clean and free from equipment.

• Information about waste disposal is on display

• Waste bags are not over-filled

• There are foot-operated bins

• Painting was ongoing within the ward

• The in-use Sharps box was observed with the aperture open but kept at a height out of reach of children in the pre-assessment examination room.

• The used Sharps box was placed in the store room but kept at floor level

and not properly secured. However the door to this store was closed with a “No Entry” sign displayed.

Other Observations or comments:

As previously noted during the last survey, furniture and curtains are old and shabby.

The carpeted areas remain in the waiting area and the rooms at the back of the ward. These carpets are shabby and dirty looking.

Curtains are in very bad repair on windows and around bed area

At the time of the previous survey nursing staff said the baby bath is cleaned each time after use. A mother was observed bathing baby and leaving the bath back on the pile without being cleaned.

OVERALL COMMENTS:

All those taking part in the repeat survey at the Erne hospital were impressed by the considerable improvements which had been made since their first survey in October 2007.

It was also noted that the front hallway leading to the stairs and wards which had been a carpeted area and observed to be dirty has now been replaced with a rubber/vinyl floor covering.

The survey team would wish to acknowledge the courteous and professional manner in which they were welcomed back to the wards to carry out the repeat survey.

Similarly they received the same welcome and courtesy at the Tyrone County Hospital.

Finally, upon receiving the October 2007 Bugwatch report, the Chief Executive Ms Elaine Way, responded by reassuring the Council that she took their findings very seriously and would immediately carry out an internal review and put in place an action plan to deal with the issues raised. It was clear to all of the surveyors that the actions taken and those still being implemented indicated that the issues had been taken seriously and dealt with in a very timely manner.

Bugwatch Survey

13 February 2008

Surveyors

* WHSSC Business Support Manager

** 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

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