Hygiene inspectors found that linen to be used by pregnant women was being stored in toilets during an unannounced visit to the city’s flagship hospital.
The Healthcare Environment Inspectorate (HEI) team said that generally “good progress” had been made at the hospital since a previous inspection in 2011, with patients praising the cleanliness of wards and noticing an improvement since earlier visits. Senior nurses were also seen to have more control over keeping the wards clean, communication between NHS staff and private sector cleaners had improved dramatically and hospital staff had good hand hygiene.
However, several areas of concern remain at the Royal Infirmary after failures were found that could potentially cause an infection risk to sick patients.
Inspectors, who turned up unannounced at the hospital over two days in April and May, found that clean linen for the hospital’s pregnancy support centre was being stored uncovered in treatment and scan room toilets, just inches from the floor.
Six out of ten mattresses which were checked by inspectors were found to be stained, while sharps bins, which can contain used needles, were not always shut, increasing a risk of injury and infection.
Cleaning in areas of the hospital was also found to be lacking, although standards were said to be satisfactory overall. It was found that cleaning in the acute medical unit fell below standards in the rest of the hospital, with senior nursing staff saying the area was so busy that it caused problems for domestic staff.
Other areas of concern highlighted were that doors to rooms where infected patients were being kept in isolation were left open before a risk assessment was carried out and that there was confusion among staff about how the use of peripheral vascular catheters, which are used to give fluid to patients intravenously, should be documented.
Dr Jean Turner, a former anaesthetist, MSP and director of the Scotland Patient Association, said: “I think people will be horrified to find out linen was being kept in toilets. Ordinary people without any nursing background may keep towels in a cabinet in a bathroom, but would not keep bed linen or sheets there. They wouldn’t do it so why is it happening at a custom-built hospital?
“When someone comes out of a bed it should be completely washed down and everything changed. Using mattresses which are soiled or look soiled is not acceptable.
“Having said that, it’s excellent that things have improved. One wonders what would happen if the HEI didn’t go in to hospitals. This process is helping busy staff, who can’t have an eye in the back of their head or produce clones of themselves to do extra work, keep up.”
It is believed that the linen in the pregnancy support department is used by women to lie on when they have scans, although not all of it was stored in toilet areas. Many of the patients who use the unit have had miscarriages while others may have had complications.
Guidelines state that clean linen must be stored in a designated area, preferably an enclosed cupboard or under an impervious covering. Dirty linen, which was also found in toilet areas, should be stored in “safe designated areas”.
Overall, five requirements for improvement were made by the HEI team. An action plan was this month agreed with the health board.
It is understood that following the inspection every mattress in the Royal Infirmary has been inspected and new stock has been ordered. Cleaning schedules for the acute medical unit will be reviewed with PFI firm Consort, which has responsibility for cleaning.
Susan Brimelow, chief inspector, said: “We found that NHS Lothian has made good progress since our previous inspection in August 2011. In particular, there has been improved communications between staff groups, including domestic services and estates staff.
“However, we also identified a number of areas for improvement. For example, the policy for the care and management of mattresses must be effectively implemented on all wards and departments. We expect NHS Lothian to address these areas for improvement as a matter of priority.”
Labour Lothians MSP Sarah Boyack said she was pleased to learn that progress had been made but that it was apparent that there were still problems at the hospital.
She added: “There are many positives in this report which underline the excellent work staff at the ERI are doing to manage infections. However, the storage of clean linen in the toilets and the discovery of dirty mattresses show that there are still clear issues to resolve.
“It is now important that steps are made to address all of the issues identified by inspectors. Healthcare associated infections remain a key issue for patients and the general public so there is no room for complacency. We need consistently high standards in every part of the ERI.”
Melanie Hornett, NHS Lothian’s nurse director, welcomed the report and said it recognised the efforts of staff in infection control and cleanliness while singling out several areas of strength.
She added: “We continually look to maintain and improve our infection prevention and control processes and recognise that there were some areas which the inspectors felt we need to improve upon.
“The inspectors found a small amount of clean linen stored in a shower area and this was immediately removed and was not used. We have reinforced to staff the procedures around appropriate linen management to ensure this does not happen again.
“We are also taking a proactive approach to supporting staff in the safe management of sharps and have procedures in place to ensure we deliver the best possible standards of hygiene for our patients and actively promote these to staff through briefings and training.
“It is reassuring that the inspectors found that the majority of patients appear happy with the information and advice they receive, and with the cleanliness of the wards.”
On the report card
Patients think the hospital is clean and has improved;
Communication is better between NHS staff and Consort cleaners;
Infection prevention team has introduced a single point of contact phone number which is working well;
Good dress code compliance among staff;
Staff are careful to wash hands;
Cleaning generally satisfactory
Linen for pregnancy support department left in toilets;
Ward staff unsure about flushing water outlets to manage legionella;
Cleaning in acute medical unit not up to scratch;
Sharps bins not always closed;
Isolation room doors open with no risk assessment;
Catheter use not always recorded
STEPS IN THE RIGHT DIRECTION?
WHILE some concerning issues were highlighted in the latest report, inspectors said
“good progress” had been made since August 2011.
Then, the relationship between NHS Lothian and Consort, which provides cleaners for the hospital under the terms of the PFI deal used to build and run the hospital, was criticised, as reported in the News, above.
It said poor communication between NHS workers and the Consort employees was leading to a negative impact on the hospital environment. However in the latest report, it was found that “work had been done to ensure senior charge nurses feel empowered in their role to influence and direct infection prevention and control activities”.
NHS Lothian nurse director Melanie Hornett said the report showed there was now good communication between NHS Lothian and Consort.
But Tory MSP and health spokesman Jackson Carlaw said: “All of these problems point to a fragile relationship between NHS Lothian and the contractors running the hospital. It has long been a concern and, judging by some of the findings here, doesn’t appear to be improving. I’m glad the unannounced inspections are persisting. It appears to be the only way to get a true picture of what is going on in Scotland’s hospitals.”
What needs to be done
NHS Lothian has been told to:
• Ensure staff comply with hand hygiene, sharps and linen precautions.
• Make sure mattresses policy is implemented.
• Ensure risk assessments that lead to isolation room doors being left open are documented.
• Implement a consistent approach around peripheral vascular catheter insertion.
• Ensure cleaning schedules meet the needs of the acute medical unit.