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Published Reports - Bugwatch Report Altnagelvin Hospital March 2008

Western Health and Social Services Council

Bugwatch Survey

Summary of Findings

12 March 2008

CONTENTS

Background

Summary of Findings

Surveyors

Questionnaire

Background

The ‘Bugwatch’ survey was first carried out in 2005 as part of the Health and Social Services Councils’ input into the development of the Northern Ireland Infection Control Strategy and public interest around hygiene standards in hospital wards. The survey was based on a similar exercise piloted in England by the Commission for Public and Patient Involvement in Health.

The survey focuses on simple observations and questions which are indications of good practice in hospital hygiene. Using a specially designed toolkit, those carrying out the survey checked against a number of key infection control indicators on hospital wards including handwashing, ward environment and storage.

Bugwatch Survey Summary of Findings

On 12 March 2008 the WHSS Council carried out a ‘Bugwatch’ survey in Altnagelvin Hospital.

2 members carried out the survey in the following wards:

Wards 20 & 21 (Elderly)

Ward 31 (Surgical)

Wards 8 & 9 (Orthopaedic)

Ward 15 (Maternity)

Ward 8 & 9 (Orthopaedic)

Hand washing

There were plenty of sanitisers available and staff were using them or washing their hands when working between patients.

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

Curtains were visibly clean and in good repair

Waste disposal

Information on waste disposal policy was clearly 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

Members noted that there was a rota completed when changing the curtains around the beds and thought this was good practice.

Sharps

The Sharps box was stored safely in the medication room on both wards.

Staff training

Staff confirmed they:

• had received training on infection control

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

One member of staff questioned did not know the name of the infection control nurse but quickly found out by asking another member of staff. Members carrying out the survey were informed that both named nurses were on night duty.

Staff said that more training on infection control is required for part-time nursing staff and cleaners who are covering periods of absence, particularly for those employed through an outside Agency. They also appreciated having the same cleaners identified for the ward on a regular basis so that they are familiar with the ward area.

Information for visitors and patients

Three patients who were asked said information is available to visitors when visiting ‘at risk’ patients.

General comments

• Ward 8 & 9 have been refurbished; the wards are clean and tidy and in an excellent state of repair.

• Four patients spoken to were full of praise for the ward.

• The physiotherapy room (ward 9) in particular was noted to be in an excellent state of cleanliness.

• Painting was ongoing in the utility room during the survey.

• Staff said they place a strong emphasis on teamwork and the importance of including cleaners as part of the ward team.

• It was felt that at least one infection control nurse should be on duty for each day or night-time shift

_____________________________________________________________

WARD 20 & 21 (Elderly)

Hand washing

Sanitisers were available and staff were using them or washing their hands when working between patients.

Mixer taps were not available at all sinks.

Elbow control taps were not available at all sinks.

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 and were not stored in public areas

Ward environment

Bathrooms in both wards were cluttered. There was no access to the sink.

There was no bath in either ward.

A cleaning schedule in the bathroom of ward 20 was last dated and signed on 21/10/07.

Toilet was not flushed.

Sink was dirty.

In the male toilet there were paper towels on the floor and the bin was full to overflowing.

The treatment room in ward 21 was extremely cluttered – full to the door with various items of equipment. Members were informed that the treatment room is not used - all treatments are carried out at the bedside.

It was noted that there was no ventilation in the male toilet in ward 21 and therefore there was a strong odour. There was a container on the floor with urine in it.

The sluice room looked dirty and was in a poor state of repair.

The shower in ward 21 was very cluttered – used as a store. There was a portable toilet seat with a disposal sign dated 8/1/08.

In ward 21 members were informed that patients with infections were being nursed in side wards but there was no notice for visitors and no aprons/gloves available outside the rooms.

Sharps

Sharps boxes were stored safely when not in use.

Staff training

Some nursing staff in ward 20 said they have not received training on infection control.

Information for visitors and patients

Members were informed that many patients are confused – therefore information is given to relatives

There are signs on the entrance to the wards regarding infection control – washing hands

Additional information (leaflet) is available on request (ward 20)

In ward 21 the leaflet is on display in a leaflet rack

General comments

• Staff informed members that most of the patients in wards 20 & 21 are over 75 years and confined to bed.

• Members felt that the ward environment itself was satisfactory but other areas such as bathrooms, toilets, sluice room, treatment room were not.

