Hygiene failures: same hospital, different ward

Royal Victoria Hospital

Royal Victoria Hospital

THE Chief Executive of Northern Ireland’s independent health regulator has publicly defended the actions of the RQIA following a series of reports by The Detail about its failure to address failing hygiene standards at the Royal Victoria Hospital.

Last month The Detail reported that ward 4F, which was at the centre of an outbreak of Clostridium Difficile at the Royal Victoria Hospital, was the same one whose persistent issues with hygiene were highlighted by us five weeks previously.

That ward was subsequently forced to restrict admission in November of this year because of two cases of the superbug there.

The RQIA had previously issued one of its most damning reports after a probe into the ward two years earlier but the ward which was supposed to be running the same hygiene standards as an operating theatre, was in fact barely making the mark in hygiene scores.

Speaking on BBC’s Good Morning Ulster earlier this week, the head of the health watchdog, Glenn Houston said:

“We’ve been back to the Belfast trust, we’ve been back to the Royal Victoria Hospital, we’ve undertaken a range of inspections and I’ve no doubt we’ll also be back to that particular ward to look at conditions and we will report what we find when we make that inspection.”

Mr. Houston’s comments come as the RQIA published a number of new hygiene reports encompassing over 250 wards.

As part of this series of hygiene reports, an unannounced inspection was undertaken at the Royal Victoria Hospital, on the 8th June 2011. The hospital was assessed against the draft Regional Healthcare Hygiene and Cleanliness Standards and four wards were inspected at The Royal, Ward 4F was not included in this inspection.

A personal campaign by Gerry Bond after his grandson almost died of infection at the Royal highlighted flaws in the system.

It took eight months for the RQIA to respond to his complaints about ward hygiene at 4F and it led to one of its most damning report. Mr Bond first made RQIA aware of hygiene failings at the RVH in October 2008 but it failed to carry out an inspection until May 2009.The Belfast Trust confirmed that the ward had suffered five C Diff cases during the eight month delay.

Addressing this issue on Radio Ulster, Mr. Houston acknowledged that RQIA had received Mr. Bond’s concerns but that they followed the proper protocol by referring him to the Belfast Trust and making the Chief Executive aware of the situation.

We asked RQIA why ward 4F had not been included in the most recent reports, in a statement it said:

“The most recent visit to Ward 4F at the Royal Victoria Hospital was an unannounced inspection in May 2010 when our inspection team found that this ward achieved an overall compliance rating of 92% and compliance with the six inspection standards. This compares to an overall minimal compliance score (69%) in the earlier inspection, with only one of the six inspection standards achieving compliance. In addition, at the inspection in May 2010, 98 of the 105 action points identified in the 2009 report had been addressed by the trust. “

Since our initial coverage on Ward 4F from October of this year, we have received the latest results of hygiene inspections carried out by the trust itself, that show a marked improvement in recent weeks:

Audit results Ward 4F

Audit results Ward 4F


However, the latest batch of hygiene audits reveal fresh concerns about another ward in the same hospital as Ward 4F.

On the 8th June 2011 a panel of four inspectors from RQIA’s infection prevention/ hygiene team along with four peer reviewers carried out an unannounced inspection at the Royal Victoria Hospital.

Using the draft Regional Healthcare Hygiene and Cleanliness Standards, the

following areas were inspected:

Ward 4E – Neurology

Ward 5F – Orthopaedics

Ward 6D – Medicine

Ward 7C – Medicine/Stroke Rehabilitation

The inspections work under a three band marking system.

Compliant: 85% or above

Partial Compliance: 76% to 84%

Minimal Compliance: 75% or below

When inspecting the General Environment of Ward 6D, such as public toilets, clinical rooms and the equipment store, it only received a worrying average score of 66%, well below the 75% minimal compliance level.

Similarly when conducting inspections on patient equipment all four wards performed badly with none of them achieving the minimal compliance level:

Hygiene Report

Hygiene Report

When it came to hygiene practices, Ward 6D was still falling short of minimal compliance with an average score of 73.

The inspectors noted that Ward 6D required further work to ensure that the “inside and outside of the drugs fridges and door touch points throughout the wards were clean and that greater attention to detail was required when cleaning, to ensure dust, debris and stains are removed from all high and low horizontal surfaces.”

One report in particular highlighted that in Ward 6D a linen bag containing used linen was stored on top of the clean linen trolley, linen bags were more than two thirds full and sterile items such as a syringe and an IV infusion bags were removed from their original packaging.

Inspectors also noted that they did not observe immobile patients being offered hand hygiene facilities prior to and after meals. They recommended that “a concerted effort is made to ensure hand hygiene occurs at all times, using the correct seven step technique.”


At a re-audit of the Royal Victoria Hospital the following month in July 2011, inspectors still raised concerns about Ward 6D.

The re-audit found that while 63 per cent of the 241 issues identified at the previous inspection of Ward 6D have been addressed, 90 issues had been repeated and the follow up inspection actually identified 46 new issues.

Inspectors noted that “newly identified issues and unsafe practice was observed during this inspection, such as an unsheathed needle that had been left on top of a sharps box on the drugs trolley”.

They also were critical of the fact that again in Ward 6D, they did not observe equipment being routinely cleaned between patient use despite this being raised in the first inspection.

We asked the RQIA if they had any plans for an action plan or a follow up inspection in relation to the unresolved issues highltied with Ward 6D. They said:

“This is an ongoing programme of inspection which takes into account all hospital settings across Northern Ireland. This includes wards and clinical areas in each of the ten acute hospitals, as well as wards/clinical areas in community, mental health and learning disability hospitals across the five health and social care trusts.

“To date, we have inspected in the region of 250 hospital wards or clinical areas across Northern Ireland. Where, through our intelligence, we have identified particular concerns we may conduct additional unannounced inspections.”

On the back of the latest revelations surrounding Ward 6D Gerry Bond has questioned whether or not the in the interest of public safety, the inspection programme at the Royal Victoria Hospital should be intensified.

He said: "Since the Royal group seem to perform so badly on inspections would it not be prudent , in the interest of public safety to intensify the inspection rate? Examine more areas and more wards.

“The question still remains when a hospital fails to respond with significant increase in quality what action do RQIA take to rectify the matter?”

Gerry’s Grandson is recovering well, but he believes if standards continue to fall it is only a matter of time before someone looses their life because of bad hygiene.

He said: "There doesn’t seem to be any sort of system, to me it’s very worrying because when the RQIA go in there, they seem to find at least one ward that is pathetically low and it doesn’t even reach the minimum level of compliance and of course they are only ever looking at three or four wards at a time, so there could be an even bigger picture here.

“I’d like to think they’ll take a look at these results and say ‘right we need to go back in there and sort this problem out’ , but in the past alarm bells didn’t seem to be ringing fast enough. Let’s face it with many of the Royal’s results they’re getting consistently poor outcomes, so why aren’t they increasing regulation and putting the pressure on the management of these hospitals because something has to be done. Without enforcement, without discipline, what’s the point?”