An overview report of hygiene inspections in public acute hospitals has been published today by the Health Information and Quality Authority (HIQA). The report summarises information that has been outlined in the individual reports published throughout the last 14 months.

HIQA carried out 54 inspections, covering 49 of the 50 public acute hospitals in Ireland (one inspection covered three hospitals), during a 14-month inspection period between November 2012 and December 2013. Ten inspections were announced and 44 were unannounced. Seven hospitals were inspected twice by HIQA arising from initial checks, while 100 recommendations were issued to the 10 hospitals which had an announced inspection.

Formal notifications of serious risks – identified in relation to the infection prevention and control standards and other areas during inspections – were issued to 13 of the 49 hospitals inspected. These related to cleanliness, hand hygiene and on communicable and/or transmissible disease control. Of these, observed hand hygiene practice (hand washing and/or use of hand-rub) was the most commonly identified serious risk, warranting six out of the 13 notifications to hospitals.

Other risks included drug trolleys not being maintained in accordance with best practice guidelines, and inappropriate accommodation of patients. This included patients observed on trolleys located outside of screened treatment bays in the emergency department and on extra beds placed into wards.

Phelim Quinn, HIQA’s Director of Regulation, said: “All hospitals which underwent announced and unannounced inspections were found to be partially compliant with the National Standards for the Prevention and Control of Healthcare Associated Infections. However, no hospital was found to be fully compliant with all of the Standards at the time of their individual inspection.”

“We noted that most of those hospitals that required a second inspection had improved and generally the feedback from the hospitals demonstrates a positive and constructive attitude to the recommendations made by HIQA as a result of its inspection programme. The quality improvement plans being put in place by hospitals as a result of the inspections show the impact and effectiveness of inspections on leadership, culture and practice within healthcare settings.”

During the inspections, nearly 1500 hand hygiene opportunities (key moments when staff should wash their hands and/or use appropriate hand-rub) were observed by the Authority. “Of the hand hygiene opportunities observed by the Authority, an average of 69% were undertaken by hospital staff,” Phelim Quinn stated.

“Non-compliances with best hand hygiene practice observed by the Authority during inspections related to issues such as not taking long enough to perform the hand hygiene technique, not performing the correct hand hygiene technique or wearing a wrist watch, jewellery or long sleeves,” Phelim Quinn continued.

One hospital – University Hospital Galway – was not inspected against the hygiene standards as it was the focus of a separate regulatory process by the Authority during this time.*

Phelim Quinn concluded: “The monitoring programme during 2013 was also aimed at enabling service providers to prepare for the eventual monitoring of services against the National Standards for Safer Better Healthcare. This area of patient safety will continue to be a priority for the Authority and will remain a core focus in its standards monitoring programme in the next three years and as part of the future licensing of healthcare facilities when the appropriate legislation and regulation are introduced. The monitoring programme for 2014 will continue to include both announced and unannounced inspections.”

Further Information: 

Please contact: Marty Whelan, Head of Communications and Stakeholder Engagement 01 814 7480 / 086 2447 623 mwhelan@hiqa.ie.

Notes to the Editor: 

• Healthcare Associated Infections (HCAIs) are a significant patient safety issue and represent the most frequent adverse event experienced by patients receiving healthcare services. It is estimated that each year, hundreds of millions of patients globally are affected by Healthcare Associated Infections. For example, in high-income countries, approximately 30% of patients in intensive care units are affected by at least one Healthcare Associated Infection.
• Research shows that such infections can result in prolonged hospital stays, long-term disability, increased resistance of microorganisms to antimicrobial drugs and high costs for patients and their families. The World Health Organization reports an estimated annual cost of approximately €7 billion due to Healthcare Associated Infections in Europe, including direct costs only and reflecting 16 million extra days of hospital stay.¥
• The Health Information and Quality Authority (the Authority) has the national statutory role for developing standards for the quality and safety of healthcare services. The National Standards for the Prevention and Control of Healthcare Associated Infections (referred to in this report as the Infection, Prevention and Control Standards) were approved by the Minister for Health and Children on 26 May 2009, and published by the Authority. The Authority has the statutory responsibility under the Health Act 2007, amongst other functions, for monitoring compliance with National Standards and advising the Minister for Health as to the level of compliance.
• The aim of these Standards, together with the Authority’s monitoring programme to assess compliance with them in public acute hospitals, is to contribute to the reduction and prevention of Healthcare Associated Infections in order to improve the quality and safety of these healthcare services. The Standards also aim to drive a culture of responsibility and accountability among all staff involved in the management and delivery of health and social care services – all of whom must play their part in preventing and controlling HCAIs.
• The underlying principles of hand hygiene opportunities are based on the detection of the ‘5 Moments for Hand Hygiene’ that are promoted by the World Health Organization, which are:
  - before touching a patient
  - after touching a patient
  - before clean/aseptic procedure
  - after body fluid exposure risk
  - after touching a patient’s surroundings.
  An average of 69% of hand hygiene opportunities were taken by hospital staff at the time of the inspections (see Figure 1). Of these, an average of 79% were compliant with best practice hand hygiene technique (Figure 2).
  
  * Investigation into the safety, quality and standards of services provided by the Health Service Executive to patients, including pregnant women, at risk of clinical deterioration, including those provided in University Hospital Galway, and as reflected in the care and treatment provided to Savita Halappanavar.
  
  ¥ World Health Organization, Health care-associated infections FACT SHEET. Accessed January 2014