UPDATED: 16.30, 12th December 2014
The Rotunda Hospital regards the Prevention and Control of Healthcare Associated Infections as a serious issue for the Hospital in maintaining and delivering high quality and safe healthcare to all its patients and babies.
The Hospital seeks to reinforce and maintain its own high internal standards as well as those of monitoring bodies including the Health Information and Quality Authority. Senior management ensure that any departure from hospital hygiene standards is corrected quickly, and, where necessary, policies are changed to remain in line with best international practice.
The Rotunda Hospital provides three main services to its patients – Maternity, Gynaecology and Neonatology.
The unannounced inspection by HIQA of two of those service areas in Gynaecology and Neonatology identified a number of hygiene and safety issues that the Hospital has taken immediate steps to resolve.
As the report notes, within the Gynaecology Ward staining and dust was found on a number of surfaces of beds, medical equipment and toilet facilities.
“We recognise that these lapses are not acceptable and since the audit, a number of steps and actions have been undertaken by myself and the management team to bring hygiene audit levels back to what they normally are. In setting out our internal policies, the Rotunda Hospital seeks to not just match, but to exceed quality standards and targets where they are set by external monitoring bodies,” said Dr Sam Coulter-Smith, Master of the Rotunda Hospital.
As the HIQA report notes, the Rotunda Hospital is part of regular national hand hygiene audits each year. The results show the Hospital’s consistent improvement in hand hygiene compliance since 2012 up to June of this year when the Hospital overall exceeded the HSE national target of 90% compliance (91.4%).
“We’re working to ensure that standards and hygiene levels within the Gynaecology Ward match the compliance levels in other areas of the Hospital. This will be a key component of the Quality Improvement Plan (QIP) currently being developed bythe Hospital and due to be approved by the Hospital Board and published on our website in January 2015,” said Dr Coulter-Smith.
The inspection team found that “the Neonatal Unit was generally clean and well maintained with some exceptions”. These exceptions related in the main to presence of dust and staining on some medical equipment and a medication spillage inside a trolley drawer. There was also specific comment on a practice around the ‘single use’ of antibiotic medication
“New procedures have been drawn up by senior management to ensure that all staff follow regular and consistent cleaning protocols. Shortage of staff resources is a common problem within the healthcare system and particularly within maternity services; however, it is not an acceptable reason for a lowering of appropriate hygiene standards within the Hospital,” commented Dr Coulter-Smith.
The HIQA team also commented on a practice within the Neonatology Unit around the use of ‘single use’ antibiotic medication. The report stated the audit team “was informed that the vial, when reconstituted, is kept for approximately 30 minutes and used multiple times for different patients requiring the same intravenous antibiotics. “
The report noted that: “the use of medications labelled as ‘single dose’ or ‘single use’ should only be used for a single patient or a single procedure as these vials typically lack antimicrobial preservatives and can become contaminated and serve as a source of infection when used inappropriately.”
Traditionally vial sharing occurred in Neonatal Intensive Care Units with commonly used medications such as antibiotics. These medicines usually come in vials that are designed for adult use. However, the dose for tiny babies is only a fraction of that required for an adult so an individual vial of medication was used for more than one baby where the babies involved were due the medication at the same time. Separate sterile equipment was used for each separate baby to administer the medication.
All the procedures involved in use of these shared medications is carried out in adherence with both the Rotunda Hospital’s Clinical Guidelines on Administration of Medications (2013) and NMBI(ABA) Guidance to Nurses and Midwives on Medicaiton Management (2007).
No adverse events or infections have been reported as a result of this practice. The Hospital’s infection rates as a whole are below the average from the Vermont Oxford Network which tracks and measures NICU infection rates internatioanlly.
Under the auspices of the Hospital’s Drugs and Therapeutics Committee, a quality improvement plan will be developed to change practice. Recent recommendations from the quality and patient safety organisation Joint Commission International (Sentinel Event Alert June 2014) will be implemented. A single-dose/single-use vial will be used for a single patient during the course of a single procedure. Recommendations from the US Centre for Disease Control (One and Only Campaign and the HIQA hand hygiene inspection will guide staff education relating to the quality improvement
Design, Space and Infrastructure Issues
The Report noted that the design of most of the clinical hand wash sinks in the Gynaecology Ward and Neonatal Unit did not conform to current Health Building specifications.
“We are already aware of this issue; in particular the need to upgrade sinks in the Neonatal Unit. Major works are required to upgrade the sinks and this would mean closing the unit while these works were completed which would be very challenging for the Hospital’s day-to-day activities,” said Dr. Coulter-Smith.
As the report notes, suitable storage space within the hospital for unused equipment, trolleys, etc., is in short supply given the infrastructure and age of the Hospital buildings. Guidelines set out for the safe and hygienic storage of such equipment will be followed in future within the restrictions imposed by the current infrastructure. Development plans for more space in the Hospital grounds are underway to help further alleviate this problem.
Legionella Risk Assessment
The Hospital accepts that it hasn’t done a formal risk assessment recently but actively manages the risk of water contamination. Legionalla and Water Quality is a regular standing item on the Hospital’s Property Committee agenda that meets every six weeks. The Rotunda carries out water quality testing throughout the Hospital every quarter and legionalla specific testing every month in high risk areas and these reports are provided to the Property Committee for assessment. A Risk Assessment will be carried out as part of the Quality Improvement Plan.
94% of staff in the Rotunda Hospital has completed hand hygiene training in the previous two years. The Report noted that there was “evidence of good compliance from all clinical staff in completing hand hygiene training”. Midwifery and nursing staff must attend an Infection Prevention and Control study day that includes hand hygiene training. Hand hygiene education is provided for staff as part of their induction programme. Staff are also encouraged to complete the HSEL and D e-learning training programme (the Health Service Executive’s online resource for learning and development).
Further information for media, please contact: