The first national hygiene audit of publicly funded acute hospitals makes for distressing reading. Not a single one of the hospitals surveyed received a "very good" report, while management structures and hygiene standards at nearly one-in-five were rated "poor". Two-thirds of those assessed were rated "fair". There is a need for urgent improvement in view of the danger posed to the lives of patients by hospital-acquired infections.
This audit is different from the basic cleanliness assessments carried out on behalf of the Department of Health in 2004 and 2005. On this occasion, hospitals are rated not alone on hand-washing practices, general cleanliness in wards and the attitudes of staff but on whether management structures have been put in place to monitor and improve performances. It also examined operating theatres, kitchens and ancillary services. As a result, some hospitals that performed extremely well in initial assessments have been downgraded.
The Health Information and Quality Authority (HIQA), which conducted the audit, recognised that its findings did not represent "an absolute assessment of cleanliness in given hospitals". It was a general assessment of performance, the report said, designed to help hospitals to identify areas of strength and of possible improvement. It concluded there was a need for "a change in culture" with clear responsibility, effective management, intelligent use of resources and continuous monitoring being established in relation to hygiene issues. Most hospitals, it said, should and could do better.
In spite of the failure of all hospitals to meet the highest standard, the HIQA recognised there had been considerable improvements in recent years concerning hand washing among staff and of hygiene in relation to medical equipment. But it noted that good leadership and management would be required in most hospitals to sustain and improve those performances.
One in 20 Irish patients contracts a hospital-acquired infection, according to a recent survey. And there is a gross shortage of isolation facilities. Many of the infections are not life-threatening. But the situation is extremely worrying, particularly where vulnerable, elderly people are concerned.
Early next year, the HIQA intends to publish new infection control standards. And it suggests these should be applied not just in hospitals but to nursing homes, community health centres, GP surgeries and other areas.
That would be a positive development. But, in the absence of effective management structures and clear areas of responsibility, little will change.