Immunology taps failing hygiene Inspections

MORE than a week after Health Minister Edwin Poots announced an investigation into the Pseudomonas outbreak, internal hygiene reports obtained by The Detail reveal that a separate ward at the Royal Victoria Hospital had already failed key hygiene targets linked with preventing the killer disease.

The Immunology Day Centre at the Royal Victoria Hospital site treats patients with serious immunodeficiencies, however documents received by The Detail show that the ward’s sink basins and taps have been consistently failing the hospital’s own hygiene tests.

It has emerged that sink taps were the source of the infection in the neo-natal units at the Royal and Altnagelvin maternity wards. Staff in hospitals were subsequently told to avoid using tap water with babies, while tests on water outlets and necessary refits were carried out.

However, despite letters being circulated to all of Northern Ireland’s health trusts last year outlining issues around water delivery systems and the risk of contamination, internal hygiene inspections for the Immunology Day Centre show that problems were identified with its taps and water pipes dating back to almost six months ago.

We are still waiting for a response from the Belfast trust in relation to the internal hygiene audit results for the Royal Jubilee Maternity ward.

INTERNAL INSPECTIONS

Through the Cleanliness Matters- A Regional Strategy for Improving the Standard of Environmental Cleanliness programme, all trusts have a duty to ensure that high standards of environmental cleanliness are being met and maintained.

Aside from the external audits carried out by the Regulation Quality & Improvement Authority (RQIA), trusts are meant to undertake regular comprehensive departmental audits of functional areas. The regularity of the audit is based on the frequency recommended for the particular risk category of the functional area:

Very high risk – All rooms within a very high risk functional area should be audited at least weekly.

High risk – All rooms within a high-risk functional area should be audited at least monthly.

Moderate risk – All rooms within a moderate risk functional area should be audited at least once every three months.

Low risk – All rooms within a low risk functional area should be audited at least once every six months.

IMMUNOLOGY DAY CENTRE

Following the outbreak at the Royal’s neonatal unit in January, we asked the Belfast Trust for the latest hygiene audit results for the Immunology Day Centre, where patients with serious immunodeficiencies are treated.

The audits from August 2011 to January 2012 show that while that day centre consistently passed the hygiene inspection in their overall mark, the state of the centre’s sinks and taps were constantly a source of failure and concern.

The Immunology department is constantly dealing with patients suffering from deficiencies of their immune system and therefore can be susceptible to infections and pseudomonas.

During the six month period there were 25 hygiene failures highlighted in the audit results that dealt specifically with problems around taps and sinks. This ranged from badly cleaned sink basins in treatment rooms, to taps needing de-scaled in the lobby and badly cleaned pipes and plug holes in allergy cubicles.

The Immunology Day Centre is now meant to be subject to weekly environmental cleanliness audits. The results over the past number of months show an inconsistent inspection routine, with some months showing hygiene inspections taken place up to four times over a four week period and other inspections only taking place twice within a month. (see below article for full hygiene reports)

In a statement the Belfast Trust said: "The Immunology Day Centre falls within the high risk category which should be audited monthly. However following discussions between the Ward Manager and Domestic Services management, it was agreed that we would escalate the risk category to very high risk.

“The Ward Manager selects a random sample (25%) of rooms for the weekly audit. All failures are rectified immediately by the Ward Domestic staff and Supervisors check the area after rectification to ensure compliance.”

NEONATAL UNITS

Following the pseudomonas outbreak in the Neonatal Unit in RJMS all Domestic Supervisors were instructed to pay particular attention to sinks and taps when they are carrying out their daily observational checks at ward/departmental level.

The neo natal unit at the Royal Jubilee maternity ward falls into the very high risk category and audits should take place on a weekly basis.

In a response to a written Assembly question by the Alliance Party’s Trevor Lunn last week, Edwin Poots stressed the importance of the DHSSPS Cleanliness Matters Strategy and the Regional Hospital Hygiene & Cleanliness Standards and Audit Tool. He added that frequencies are expressed as daily or weekly as a minimum requirement but may be cleaned additionally as needed.

The trust has yet to provide The Detail with any of the Royal’s neonatal ward hygiene audits results, despite the fact that our initial media request was placed over a week ago.

A recent statement from the Public Health Agency confirmed that water sample results for the Southern Trust and the Western Trust show that Pseudomonas has now been detected in a small number of water outlets in the neonatal units at Daisy Hill, Craigavon and the Erne hospital.

They said: "As in all neonatal units, steps had already been taken to ensure that babies are not coming into contact with the water supply. Only sterile water is being used for direct care of babies and a range of very strict infection control measures are also in place.

“In addition to the normal robust infection and control measures which hospitals are required to have in place, as a precautionary measure, taps in all neonatal units in Northern Ireland are being replaced and other remedial action will be taken as required.”

AN AWARENESS

In December 2011 a letter was circulated round all of Northern Ireland’s health trusts which warned of the danger pseudomonas infections from taps and basins after the outbreak at Altnagelvin hospital. In the same letter it makes reference to earlier correspondence from September 2010 from the Department raising awareness of potential cross infection risks from taps and basins. This followed receipt of a number of reports from English NHS Trusts and Public Health Wales concerning outbreaks of infection with Pseudomonas.

The hygiene inspection audits we received show that by December 2012, both the immunology centre had already been showing consistent concerns around their water systems in Royal’s internal inspections.

We can also reveal the existence of another letter by the Health Estates Investment Group dated the 1st July 2011 that points to an even greater awareness of the issues surrounding such bacterial infections.

In 2010 the Belfast HSC Trust together with Health Estates Investment Group, facilitated a workshop in 2010 to share with HSC Trusts and other stakeholders including RQIA and the Health and Safety Executive Northern Ireland, the lessons learned from a case study of control of legionella in a healthcare facility.

The Professional Estates Letter summarises that the key outcome from the workshop, was to monitor the water delivery systems in healthcare facilities to minimise and manage the risk of contamination by organisms such as legionella and pseudomonas.

It states: “In Northern Ireland, it has been highlighted that current written schemes for the controlling the risk from legionella in water systems need to be reviewed in light of the detection of legionella across a number of local healthcare facilities.

“Following discussion at the 2010 workshop, it was generally acknowledged by participants that the use of trained HSC estates staff who are familiar with the installed water systems are best placed to undertake an effective and thorough risk assessment. Operational experience has also indicated that this approach is also cost effective. Trusts are therefore advised to review how they currently undertake their risk assessment and consider the adoption of such an approach.”

Following the Minister’s announcement of a major independent investigation into the outbreak which has claimed the lives of four babies across Northern Ireland, every tap on every clinical hand washing basin in every neonatal unit in Northern Ireland is being changed. Water samples from these taps will also be tested as part of the investigation.