By
Royal Victoria Hospital
THE ward at the centre of an outbreak of Clostridium Difficile at the Royal Victoria Hospital is the same one whose persistent issues with hygiene were highlighted by The Detail five weeks ago.
Belfast Trust today (Wednesday) announced it was restricting admissions to Ward 4F because of two cases of the superbug there.
In October The Detail revealed how the healthcare watchdog, the Regulation Quality and Improvement Authority, had issued one of its most damning reports after a probe into the ward two years earlier but that the ward which was supposed to be running the same hygiene standards as an operating theatre, was in fact barely making the mark in hygiene scores.
The latest health scare raises questions about hygiene enforcement in our hospitals, which currently takes the form of internal hospital hygiene reports and external inspections by the RQIA .
HISTORY OF HYGIENE FAILINGS
In June 2009 it was revealed that following an unannounced RQIA inspection at Ward 4F the Belfast Trust had been forced to close the ward for refurbishment.
Nine neurosurgery beds at the west Belfast site were closed as a result.
RQIA did not reinspect Ward 4F before it was reopened in January 2010.
It did not inspect the ward until May 2010, a full 12 months after its first damning report into the ward’s hygiene.
At that time RQIA claimed that the vast majority of the risk factors identified by the previous inspection had been fully addressed, stating:
“The follow up inspection evidenced a move from an overall minimal compliance level in both areas to a compliance level in Ward 4F and a partially compliant level in the Accident & Emergency department.
“It is notable that Ward 4F has increased compliance from having six minimally compliant areas to compliant in all areas.
“The vast majority of the risk factors identified at the previous inspection had been addressed in Ward 4F.”
However health experts now fear that the ward may now have to close once again to deal with the latest `C’ Diff outbreak.
RQIA’s 2009 findings was widely reported in the media as one of the worst the regulatory body had ever seen with 122 hygiene failures.
Gerry Bond previously give evidence to the Health Committee
But behind these figures was a personal campaign by Gerry Bond. It took eight months for the RQIA to respond to Gerry Bond’s complaints about ward hygiene at 4F after his grandson almost died of an infection and it led to one of its most damning report.
Mr Bond first made RQIA aware of hygiene failings at the RVH in October 2008 but it failed to carry out an inspection until May 2009.
The Belfast Trust confirmed that the ward had suffered five C Diff cases during the eight month delay.
In October The Detail revealed how Ward 4F was still falling short of expected hygiene standards.
Between January 2010 and July 2011 there were four more C Diff and one MRSA cases on Ward 4F .
Reacting to the latest C Diff outbreaks on Ward 4 F, Mr Bond told The Detail:
“I’m not surpised, but given what my grandson has been through as a result of a lack of hygiene in this particular ward I can’t help but be angry and extremely disheartened.
“This could have happened on any ward.
“But this ward has an appaling history and because of that its hygiene auditing had been increased to operating theatre level as a very high risk category.
“You have to wonder what have the previous changes and refurbishment really achieved?
REGULATION
In 2008, following the outbreak of other C Diff cases in the Northern Trust area, RQIA was tasked with conducting infection prevention/hygiene inspections at hospitals across Northern Ireland.
Even if RQIA identifies concerns through inspections – it can only make recommendations for improvement to the relevant trust or health board.
It is only in exceptional circumstances that the RQIA can refer a report directly to a chief executive of a health board or trust.
RQIA can also refer a report directly to Health Minister Edwin Poots.
In a statement to The Detail, the RQIA said:
“As part of its programme of infection prevention and hygiene, RQIA conducts a programme of inspection at a range of health and social care facilities in Northern Ireland. Where issues of concern are identified, RQIA may conduct additional inspections to ensure the safety and wellbeing of service users.
“To date, RQIA has inspected Ward 4F at the Royal Victoria Hospital on two occasions. In 2009 significant issues were identified during the inspection. The ward was re-inspected in May 2010 following a refurbishment conducted by the Belfast HSC Trust. At the time of this inspection all areas were compliant with infection prevention/hygiene standards.”
However, Gerry Bond hopes the latest revelations about Ward 4F will prompt serious action.
“I think it’s now time that there is an in-depth look at what has been happening at this ward,” he said.
“Questions have to be asked about the money and time that was taken to refurbish this ward.
“RQIA went in before and it was subsequently closed, but bare in mind they didn’t go back again before it was reopened.
“Maybe it is time that they go in again and take more serious measures and if they don’t have the power to do that, then they need to be given the power to do so, or history will repeat itself once again.”