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Royal Surrey County Hospital Good

All reports

Inspection report

Date of Inspection: 16 August 2012
Date of Publication: 4 September 2012
Inspection Report published 4 September 2012 PDF

People should be cared for in a clean environment and protected from the risk of infection (outcome 8)

Meeting this standard

We checked that people who use this service

  • Providers of services comply with the requirements of regulation 12, with regard to the Code of Practice for health and adult social care on the prevention and control of infections and related guidance.

How this check was done

Our judgement

People were protected from the risk of infection because appropriate guidance had been followed and people were cared for in a clean, hygienic environment.

The provider was meeting this standard.

User experience

When we asked in-patients and people in A&E whether the ward was kept clean and fresh, the majority of people who were able to answer this question said it was. When we asked them if they had noticed how often the ward areas were cleaned, most people said “Daily” or “They come regularly.” One person said “They seem to be perpetually cleaning. And I saw someone checking their work.”

An A&E patient who had attended more than once said that whilst he did not look for dirt, “None stood out” and “Standards are good.” This same person and their accompanying relative told us that they did not see staff washing or gelling their hands. They had seen staff wearing gloves but were not certain if these were changed between patients. However, other comments from patients confirmed staff washed their hands and that they wore aprons and gloves during activities. One in-patient told us that not only was the ward clean, but she was given clean sheets every day as well.

On the Outpatients’ self completion questionnaires we asked people if the hospital was kept clean and fresh, and 70 out of the 79 respondents answered ‘Yes’ to this question. We then asked if people had any concerns about the cleanliness, and the majority did not. A few issues raised on the questionnaires such as the toilets needing more attention, were passed to the hospital’s management for their attention. Positive comments relating to whether the hospital was clean included ‘Yes, very’ and ‘Excellent level of cleanliness.’

Other evidence

We spoke to a range of clinical and non clinical staff working in all the areas visited, including wards and A&E about the arrangements in place for managing infection prevention and control (IPC). We found that there were effective systems in place to reduce the risk and spread of infection.

In our discussion with domestic personnel we were told that there was training in relation to IPC, which included hospital cleaning standards and techniques. The colour coded cleaning system used in the hospital to manage different areas such as toilets, bed areas and non direct clinical areas were also taught to them. We were told that there were cleaning schedules for each area and we were able to see these in each area that we visited.

Domestic staff said that there was monitoring of the environment and checks on their standards of work. We saw that there were check lists for cleaning of areas and separate ones for cleaning of equipment, which nursing staff undertook. In one area records were not up to date and in particular the information recorded indicated that the required cleaning was not done on a daily basis, and this was passed to the hospital’s management for their attention.

This was also apparent during our checks of equipment in two areas, where we found that some items, such as drip stands, and storage units used for technical equipment and drug trolleys, were not always sufficiently clean. We saw too that some higher surfaces including shelves and the electrical covering units behind trolley bays had levels of dust that indicated infrequent cleaning; this information was also passed to hospital management.

Clinical staff told us that they had received IPC training as part of their induction and as annual updates. They were able to tell us about the content of the training such as the focus on hand hygiene. We spoke to a trainee doctor who confirmed that IPC training was provided as part of their induction. The process included formal lectures, observation of specialised tasks and the completion of various competency assessments. These related to activities that could pose an infection risk if not undertaken correctly.

Members of the IPC team, including the medical director who acts as the director for infection prevention and control (DIPC) spoke with us and explained how the training was managed. This included regular formal sessions and practical training on ward or other clinical areas. Training extended to consultants and all personnel, be they directly or indirectly involved with patient contact. We heard that there were systems in place to advertise training, to monitor attendance and to chase people who did not complete their training.

In our discussion with staff in the clinical areas they were all aware of their responsibilities for minimising the risk of infection and for following policies and procedures correctly. In all areas visited we saw that staff had access to IPC polices and procedures to guide them in their work. In our discussion with staff they knew how to access this information and were aware of the correct procedures to follow for cleaning equipment, handling waste and managing linen. We saw staff following such guidance when going about their duties.

Staff were also able to describe the arrangements that were in place for managing potential or actual infections, including isolation procedures. We saw that staff used appropriate signage to indicate that a person was being nursed under isolation precautions. We were also told about how the beds were managed in the event that a person became unwell with a potential or actual infection that could spread to others. The information provided to us demonstrated that the trust had an efficient way of managing such events through the organisational practices and responsibilities of staff.

We observed that staff were adhering to the trust's policy to be bare below the elbow (not wearing wrist watches or other jewellery) and th