An unannounced visit by health officials to one of the country's busiest hospitals identified a number of issues that could present ‘a serious risk to the health and welfare of patients receiving care there'.

Beaumont Hospital in Dublin is one of Ireland's largest major acute hospitals, serving a catchment area of 250,000 people.

However, when officials from the Health Information and Quality Authority (HIQA) carried out an ‘unannounced monitoring assessment' on July 23, they found a number of worrying issues, including poor hand hygiene practices by staff, dusty and dirty equipment and potential access by patients to dangerous chemicals, medication and equipment, such as syringes.

Three units were assessed - the neurosurgical intensive care unit, the emergency department (ED) and St Teresa's Ward, which is a transplant ward.

HIQA found that the neurosurgical intensive care unit was ‘clean but cluttered', which could ‘impede effective cleaning'.

The clean utility room, where items such as syringes and intravenous fluids are stored, ‘was an unsecure alcove'.

"A drugs fridge was in place and while this was lockable, it was not locked enabling unauthorised access."

In the ‘dirty' utility room, which is a temporary holding area for soiled and contaminated equipment, materials and waste, hazardous solutions were stored on the ground and low shelves and this room was ‘neither locked or lockable'.

Meanwhile, it was reported to HIQA that ventilator wires are removed from a ventilator when a patient no longer requires ventilation. These wires are immersed in a special chemical for decontamination prior to cleaning. However, these wires ‘were observed to be inadequately immersed in a solution as the container used for the procedure was not fit for purpose'.

There was evidence of good practice however, including the appropriate storage of linen and the regular changing of curtains in the unit.

When it came to the hospital's ED, the officials found the area to be ‘cluttered' and in need of improvements in relation to ‘the cleanliness of the environment and of equipment'.

Problems observed included dust on the undercarriages of patient trolleys, on electrical fixtures in the resuscitation room and on oxygen and suction equipment. A ‘heavy' amount of dust was observed on shelving, including those holding cardiac monitors.

Meanwhile the lid of the non-clinical waste bin in the men's toilet was ‘encrusted with dust and grime'.

The HIQA staff found that while the unit's clean utility room had a swipe card access facility, the door to this room was propped open with a sharps bin, i.e. a needle disposal unit. This allowed unauthorised access to needles, syringes and medications being stored there.

Furthermore, while best practice states that sharps bins should not be filled to more than two-thirds of their capacity, ‘several of the sharps bins were greater than two-thirds full'.

The HIQA staff also assessed the transplant ward, St Teresa's Ward. Overall, it found that ‘improvements were required in the cleanliness of the environment and of equipment'.

While the ward's bathrooms were found to be clean, dust was observed on bed frames, bed rails and bed wheels. A ‘sticky residue' was found on the headboards of beds assessed and ‘heavy staining was observed on the bed frame area under the mattress'.

The wheels of intravenous stands were ‘heavily soiled' and while glucometers - used to assess the amount of glucose in the blood - were clean, the containers they were kept in ‘were stained with a blood-like substance'.

"While the resuscitation trolley was covered with a protective plastic sheet, the drawers to the trolley were not locked, allowing unauthorised access to equipment and drugs. This poses a health and safety risk," HIQA noted.

Meanwhile, the dirty utility room was ‘unsecured allowing unauthorised access' and the frames of two commodes that were assessed there were ‘unclean'.

When it came to the issue of hand hygiene among staff, HIQA observed 60 opportunities when hands should have been washed, including 19 before touching a patient and seven after touching a patient. However staff actually washed their hands in just 28 of these opportunities.

As a result, HIQA declared the hand hygiene practices of some medical staff as ‘poor'.

"Hand hygiene is recognised internationally as the single most important preventative measure in the transmission of healthcare associated infections in healthcare services. It is essential that a culture of hand hygiene practice is embedded in every service at all levels.

"Hand hygiene practice and standard precautions were not operationally embedded posing a risk to patients in Beaumont Hospital," HIQA insisted.

It added that this unannounced visit provided a ‘snapshot of the hygiene levels' in some areas of the hospital at a specific point in time.

"Based on the findings of this assessment, the authority will, within the next six months, undertake an announced follow-up assessment."