This hospital has a long record of low Healthcare Associated Infection rates. In this financial year there have been nine cases of MRSA blood infection (four of these patients already had MRSA on admission) and low rates of Clostridium difficile.

Our figures and those of all other Trusts are published annually by the Health Protection Agency and are publicly available [1]. Our annual rates are below the national average [2,3] and represent a low risk of acquiring infection.

We have put a new team in place to take this top priority work forward and are aiming to have the notice lifted by the end of January.

1. Health Protection Agency website
2. Homerton Hospital’s Clostridium difficile rate for 2007 (the last year for which national figures are available) was 0.9 per 1,000 bed days which is lower than the national average of 2.25 per 1,000 bed days
3. Homerton Hospital’s MRSA blood infection rate for 2007/8 was 0.83 per 10,000 bed days, which is below the national average of 1.19 per 10,000 bed days.

Key points and FAQs

Key points   

1. The Healthcare Commission (HCC) made an unannounced Hygiene Code inspection of the hospital on 10th & 11th November 2008. On 23rd December we received the report of their visit which highlighted certain concerns with compliance with the Hygiene Code. It did not however raise concerns about the levels of Healthcare Associated Infections (HCAI), MRSA and C difficile (C diff), at Homerton

2. Homerton has consistently had low levels of HCAIs. The Health Protection Agency’s figures for last year showed us to have a rate of 0.83 MRSA blood infections per 10,000 bed days. This was one of the lowest levels in London and equated to less than one case per month. This financial year we have had equivalent to one case per month – 9 cases in total against a Department of Health year end target of 12; four of the patients were admitted to the hospital already carrying MRSA.

3. On other inspections Homerton has done well. When the HCC inspected last year under the Hygiene Code (also unannounced) their report made no specific recommendations for improvement. The National Patient Safety Agency’s Patient Environment Action Team inspected Homerton this year and rated us as ‘good’ on all areas. The NHS Litigation Authority assessed both our general and maternity services as meeting the required safety standards. In the summer the HCC rated Homerton ‘excellent’ for service quality.

4. Failings were found at the November inspection visit. This is something we are very sorry and concerned about. These failings however have already been or will be quickly remedied. A new team has been put in place to take this work forward.

FAQs

What failings were found and what are you doing about them?

• Our endoscopy suite facilities need to be improved. This we knew and had plans to address. The immediately necessary works will be completed in the next few weeks. There is a longer term plan to improve the department
• Our sluices were not all up to standard, with some of our bed pan cleaning equipment needing upgrading. This is being dealt with
• Whilst much of the hospital was very clean and tidy, certain ward areas and fittings were not up to standard at the inspection. This will be dealt with, but requires meticulous attention to detail from the cleaning and maintenance teams and ward staff, with intervention from senior people when the usual measures fail to ensure standards are met
• We have not got good records to show that people have had training; a number of planned audits were not completed; and other process issues came to light.  We were without a full infection control team for part of the year, so we did get behind with audits. This is now being dealt with. An electronic system for recording training is being introduced.

The HCC said they found dirty bedpans and commodes – what is your response?

The HCC did indeed find dirty bedpans on one ward and commodes that hadn’t been fully cleaned. These items were all in the sluice (waste) room and were not provided to patients. In the late summer we introduced new commodes with a new labelling system to show that they have been cleaned between patients (similar to if you go to a hotel and the toilet has a paper ‘sash’ across the bowl to show the cleaning has been completed). You will see our green paper labels on commodes to show they are clean – if there is not one then please ask the nurse to bring a replacement for you. It is unacceptable to be offering patients soiled bedpans, and if anyone sees any evidence of this happening they should bring it to the attention of staff immediately.

The HCC said that your decontamination systems in endoscopy had failings. What does this mean? Am I likely to be affected?

An endoscopy is a specific investigation during which a tube is passed into a part of the body, usually the lung, stomach or bowel, with a camera attached in order that the doctor can directly examine the area. Thousands of endoscopies are carried out each year at Homerton and we have no evidence at all of any problems occurring. Our endoscopy unit was however built some years ago and the arrangements for storage of endoscopes and the layout of the unit are not up to modern day standards.  In addition we have not kept the kind of detailed records relating to all processes which we should have done.

It is extremely important that patients booked for endoscopies continue to have them.  If you have any concerns about the procedure please speak to the doctor or nurse specialist carrying out your procedure.

Shouldn’t you bring back Matrons?