• There is very little room for storage.

• Nurses are having to work under appalling conditions in these wards and members felt they should be commended.

• Members were informed that the wards will be moving to a new building before the end of 2008.

• A relative who spoke to members was full of praise for the staff and the care they are providing to patients
  

_____________________________________________________________

WARD 31 (Surgical)

Hand washing

Sanitisers were available and staff were using them or washing their hands between patients.

Not everyone entering the ward used the sanitisers.

Patient told members that a nurse blew her nose on a green paper towel but did not wash her hands afterwards.

A nurse was observed wearing jewellery.

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 and were not stored in public areas

Ward environment

In general the ward appeared to be clean and tidy.

Members were informed that a patient with MRSA was being nursed in a side room just inside the entrance to the main ward. The door to this side room was wide open during the time of the survey. There was a notice on the door telling visitors not to enter unless wearing a disposable apron and gloves. However these were only available from inside the room. There was a sign to ask visitors to report to the nurse in charge but it was quite small and could easily be missed. There was no sanitiser available outside the room.

Clean linen was stored on what appears to be permanent shelving in an open area opposite the side rooms where patients with infections were being nursed. Members were unsure why the linen was stored in this area as there appeared to be adequate storage space in the linen store.

In the ward members observed that after beds were cleaned they were labelled as such – this was noted as good practice.

Bathrooms/showers and toilets were clean.

Curtains were visibly clean and in good repair but some had curtain hooks missing and were hanging off the rails.

Sharps

Sharps boxes were stored at waist level in the treatment room with the aperture open. The treatment room door was open.

Staff training

An auxillary nurse had received training on the ward as the course they were due to attend had been cancelled.

Some staff who were new to the ward had not yet received training on infection control.

Members were told that annual infection control training is compulsory for staff; however some training sessions are cancelled, possibly due to poor uptake.

General comments

• In general patients gave positive feedback about cleanliness in the ward.
  

____________________________________________________________

Ward 15 (Maternity)

Hand washing

Sanitisers were available and staff were using them or washing their hands between patients.

Posters designed by children were on display regarding hand washing.

The sanitiser at the entry to the ward was stuck by a clip to the top of a blackboard – no notice was displayed to invite visitors to use the sanitiser.

Elbow control taps were not available at all sinks.

Ward environment

The furniture in the ward is old but generally clean.

The dado rail in corridors and paper towel dispenser in 1 bathroom were dusty.

There were 3 chairs in 1 bathroom which were old and grubby looking.

The tiles in bathrooms/showers were chipped and broken and dirty looking.

One bath appeared rusty, old, stained looking.

There are 4 bathrooms in total. 3 out of 4 did not look clean with stains on the floor.

There were cigarette burns on a bath, on several paper towel dispensers and on the tops of toilet bowl cisterns. There was an assumption that these were old cigarette burns.

Toilets looked fairly clean but members witnessed what looked like blood stains on toilet floor.

There is no cleaning schedule or cleaning equipment in 2 of the bathrooms.

Some curtains looked old and shabby and were hanging off hooks in places.

There were stains on radiator in one of the double bed bays.

In the single rooms there were cracks along the floor and staining in sink.

The sink was not cleaned in blue bathroom – hair & toothpaste – no cleaning materials or cloths in bathroom or shower.

Staff training

Not all staff questioned had received training on infection control.

Members were told there is an infection control midwife but no-one who was asked could identify who she was.

Waste Disposal

Information on waste disposal policy was on display

Waste bags were not over-filled

Members observed 2 bins which were very full

There were foot operated bins in working order for clinical waste

Linen

Linen was segregated into colour-coded bags

Bags were not over-filled and were not stored in public areas

Sharps

Sharps boxes were stored in sluice room. They were not at floor level but easily accessible and the aperture was open. The door to the room was propped open by a clinical waste bin.

Sharps boxes also in clinical room. This room was very ordered and everything was labelled but the aperture was open on the Sharps box. The door to the room was open but not propped open. There was a single tablet sitting on the counter.

In the sluice room itself – bed pan washing machine could do with a proper clean and sink and counter tops.

General comments:

• Several patients who were asked if they had any comments on cleaning or infection control said they had no complaints.

• posters made by children were laminated and on display in most of the 4 bed bays encouraging hand washing.
  ___________________________________________________________
  

Bugwatch Survey

12 March 2008

Surveyors

I nfection 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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