Washing away years of bad practice

IT WAS hard to know whether to be heartened or horrified by the gathering of health professionals that took place one early morning in mid-September this year.

The theme of their meeting hospital hygiene was worthy. The timing of the gathering when fears about MRSA and the other superbugs plaguing hospital patients were running high was appropriate.

But the conclusion that people working, receiving treatment or visiting hospitals should wash their hands was alarming.

The idea that highly trained medical professionals would be doing their ward rounds with dirty hands was akin to hearing that airline pilots never had their eyes tested.

The notion that patients would not have adequate facilities to wash their hands was just as unsettling. The thought that visitors popping in to see a loved one would not be reminded to visit a sink before approaching a bedside was downright depressing.

Yet that is exactly the picture presented of Irish hospitals at that early morning meeting in September.

Other, more sophisticated tactics were considered at the meeting. The recruitment of more microbiologists, infection control nurses and laboratory scientists was recommended, as was screening programmes for patients, more isolation rooms and better use of antibiotics.

But the key message to emerge for that day was that much of the above could be avoided if only more hands were washed.

Hand hygiene, which is the technical term, is so important, and so lacking, that the Health Service Executive even declared this week "Hand Hygiene Awareness Week" with the slogan "Clean Hands Save Lives".

That was before the results of the National Hospitals Hygiene Audit were known. If there are to be more awareness weeks, they will have to be under the headings of bin hygiene, toilet hygiene and other equally basic themes.

If anything, the audit presents a worse picture of hospital hygiene than was feared.

Visitors had long complained about the visible problems of dirty toilets, medical staff injecting patients, dressing wounds and assembling drips without washing their hands, and immobile patients having no means of washing their hands before meals or after using commodes.

Behind the scenes, however, there were equally disturbing findings. Kitchens left a lot to be desired in some hospitals, as did surgical units and even intensive care units where the most vulnerable patients are cared for.

Some of the blackspots uncovered by the audit included insufficient storage areas for cleaning supplies so that cleaning fluids are not readily available at the moment a clean-up is required.

The audit found most wards had a dedicated "dirty utility" for the washing of contaminated utensils but half did not have a separate sink for hand washing. Most wards did not supply single use toiletries, such as sachets of shampoo, which would limit the amount of wet bottles moving back and forth.

About half the places visited had chairs that were not washable and "the standard of cleanliness of work station equipment in clinical areas including telephones, computers, printers etc was poor in almost half of the areas audited". More than half of bed frames were dusty or stained.

SOME HOSPITALS scored as low as 33% for the condition of their kitchens.

Common sins recorded included lack of fly screens on windows, not enough sinks, open packages of food not stored in airtight containers, tea towels used instead of disposable paper rolls and "the majority of waste bins were not labelled and/or were dirty".

Waste management was another low point. Bins were often overfilled, many containers for clinical waste had broken locks and "sharps boxes" for the disposal of needles and other equipment with blades or points were routinely kept in unlocked boxes. In many places, used linen was not separated from soiled linen.

Surprisingly, the findings show it doesn't really matter whether a hospital has a microbiologist on its payroll, whether it is a particularly modern facility or even whether it is huge and packed, or small with a comfortable level of occupancy.

The best in the country, Mallow General, is a small, local hospital much like St Columcille's, Loughlinstown, which was one of three sharing the worst spot. Second best, St James' in Dublin, is a hi-tech, specialist hospital like Beaumont, which also shared the bottom place.

Tánaiste and Minister for Health Mary Harney expressed dismay at the findings which she described as "very disappointing". "There has to be a rigorous overhaul and it has to begin now," she said, deviating from her bland pre-prepared speech.

She said it was "extraordinary" that some modern, well-equipped, high budget hospitals which carried out highly complex surgery ignored basic things like hand washing.

Her tone differed from the officials from the National Hospitals Office (NH0) whose job it will be to implement the changes required. The furthest Dr Mary Hynes, assistant director of the NHO, would go was to admit the report "does not make pretty reading".

Director Pat McLoughlin also stressed the positive, emphasising the high level of co-operation by hospitals with the audit and their willingness to make the changes demanded.

The main problem all along, apparently, was the lack of a set of national standards to tell staff how clean their hospitals should be, and the fact that the health services were run by a myriad of health boards.

Neither explained why highly skilled medics had an aversion to washing their hands. For all its appalling detail, the audit was presented yesterday as an all-round encouraging development.

If the same gloss could be applied to hospital equipment, it's arguable that the audit wouldn't have been necessary in the first place.