DRIVING IMPROVEMENT THROUGH INDEPENDENT AND OBJECTIVE REVIEW. Cardiff and Vale University Health Board Unannounced Cleanliness Spot Check

Transcription

1 DRIVING IMPROVEMENT THROUGH INDEPENDENT AND OBJECTIVE REVIEW Cardiff and Vale University Health Board Unannounced Cleanliness Spot Check Date of visit 24 November 2009

2 Healthcare Inspectorate Wales Bevan House Caerphilly Business Park Van Road CAERPHILLY CF83 3ED Tel: Fax: Crown copyright February 2010 E

3 Contents Page No. 1. Introduction 1 2. Findings. Areas of strength, areas for further improvement and actions that need to be taken General environment of Llandough Hospital Ward East 8. Care of the elderly 3 Environment 4 Linen, waste and sharps handling and disposal 6 Equipment and storage 7 Staff knowledge and practice Theatres 8 Environment 8 Linen, waste and sharps handling and disposal 9 Equipment and storage 10 Staff knowledge and practice 10 i

4 2.4 Ward East 7. Care of the elderly 11 Environment 11 Linen, waste and sharps handling and disposal 13 Equipment and storage 13 Staff knowledge and practice 14 ii

5 1. Introduction 1.1 In May 2006, in response to concerns raised by public and patients across Wales, Healthcare Inspectorate Wales (HIW) announced its intention to undertake unannounced cleanliness spot checks of healthcare organisations across Wales. A programme of unannounced visits is carried out every year. 1.2 Many different sources of information relevant to this agenda are considered and used to shape the direction of the spot check programme, which is kept under review in light of any new information that comes to our attention. 1.3 As part of our Unannounced Cleanliness Spot Check, discussions are held with clinical staff and direct observations of clinical areas are undertaken. The check list used to guide the spot checks is based on the Infection Control audit tool developed by the Infection Prevention Society (IPS). 1.4 Further information about HIW, its spot check visits and the audit tool used can be found at Visit to Cardiff and Vale University Health Board 1.5 On 24 November 2009 HIW visited Llandough hospital which is part of Cardiff and Vale University Health Board and undertook cleanliness spot checks of the following areas: Ward East 8, Care of the elderly. The Theatre department. Ward East 7, Care of the elderly. 1

6 1.6 Our findings are set out in the following sections of this report. Areas of strength as well as areas for further improvement, including recommendations for action are highlighted. The Health Board is required to complete an improvement plan to address the key areas of concern and to submit it to HIW within two weeks of this report being published. 2

7 2. Findings. Areas of strength, areas for further improvement and actions that need to be taken 2.1 General Environment of Llandough Hospital The general environment throughout the hospital was not considered to be of an acceptable standard of cleanliness; refurbishment work is being undertaken in order to improve many of the estate s issues. However, public corridors and walkways were found to be cluttered with equipment and beds which were visibly dusty. 2.2 Ward East 8. Care of the elderly As part of the fieldwork for our All Wales Review of the Management of Patients with Diarrhoea and Vomiting, that was carried out in May 2009, we visited Llandough hospital and as a result concerns were raised in relation to estate issues, cleanliness and infection control on ward East 8. We issued an immediate action notice to the then Cardiff and Vale NHS Trust and we required an action plan to address the issues of concern to be prepared and taken forward. As part of the action plan the then Trust confirmed that work on refurbishment of the ward would be completed by September

8 However, our November visit highlighted that this work had not been completed. We were advised that this was due to the new Health Board having considered the future of the ward and the Board recognising the need for development and a comprehensive refurbishment programme. Following the re-visit, the Health Board decanted the ward. Environment Ward East 8 was found to be in a poor state of repair and there were some significant issues identified, including the condition of the wall on the entrance to the ward. Cleanliness on the ward was poor and high level dust and cobwebs were found. However, it was evident that the nursing staff on the ward were working hard to ensure that cleaning duties were undertaken. The handrail in the female bathroom was found to be rusty and should be repaired or replaced. Communal toiletry items were found on the ward. These should be removed as there is a potential, if used by a number of patients, for them to become contaminated. 4

9 There was a drainage problem in one of the shower cubicles and as a result there was a stagnant pool of water. This issue needs to be addressed as this can cause a build up of germs and bacteria, increasing the possibility of contamination between patients. The windowsill and frame was in a poor state of repair. It was visibly dirty and the corners were full of cobwebs. The wooden surround in the dirty utility is not acceptable and should be replaced as wood cannot be cleaned effectively and this can cause a potential risk of contamination The hand washing sink in the dirty utility is not acceptable as the taps are incorrect and do not conform to HTM 64. All clinical hand washing sinks should have elbow, knee or sensor operated taps. Taps should be easy to turn on and off without contaminating the hands. 5

