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Watford General Hospital Requires improvement

All reports

Inspection report

Date of Inspection: 17 December 2013
Date of Publication: 21 January 2014
Inspection Report published 21 January 2014 PDF

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

Not met 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

We looked at the personal care or treatment records of people who use the service, carried out a visit on 17 December 2013, observed how people were being cared for and talked with people who use the service. We talked with staff, reviewed information given to us by the provider, reviewed information sent to us by other regulators or the Department of Health and talked with other regulators or the Department of Health. We were accompanied by a specialist advisor.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Our judgement

People were not protected from the risk of infection because appropriate guidance had not always been followed. People were cared for in an environment that was not clean, we found an area that had not been cleaned in line with trust policy. We were not assured that staff adhered the trust uniform policy in relation to jewellery worn, which can increase the risk and spread of infection.

Reasons for our judgement

We saw hand gel dispensers on the end of each bed, by the entrances to bays, in all treatment areas and outside each department. Outside each department there was a movement sensor which activated a message reminding all to apply hand gel. This meant that staff and visitors were reminded and encouraged to cleanse their hands regularly in order to ensure that risk and spread of infection was minimised.

We spoke with the lead nurse for infection and prevention and control who provided us with information and an action plan on reducing the risk of healthcare acquired infections. The action plan was comprehensive and covered existing guidance that the trust was required to adhere to. The action plan also referenced the implementation of new protocols issued by the department of health, for example the early detection, management and control of carbapenemase-producing Enterobacteriaceae. We were assured by the understanding of infection control that the action plan to reduce infection risks in the trust would be effective.

In the emergency department we observed a member of staff make a bed that had been vacated. We observed another staff member wipe the mattress, bed frame, the chair and the bed table with a chlorine based solution. The staff told us that each area is cleaned after each patient. The staff member informed us that they had to turn the bed to clean but was unable to do this on their own so they wiped, “As much as I can.” On another ward we asked a staff member how the mattress was cleaned, we were told that the mattress was wiped over. When we asked if the inside of the mattress cover was checked we were told that they were not. We viewed a mattress cleaning procedure displayed on one ward which said that inside mattress cover checks were required when visible damage to the surface of the mattress cover was observed. We checked inside the covers of three mattresses in the hospital and found that all were in good condition. However we were not assured that the mattress cleaning protocols were sufficient in terms of minimising the risk of infection. We raised our concerns regarding the mattress protocols to the lead nurse for infection control. They told us that staff should be checking inside mattress covers. They assured us that they would look at the protocols on the wards.

We noted that an arm chair in an A&E cubicle had a tear in it; we raised this to the staff member who told us that they, “Could not do anything about it.” They also told us that they were aware that it should not be there. We also observed a pillow on a bed which was marked with large stains. The staff member told us that the department had run out of appropriate pillow cases. We then noted that the staff member wrapped a plastic bag around the pillow. We also observed in the corridor between A&E and fracture clinic that there was a blood stain on the floor. This was dried on the floor. We raised our concerns regarding the blood stain and the pillow to the manager within A&E who immediately placed that pillow in the bin and replaced it with a new pillow. They also ensured that the floor corridor was cleaned.

On Aldenham Ward we examined a cubicle that was waiting for a new admission to arrive. We asked the staff if this bed area had been fully cleaned prior to the arrival of the new patient. We were informed that it had been cleaned. We found the cubicle to be dusty at high levels, behind and bed and under the side table. We found a used plaster, a straw and orange fruit on the floor under the bed. When we examined inside the cover of the chair’s seat cushion we found a large dark stain. We inspected the commodes and patient equipment and found them to be clean and fit for purpose.

On Langley Ward we found that the curtains that were placed around people’s beds had not been dated. Therefore we were not assured of when the curtains had been cleaned. We found two pillows in the linen cupboard that had been torn. We raised our concerns to the