There has been much publicity concerning the enforced closure by the CQC of the Merok Park nursing home in Surrey.

It is reported that conditions were little short of appalling, but high up on the list of problems, as so often, are issues with clinical waste.

The report states:

“Staff (including the cleaner) had not had infection control training and there were no cleaning checklists. Staff had left soiled clinical waste in open bags in a bathroom and the outside clinical waste bin was unlocked which was a serious infection control risk.”

Clearly it is inappropriate to read too much into an individual CQC report since we did not see what the observers saw on the day of inspection. [The image is for illustrative purposes only and not linked to this CQC report or nursing home]

However, an open clinical waste bin – it should have been a tiger bag – in a patient bathroom is not unusual or inappropriate. It should be in a clean holder, secure yet in a location that is not likely to obstruct or trip users, and replaced periodically. If waste accumulated slowly, use a fresh but smaller waste sack and aim to replace daily. If that is still too much, I would support less frequent replacement as long as it not odiferous or otherwise offensive; every 2 or 3 days might suffice.

What concerns me most is the “outside clinical waste bin … unlocked which was a serious infection control risk”. Well, if you jumped inside and rolled around in the waste, perhaps it would be an infection risk. But that undermines the obvious, the cart or bin should have been locked. There is no excuse.

Now, go around any NHS establishment and there is a high probability that carts are stored outside, and in an unsecure area. If there is a lockable compound it probably will not be locked. Carts inside may have locked that are engaged, but in at least 1/3 of premised these locks will not be engaged. So too for those carts used for satellite storage. Worse, depending on the contractor and/or region, some carts will have defective locks or no lock at all.

Contractors will blame their users who deliberately break locks, but the responsibility for repair rests with the contractor. Ideally, users and contractors finding a defective lock should mark this to indicate a repair is needed, and the cart should be taken out of use until that has been completed. If extra keys are required by users, provide them, and if defective carts are delivered, reject them.

Sounds good, doesn’t it? We will all keep our eyes open for this particular problem, and bring things up to a satisfactory standard. But will it happen?

Don’t hold your breath.