Perhaps not surprisingly, another Ireland hospital has been found in breach of hygiene standards, and clinical waste mismanagement features in the list of failures.
Presently, Ireland is in the middle of a purge as health regulators get their act together to drive up deficiencies in hygiene standards in hospitals. There is always something to find, and few hospitals might be expected to get it right every time, but it is widely reported that for some considerable time standards have been inadequate, as indeed was until recently the case in the NHS also.
In the most recent case, Nenagh Hospital in Co Tipperary, has been ordered to clean up its act within weeks after inspectors found dirty sinks, soiled toilets and unclean floors posing a risk to patients. Among the list of failings was:
- a lack of doors, or locked doors, to clinic room thus allowing unfettered access to hazardous waste, as well as needles and syringes, and to oral medications.
- stained bedsteads
- soiled areas in patient toilets and showers
- sticky residue on bedside lockers
- crumbling wall surfaces and dusty surfaces
- faulty electrical fittings
- a medical device for monitoring patient temperatures was unclean
- stained floors
- black mould on sinks in shower rooms and toilets
- unclean surfaces
- severed electrical wiring hanging free in a utility area
State health watchdog Health Information and Quality Authority (Hiqa) said there was “much evidence” of the hospital breaching national hygiene standards.Hospital chiefs have been given six weeks to produce a report on improvement plans.
Our concern, above making sure that we might not be admitted until the place is properly cleaned, repaired and perhaps re-staffed since those presently responsible for the service are clearly not performing, is the matter of clinical waste management.
And it is the lack of a door to close and secure an internal waste store that catches the eye.
Clinical waste sacks are, by definition, insecure, so perhaps we need not concern ourselves with those same sacks when they are stored in bulk.
But if we do, must we be concerned about carts full of waste sacks, the inevitable side wastes and the bits and pieces protruding from beneath gaping lids? Do we concern ourselves that these can be found in the corridor of just about every hospital?
And when the waste carts are moved to a waste store to await collection, is it secure? Unlikely.
Access might be required at all times so a gated compound, if it exists, will be unlocked and probably have the gates wide open 24/7 .
Carts without locked lids, and lids without locks.
Carts in the hospital grounds, blocking or at best restricting egress from fire escapes, obstructing walkways. Used as general waste receptacles, sometimes as ashtrays or worse and visitors fail to recognise the colour coding and labels, if present, but who might try their best to place their waste into some sort of container.
But never mind. The Regulators will not since few health regulators would step beyond the immediate clinical area. And regulators of the Environment Agency, more talk than action and happy to let issues fall through the gaps of what should be joined up regulation.
For all its fault, HTM 07-01 contains much useful information and outlines not a standard, since it has no status in law, but a useful framework for performance in clinical waste management. Once this is teased out from what has become a ludicrously bloated document that in other jurisdictions can be just as effective but little more than a 5 or 10 page document, there should be no reasonable excuse for poor performance.
Improvement can save money, by identifying waste reduction strategies, and reconsidering waste categorisation/classification in order perhaps to reduce costs in disposal. Integrated with improvement in hygiene management, health & safety standards for staff, patients and visitors, and environmental, fire and general management including the not insubstantial staff costs that might be reduced through waste management improvements, there is so much to gain.