10 The domestic room was found in a poor state of repair. It not suitable for use as there was no hand washing sink available. A number of items, including mop heads, were on the floor. On examination a raised toilet seat was found to be old, worn and showing some stains. This should be removed along with any other raised toilet seats that are also not in an acceptable condition. Linen, waste and sharps handling and disposal All clean linen on the ward was stored correctly in a designated area which was free from inappropriate items and used linen was segregated in appropriate colour coded bags and stored correctly prior to disposal. The ward complied with national standards in relation to the safe handling and disposal of sharps. However, we did not see any evidence of sharps trays being used on the ward and therefore it is unclear how staff are disposing of sharps while at the patients bedsides. We found bins that were inappropriate for clinical areas. They should be removed and replaced with bins of appropriate specification for healthcare settings. These should be foot operated, lidded and correctly labelled as to what waste is to be placed in them. 6

11 Equipment and storage Following the visit we made in May 2009, we recommended in the immediate action notice that documented cleaning regimes should be put in place. It was evident that a number of cleaning schedules have been put in place for different pieces of equipment and that nursing staff are working hard to ensure that cleaning is being undertaken. However, having so many cleaning schedules in place on the ward may cause confusion for staff as to which ones need to be completed and when. An organisational wide documented cleaning system should be in place that is robust and clear for staff, so they know who is responsible for cleaning what and when. Clinical equipment on the wards was generally found to be clean and instruments were appropriately and safely stored. However, items such as pat slides and stands aids were found to be dusty. Staff knowledge and practice Hand hygiene practices were observed and we considered there to be a tendency for staff to over use and rely on gloves for all patient contact. Staff were also observed as not always decontaminating their hands after removing their gloves. All staff should be trained as to when it is appropriate to wash hands, use alcohol gel and when to wear gloves. Following discussions with staff it was clear that not all staff had received infection control training within the last 12 months. All staff should undertake infection control training/updates annually, such training should cover practical hand hygiene practices. Hand hygiene audits are not being carried out on a regular basis and the results of previous audits have shown that there is poor compliance by staff. Hand hygiene audits should be undertaken on a monthly basis and staff should be engaged and informed of the results and any issues identified addressed. 7

12 The ward has had an increased number of Clostridium difficile cases recently and a task and finish group has been put in place to consider how to address the situation, such as reducing antibiotic prescribing on the ward. However, we were concerned that consideration had not been given to the ward environment and how this might be contributing to the increased number of Clostridium difficile cases. Gel/soap dispensers were found to be empty in the dirty utility and the treatment room; this is not acceptable as staff would have to leave the room before washing their hands. All gel/soap dispensers should be checked on a regular basis and replenished when necessary. There were inconsistencies in relation to the dilution of actichlor used for decontaminating equipment and cleaning blood spillages. There should be clear signage in place informing staff of what dilution needs to be used for different areas of cleaning. 2.3 Theatres Environment The general environment within the operating theatres, anaesthetic rooms and recovery area was found to be acceptable with fixtures and fittings in good condition. We found the changing areas, operating theatres and recovery area generally clean, tidy and free from dust. The waste disposal area was cluttered with boxes and other items. These should be removed and placed above floor level to allow effective cleaning to take place. 8

13 The domestic room and trolley was found to be in a poor condition and unsuitable to be used. All domestic equipment should be cleaned and stored correctly in a clean area. There was no evidence of decontamination facilities for footwear being available and it is unclear how staff clean their shoes after use. A decontamination area should be made available for staff to ensure that suitable cleaning of footwear is carried out. An instrument bag for the sterile service department was hanging on the handle of the macerator in the dirty utility room, within the recovery area, at the time of our visit and this should be removed. Linen, waste and sharps handling and disposal In relation to safe handling and disposal of sharps, we found a sharps bin that had been overfilled which could lead to needlestick accidents. Staff should ensure that all sharps bins are changed when needed. All clean linen on the ward was stored correctly in a designated area, which was free from inappropriate items and used linen was segregated in appropriate colour coded bags and stored correctly prior to disposal. We found bins that were inappropriate for clinical areas, they should be removed and replaced with bins of appropriate specification for healthcare settings. These should be foot operated, lidded and correctly labelled as to what waste is to be placed in them. 9

