Healthcare watchdog puts Bromley Hospitals NHS Trust on notice over cleanliness and decontamination procedures
The Healthcare Commission today (Monday 4 February 2008) announced that it has issued Bromley Hospitals NHS Trust with an improvement notice, ordering immediate changes to its infection control practices.
The Government gave the Commission the power to issue improvement notices for serious breaches of the hygiene code when the code was introduced in October 2006. The code outlines 11 compulsory duties to prevent and manage healthcare-associated infections (HCAIs) such as MRSA and Clostridium difficile.
Bromley Hospitals NHS Trust is the second trust to be issued with an improvement notice. The trust runs three hospitals in south London, the Princess Royal University Hospital, Orpington Hospital and Beckenham Hospital.
The Commission made unannounced visits to Princess Royal University Hospital on Monday 21 and Tuesday 22 January 2008.
The regulator found breaches of duty four, which covers arrangements for clean and appropriate premises and decontamination of equipment.
The Commission has given the trust deadlines to address these issues. The strategic health authority, NHS London, will oversee this work.
The visit was part of the Commission's biggest ever programme of inspections relating to healthcare-associated infection. Launched last year, the programme will cover two thirds of NHS acute hospital trusts in 2007/08. In 2008/09, the Commission will visit every trust in England.
Anna Walker, the Commission's Chief Executive, said: "There is serious public concern at the moment about infections in hospitals. Trusts and patients should be clear that we remain vigilant and will not hesitate to use our powers when it comes to enforcing the hygiene code.
"We undertook unannounced visits to this trust. We found that cleanliness was not good enough and equipment decontamination processes needed improving. This is not acceptable to patients, who want to know that everything possible is being done to protect their safety and ensure a good standard of care."
"We have been back to the trust again. I am reassured that it has already implemented our requirements on decontamination, and patients can also be reassured by this.
"The cleanliness levels and procedures need to be improved. This is a management issue. Managers must take responsibility for clarifying and resolving problems to protect patients from risk at all times. We will check again on progress in March."
Details of the two breaches at Bromley Hospitals NHS Trust are:
Duty 4(c) An NHS body must, with a view to minimising the risk of HCAIs, ensure that all parts of the premises in which it provides healthcare are suitable for the purpose, are kept clean and are maintained in good physical repair and condition.
Breach: In three wards, thick layers of dust were observed on the curtain rails around patients' beds and on ventilation plates, which shows that thorough routine cleaning is not taking place. A supporting column outside two side rooms of an isolation ward was not maintained, with exposed metal protruding through the plaster; similar problems were noted in other areas of the same ward.
Duty 4(f) An NHS body must, with a view to minimising the risk of HCAIs, ensure that there are effective arrangements for the appropriate decontamination of instruments and other equipment.
Breach: Bench top sterilisers were observed to be in use in theatres and the day surgery unit with insufficient evidence of a process to trace the origin, history and use of instruments decontaminated in the machines. Evidence of poor decontamination procedures of patient equipment was found. Soiled commodes, marked clean and ready for use, were found on one ward. Several bed frames and wall mounted suction bottles were very dusty in three wards. A thick layer of dust was observed on the blood culture bottle trolley outside an isolation ward. Patients on two wards expressed concerns to Healthcare Commission staff about the hospital's cleanliness, directing them to examples of unclean areas and equipment such as bloodstains on a bed rail and blood splashes on a wall behind another bed.
Bromley Hospitals NHS Trust has been given two requirements:
- The trust must immediately implement a robust tracing system for any instruments decontaminated using bench top sterilisers, with immediate effect.
- The trust must develop a robust action plan to ensure the cleanliness of all patient areas in line with NHS national minimal standards as published in 2004, by Friday 29 February 2008.
The Commission returned to the trust on Thursday 31 January 2008 and is satisfied that the trust is now compliant with the first requirement of the notice.
The trust has made changes to its decontamination processes, resulting in a faster tracing system. Relevant staff have been trained in the new process.
A further visit will take place in early March to check on the cleanliness of patient areas and other decontamination issues.
In addition to work on the hygiene code, the Healthcare Commission is currently undertaking the annual health check for 2007/08. As part of that process, trusts must declare whether they believe they are meeting 24 core standards set by the Government, which also cover infection control.
Where a trust declares compliance and is subsequently found to be not compliant with the hygiene code, it may affect their annual performance rating. For the 2006/07 annual health check, Bromley Hospitals NHS Trust declared itself to be compliant with two out of three core standards relating to infection control. Declarations for trusts for the 2007/08 year are expected at the end of April.
Hygiene code reports published so far are available on the Healthcare Commission's website.
Inspection reports and improvement notices
Ends
Notes to editors
- Bromley Hospitals NHS Trust operates three sites, Princess Royal University Hospital, Orpington Hospital and Beckenham Hospital (outpatients only) in south London.
- The £155m PFI Princess Royal University Hospital opened on 1 April 2003 with 525 acute beds.
- A copy of the hygiene code (The Health Act 2006: Code of practice for the prevention and control of healthcare associated infections) is available here:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081927. - Health Protection Agency latest quarterly infection rates for MRSA and Clostridium difficile, published on Wednesday 30 January, are available here:
http://www.hpa.org.uk/hpa/news/articles/press_releases/2008/080130_mrsa.htm - Bromley Hospitals NHS Trust was rated as "good" for quality of services and "weak" for use of resources in the 2006/07 annual health check carried out by the Healthcare Commission.
- This is the second improvement notice to be issued. The first was to Barnet and Chase Farm Hospitals NHS Trust in July 2007.
Information on the Healthcare Commission
The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.
Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.
The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.
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