Hygiene Report at Drogheda Hospital Inspection of December 2009

The recent National Hygiene Services Monitoring Assessment Report by the Health Information and Quality Authority (HIQA) on the Lourdes Hospital Drogheda received widespread publicity as it placed Drogheda at the bottom of the national pile at a time when the outbreak of clostridium difficile infection which probably lead to fatalities was coming to an end. There were 2 deaths which were referred to the coroner, 10 confirmed cases and 2 suspected cases of C Diff in the hospital to 3rd November 2009.

This report focused on cleanliness, hand hygiene, and waste and linen management practices. As there are 340 beds in the Lourdes hospital, the inspection took place on 16th December and visited the maternity ward 2, second and sixth floor medical wards, third floor surgical, the A&E, OPD, laundry and waste compound. On the same day the hospital infection committee declared the outbreak over.

The findings were not alarming. Most were cleaning and maintenance problems with dust and mould found in obvious places at windows, showers etc. My conclusion is that there is a need for better supervision achievable through focused training or a change in personnel. Most of the non-conformances are relatively easy to eliminate but will be more difficult to sustain everywhere not just in Drogheda.

There should be a change in the HIQA system with a hierarchy of critical and non-critical non-conformances with best practice standards introduced.
The issue of smoky fuel in domestic dwellings in towns like Drogheda add to the problems as it leads to dirty air and carbon deposits building up quickly. This is never alluded to by the establishment and the smoke free fuel law in Dublin is the only achievement that I can think of that vindicates Minister Harney’s place in politics.

There is one serious problem identified by this inspection – an inconsistent approach to hand hygiene. The description of where there exactly were no alcohol hand-gels is ambiguous and inadequately reported.
(HIQA please note your own standards are not up to standard) I quote “in Maternity Ward 2, Second Floor Medical, Sixth Floor East and the emergency department, an antimicrobial hand-wash agent was available at all sinks and no alcohol hand-gels were available in the outpatient department and third Floor Surgical Ward, an antimicrobial hand-wash agent was available at all sinks and alcohol hand-gels were readily available.”

91% of staff had attended hand hygiene training in 2009.

During observation, “all opportunities to practice hand hygiene were not taken. The hand-washing technique used did not always comply with best practice.”

This whole area got a C rating from HIQA. ie The organisation demonstrated broad compliance of between 41% and 65% with the requirements of the criterion.

Lourdes hospital and Roscommon achieved over 85% compliance in only one of the seven core criteria of service delivery standard 4. Tallaght hospital, Kilkenny and Mullingar had two of the seven for example, Mercy in Cork had three of seven whereas Cappagh Orthopaedic had six of the seven. This gets things into prespective

HIQA is meeting with Lourdes Drogheda to discuss the management of infectious disease outbreaks at the hospital.

Solutions

Internally, all staff who fail to comply with the hand washing regime should be listed and visited by the Infection Control Committee. Alcohol gel dispensers should be placed at the end of every bed to make the regime as user friendly as possible

Lesson for HSE management – The Hygiene Services Assessment Scheme, Quality Improvement Plan for Drogheda of April 2009 flagged many of these problems and the solutions. Rapid implementation of the plan and better clinical leadership will solve the problem and relieve Drogheda from the consistent disproportionate dreadful press the hospital receives. Morale impovement will inevitably follow.
Both documents are available on the net.