Musgrave Park Hospital, Belfast - 10 March 2011 - Regulation and ...

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Meadowlands 2 shower fixtures and fittings were old, worn and had limescale present, while the metal chain flushing mechanisms on the toilets is difficult to clean and has no end toggle. In both wards fixtures, fittings and equipment in some areas, especially the kitchen and sluice areas, were damaged, old and worn; laminate was missing from cupboards, taps were tarnished and worn and metal bedrails and chair castors were worn or rusted. 7.5 Information An agreed set of core HCAI public information leaflets are available for patients and visitors, hand hygiene posters were widely displayed throughout the hospital and the areas inspected. Clear instructions were in place to advise staff and visitors of isolation precautions. There was a range of posters in place for staff to reference such as waste and sharps management and domestic colour coding (Picture 3). However in Meadowlands 2 there was no colour coded poster clearly displayed for nursing staff to reference, no poster on the segregation of linen and no leaflets on hand washing. Picture 3 Domestic colour coded information In Meadowlands 2 inspectors noted that fridge temperature checks or records for the kitchen fridge had not been taken or recorded on the 8 March 2011. It is imperative that fridge temperature checks are taken and recorded on a daily basis to ensure all foodstuffs are stored at the correct temperature prior to serving to patients, and that any temperature recorded outside the designated temperature range can be actioned. Meadowlands 2 nursing cleaning schedules while available were not detailed enough to cover all equipment used at ward level. Detailed 32
nursing cleaning schedules are required which outline all equipment to be cleaned. The trust’s policy on cleaning roles and responsibilities was available at ward level. Additional Issue In Meadowlands 2 the inspectors observed that the patient name board behind each patient bed was made of cork and had a felt cover. It is advised that as this fabric cannot be effectively cleaned, especially in an isolation room, that an alternative method of displaying patient details should be is investigated. Recommendations 17. The trust should work to ensure all staff are aware of their roles and responsibilities to improve and ensure that environmental cleaning is carried out effectively and that patient equipment is fit for purpose. 18. The trust should continue to work on the repair and maintenance of ward and public environments and to replace damaged fixtures and fittings. 19. The trust should ensure all relevant information is available for patients, visitors and staff to reference. 20. The trust should develop detailed nursing cleaning schedules. 33
Page 1 and 2: RQIA Infection Prevention/Hygiene A
Page 3 and 4: 1.0 Inspection Summary This is the
Page 5 and 6: An assurance strategy is in place t
Page 7 and 8: Table 6 Hygiene Factors 6A M2 Avail
Page 9 and 10: 3.0 Inspections The DHSSPS has devi
Page 11 and 12: The findings, report and follow up
Page 13 and 14: Compliant 85% or above Partial comp
Page 15 and 16: eview of documentation evidenced th
Page 17 and 18: A sample of the different services
Page 19 and 20: areas. PCSS are currently running a
Page 21 and 22: There are a range of supporting sub
Page 23 and 24: of every element is identified as t
Page 25 and 26: The terms of reference for the Medi
Page 27 and 28: 6.5 Criterion 1.5 The trust has rob
Page 29 and 30: 6.6 Criterion 1.6 The trust has app
Page 31 and 32: 7.0 Environment STANDARD 2.0 GENERA
Page 33: 7.3 Maintenance and Repair Withers
Page 37 and 38: 9.0 Waste and Sharps 9.1 Waste STAN
Page 39 and 40: 10.0 Patient Equipment STANDARD 5.0
Page 41 and 42: 11.0 Hygiene Factors STANDARD 6.0 S
Page 43 and 44: 12.0 Hygiene Practices STANDARD 7.0
Page 45 and 46: 13.0 Key Personnel and Information
Page 47 and 48: 14.0 Summary of Recommendations 1.
Page 49 and 50: 28. The trust should ensure the con
Page 51 and 52: Reporting & Re-Audit Episode of Ins
Page 53 and 54: 17.0 Action Plan Recommendations Lo
Page 55 and 56: Location Ref No Recommendations Des

Musgrave Park Hospital, Belfast - 10 March 2011 - Regulation and ...

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