Spanish Town Hospital - Outbreak reported in nursery

Accident and Emergency Department

- Handwashing guidelines are not being adhered to. Blood is taken without gloves and hands are not washed after removing gloves

- Cleaning materials are not labelled

- There is no documented cleaning schedule

- The cleaning methods do not conform to standards

- Job descriptions are to be prepared and given to all staff on recruitment

- Staff need to be made familiar with the mass-casualty plan, and the plan should be tested at least once per year

- Wheelchairs and stretchers are in short supply. Patients who are awaiting admission to the wards stay on the chairs and stretchers for extended periods

- Additional wheelchairs are needed in the department. A number of wheelchairs are defective, with no rubber on the wheels and no footrests

- Additional stretchers are needed in the department

- Sharps containers are inappropriate. Cardboard boxes and plastic bottles are used

- Patient bathrooms need to be upgraded. Seats and tank covers are missing in a few places. The staff toilet in the records department does not flush

- Orientation guidelines need to be prepared for clinical staff

- No logbooks are being used. Sheets of paper are used for triaging, and these are put in the patients' records. Therefore, no record remains in the department.

- A system is needed for the monitoring of the usage of drugs and supplies in order to prevent stock-outs

 

Neonatal Nursery

- On the day of the audit, a gram-negative organism outbreak was reported in the nursery and there was said to be an absence of the appropriate antibiotics required for the treatment of the babies

- The containers with the cleaning agents are not labelled

- The cleaning methods do not conform to standards, and schedules are not documented

- Makeshift sharps containers are being used. These present a risk to staff

- The storeroom has a number of non-functional pieces of equipment. These need to be removed so that the spare beds for the nursery can be stored there instead of in a space on the nursery ward

- Excess furniture in the clinical area hampers the proper cleaning of the floor

- Food and drugs are stored in the same refrigerator. This affects the cold-chain management of the drugs. A refrigerator is needed to store the food and drink belonging to staff

- Hand towels are in short supply, hence expensive gauze is being cut for hand-drying. This is penny wise and pound foolish

 

Operating Theatre Suite (Main)

- The tiles on the walls do not allow for adequate cleaning

- The operating room is crowded with boxes, supplies and unused equipment. These all hamper proper cleaning of the area

- The operating lights are dull in intensity

- There is 'fungus' growing between the panes of glass in the window of the operating room

- There is no documented cleaning schedule or documented evidence of monitoring of the cleaning activities

- The storage areas are without doors and are scattered in different areas of the operating suite

- The delineation of the access areas needs to be made clear. Infection control is being compromised

- The disposal of waste from the theatres requires an urgent review and reorganisation.

- Bins with dirty linen, etc., are left in the sluice room overnight and removed in the morning through the operating theatre

- The segregation of linen needs to be implemented. Soiled linen is put in the open bin with dry dirty linen and the correct colour-coded bags are necessary

- The expiry date is not affixed to the sterile packs. The date of sterilisation is used. This is not the policy

- The carbolic soap being used for hand-scrubbing needs to be removed if the antimicrobials are now to be used

- Material safety sheets for the disinfectants need to be made available to the staff

- Janitorial staff require training in the correct methods of cleaning and the materials and concentrations of chemicals to be used

- The mops being used are not of the required standard and the number of mops and buckets provided are inadequate

- The workload in the theatre is enough to warrant the assignment of a secretary or records officer