14 Equipment and storage A number of items were being stored in corridors and these should be stored in a designated area. Limb holders were found to be dusty and covered with sticky tape. This sticky tape should be removed as there is the potential for contamination as the limb holders cannot be cleaned appropriately. Inappropriate items were being stored along the corridor towards the orthopaedic theatre. These items should be removed and stored correctly as the area is part of the patient pathway. Staff knowledge and practice Generally staff knowledge and understanding of clinical practices in relation to infection control was acceptable. However, there was evidence of food being stored within fridges in the anaesthetic room. This is not acceptable and all staff should ensure that food and drink is not taken into clinical areas. During our visit we observed staff and their use of protective clothing. Staff generally wore their clothing appropriately, however we did observe theatre staff wearing masks while they were in the corridor and surrounding areas. Staff should ensure that they do not wear items of protective clothing outside of designated areas. 10

15 Staff generally had a good knowledge of the procedure for the decontamination of theatre equipment but there is no guidance in place for staff in relation to the preparation of chlorine releasing agents and the dilutions that should be used. Hand hygiene practices were observed and we considered there to be a tendency for staff to over use and rely on gloves for all patient contact. Staff were also observed as not always decontaminating their hands after removing their gloves. All staff should be trained as to when it is appropriate to wash hands, use alcohol gel and when to wear gloves. The theatre department has introduced the use of Biosure for scrubbing before some procedures, it was unclear if this product had been introduced with the involvement and approval of infection control staff. Proposals for the introduction of new products should be discussed and authorised by the infection control team. Cleaning and maintenance of equipment was being carried out in the theatre department, however, there were no formal documented regimes in place. An organisational wide documented cleaning system should be put in place that is robust and provides clarity as to who is responsible for cleaning what and when. 2.4 Ward East 7. Care of the Elderly Environment The general standard of cleanliness was poor throughout the ward as there was high level dust on the tops of patients lockers and curtain rails. There are also a number of maintenance and estate s issues that need to be addressed, such as the poor state of the wall on the entrance to the ward and the paintwork throughout the ward. 11

16 We found the skirting in the female bathroom to be of a poor state of repair and it should be replaced or repaired. The domestic room was found to be in a poor state of repair and not suitable for use. There was no hand washing sink available and a number of items, including mop heads, were on the floor. On examination we found a commode that had not been cleaned to an acceptable standard. A consistent approach to the cleaning of commodes should be in place across the organisation. There should also be a visible sign to indicate that the commode is clean and ready for use. Communal toiletry items were found on the ward, these should be removed as there is a potential, if used by a number of patients, for them to become contaminated. 12

17 Linen, waste and sharps handling and disposal The ward complied with national standards in relation to the safe handling and disposal of sharps. However, during the visit we did not see any evidence of sharps trays being used on the ward and therefore it is unclear how staff are disposing of sharps while at the patients bedsides. All clean linen on the ward was stored correctly in a designated area which was free from inappropriate items and used linen was segregated in appropriate colour coded bags and stored correctly prior to disposal. We found bins that were inappropriate for clinical areas. They should be removed and replaced with bins of appropriate specification for the healthcare setting. These should be foot operated, lidded and correctly labelled as to what waste is to be placed in them. Equipment and storage There were inappropriate items being stored in the treatment room and generally the available storage space on the ward was not being utilised effectively. A decluttering exercise should take place on the ward to ensure effective cleaning can take place. 13

18 A bed was found being stored in the day room; items and equipment should be removed from the ward when they are no longer required. Staff informed us that this bed was in the process of being removed. Equipment such as dressing and resuscitation trolleys were found to be visibly dusty. An organisational wide documented cleaning system should be in place, which is robust and clear for staff so they know who is responsible for cleaning what and when. Staff knowledge and practice We found that alcohol gel was not always available at the point of care, the appropriate placement of alcohol-based hand rub products within the patients immediate environment can support hand hygiene compliance. Placement can be at the foot of the bed or on a patient s locker. The hand washing sink in the dirty utility is not acceptable as the taps are incorrect and do not conform to HTM 64. All clinical hand washing sinks should have elbow, knee or sensor operated taps. Taps should be easy to turn on and off without contaminating the hands. There were inconsistencies on the ward in relation to the dilution of actichlor used for decontaminating equipment and clearing blood spillages. There should be clear signage in place informing staff of what dilution needs to be used for different areas of cleaning. 14