Rhoda Grant MSP Welcomes Caithness General Report

7th November 2013

Shadow Wellbeing Minister Welcomes Healthcare Environment Inspectorate Report on Caithness General

Rhoda Grant MSP, the Shadow Wellbeing Minister, part of the opposition health team in parliament, has welcomed the publication of a report by the Healthcare Environment Inspectoratewho made an unannounced inspection of the Wick hospital back in September.

The HEI said that overall NHS Highland was meeting hygiene standards and whilst most infection controls were being met, inspectors found dirty and contaminated patient equipment in two areas of the site.

NHS Highland has been asked to meet three requirements and three recommendations to improve cleanliness. Caithness is an acute general hospital with 74 beds.
Its services include accident and emergency, assessment and rehabilitation, palliative care, obstetrics, renal, general surgery and general medicine.

Mrs Grant said:“Caithness General has seen a year on year improvement since its last inspection and overall the hospital has a high compliance rate with standards aimed at ensuring patients, public and staffs are at low risk of infection.

“It is important these checks are carried out to make sure the public receive the high standards of service they expect from the NHS.

“I know our hardworking and dedicated NHS staff and management will take the findings from the report on board and implement the requirements fully.”

The Report states -
Overall, we found evidence that NHS Highland is complying with the majority of NHS QIS HAI standards to protect patients, staff and visitors from the risk of acquiring an infection. In particular:
• staff demonstrated a good awareness and understanding of the NHS board’s infection prevention and control manual, and
• staff have started to take measures to control the risk of Pseudomonas aeruginosa infections and a risk assessment has been done that identifies all high risk units.

However, we did find that further improvement is required in the following areas:
• the standard of cleaning and maintenance of reusable patient equipment, particularly in the Henderson unit and Rosebank ward, and
• the standard and frequency of cleaning in the high dependency units.

Cleaning
We found that the standard of environmental cleaning was generally good across all the areas inspected.
During the inspection of the high dependency areas of the Henderson unit and Rosebank wards, we noted significant issues with high and low level dust. The NHSScotland National Cleaning Services Specification (2009) states that high dependency beds are classified as category B which would require high level cleaning at least once a week and daily cleaning of low level areas. However, we noted that the high dependency areas in these wards and units are included in the general ward cleaning schedules for environmental cleaning which is category A1. This category covers general ward areas only and not high risk areas such as high dependency. This means that the frequency for environmental cleaning in these areas is not compliant with national policy.

We found the cleanliness of patient equipment was poor in Rosebank ward and the Henderson unit. We found dirty and contaminated patient equipment.
In Rosebank ward, we found:
• five out of 12 blood pressure cuffs inspected were contaminated (high dependency room)
• dust on the lower levels of the resuscitation trolley (high dependency room)
• one out of two pressure relieving cushions inspected were contaminated (high dependency room)
• significant blood contamination on the underside of a shelf above a sharps disposal bin (clinical preparation room)
• blood contamination on the external surfaces of storage containers and two small sharps bins (clinical preparation room)
• two patient duvets stored in the clean laundry trolley: one damaged and no longer able to clean effectively and one with significant contamination along the seam
• two contaminated commodes, and
• two contaminated raised toilet seats.
We returned to Rosebank ward the following day to ensure that identified cleanliness issues had been dealt with. We were assured that significant progress had been made to address the issues identified the previous day.
In the Henderson unit, we found:
• significant blood contamination to the stirrups and cover of the stirrups of a delivery bed that had been recorded as cleaned and ready for use (delivery room 1) (see Image 1)
• blood contamination to the underside of bed frames and bed rails (delivery rooms 1, 2 and room 5)
• blood contamination to the underside lid of clinical waste bins and external surfaces of a clinical waste bin (delivery room 1 and sluice room), and
Ensuring your hospital is safe and clean
HEI Unannounced Inspection Report (Caithness General Hospital, NHS Highland): 10–11 July 2013
12
• dust on an overhead lamp (high dependency room).

We returned to the Henderson unit the following day to ensure that identified cleanliness issues had been dealt with. We were told that midwifery staff had been made aware of the cleaning issues and had cleaned the identified equipment overnight. However, we found that overall little improvement had been made and that a number of cleaning issues remained. As a result of this, we looked at additional patient equipment. For example, we saw detachable stirrups for the bed in delivery room 2 and found they were contaminated with blood (see Image 2). We were not assured that progress had been made to improve the standard of cleanliness of patient equipment on this ward.

During the inspection, we spoke with 11 patients and visitors. They all commented on the good standard of cleanliness throughout the hospital. Patients spoken with noted that cleaners were in the wards at least twice a day. We also received positive comments and feedback from our surveys. Of the 37 patients who responded to our survey:
• 36 stated that they thought the wards were always clean, and
• 31 stated that the equipment used for care was always clean and in good repair.
One patient we spoke with said ‘…nursing staff are wonderful and always busy.’ One patient commented in our patient questionnaire that ‘…this is an excellent hospital with lovely, caring and understanding staff.’

Full report by the Healthcare Environment Inspectorate