Homerton has 13 Modern Matrons – the Matrons are sometimes referred to as Lead Nurses. Each ward has a Matron or Lead Nurse assigned to it. The Matrons are not present in the hospital 24 hours a day but the Clinical Site Managers are, so there is always a senior nurse in the hospital (as well as senior doctors, with senior managers available to come in 24 hours of the day).

Who is in charge of cleaning?

The cleaning is outsourced to the specialist cleaning company Medirest but Homerton remains responsible for cleaning standards and for making sure Medirest fulfil their contract requirements

Have budget cuts led to problems?

No. We have enough funds available to do the changes to the endoscopy suite and ward sluices. The endoscopy work was already planned and there is a programme to upgrade the wards.

We cannot do the work on the wards as fast as we would like as we are short of decanting space – that is, room to re-house wards whilst we do the works. We have however completed work on Halley, Thomas Audley, Priestly and Aske wards. The next ward we plan to do is Graham.

We are more reliant on agency staff that we would want to be. Recruiting and retaining staff in London is not always easy. The agency staff we use are trained and monitored, and as with all hospitals we will continue to need them to run our services.

The HCC said your staff haven’t been trained – how can you assure me that they know what they are doing?

All our staff are trained when they start working at the hospital and then receive updates in the form of training on the wards as well as classroom based sessions. What we were unable to show the HCC was evidence that this has been happening. There are also some staff who have been with us for a while who need their updates. We had already identified that keeping track of who needs training and when was an issue and have launched a new training database so we can see quickly where additional training is required. We are confident however that in every ward and department there are sufficiently trained staff to keep patient care safe. In addition our infection control team (three nurses and two doctors) go onto the wards every day.

Are gels as good as soap and water for hand hygiene?

Hand hygiene is an important part of preventing infections, and should be performed before and after patient contact.  Hand hygiene can be carried out using soap and water or with an alcohol hand gel. Alcohol hand gels are widely available throughout the hospital – you will see them at the door to all wards. Increasingly clinical staff carry their own personal supply. Alcohol gels are effective against some bacteria, such as MRSA, but they are not effective against C diff and some viruses, so it is important to use soap and water aswell when dealing with patients with vomiting or diarrhoea.

What is ‘bare below the elbows’?

‘Bare Below the Elbows’ is the name given to the Department of Health initiative to ensure that clinical staff dress in a manner which minimises infection risk and inspires public confidence. White coats and material aprons have been removed from use and replaced with disposable aprons and ‘scrubs’. Doctors and staff working on the wards should wear their sleeves rolled up, with watches and jewellery removed, to ensure best practice in hand washing.

Should I worry about antibiotics?

Yes and no. Antibiotics are one of the truly great medical inventions and millions of lives have been saved by them.  They are however not without risk and these days we try to keep use to a minimum. Some of the bacterial resistance has occurred because of overuse of antibiotics, and there are a number of problems that can arise as a result of their use. The most well known is C diff, which some of us carry in our bowel. It causes no problems on a day to day basis. However a course of antibiotics may cause the C diff in the bowel to become active, potentially causing severe diarrhoea and abdominal pain. 

As a visitor or patient, what do I do if I spot something that I don’t think is right?
 
If you see something you believe is not right please report this to the senior ward nurse. If they cannot deal with the problem themselves they can contact the cleaning supervisor or Matron or Lead Nurse for help. If you would like to speak to the Lead Nurse yourself, this is something the ward nurse can arrange. If you cannot get satisfaction, please contact our Patient Advice and Liaison Service (PALS) based in the main entrance. They can assist with queries from patients or public.

Am I or my relative at risk if they come into the hospital?

This hospital has relatively low rates of healthcare associated infection, so you are at low risk here. We can never completely eliminate healthcare associated infection. We are however proud of the work we have done to maintain our MRSA and C diff rates at such a low level. We will be very sorry if you gain the picture of Homerton as a hospital where a patient is likely to acquire an infection – this is not the case. 

Will the HCC re-inspect Homerton to check it has met all standards?

An action plan has been put in place to address the issues raised by the inspection and our aim is to complete all necessary work by the end of January (for endoscopy we must do this by Jan 21). We will then be re-inspected by the HCC.
 
Who is in charge of running the Homerton?

Details of the Homerton Board of Directors can be found on our website. The chief executive is Nancy Hallett, the chief doctor is Dr John Coakley and the chief nurse, Pauline Brown.  Pauline Brown recently resumed the role of chief nurse, having previously held the role four years ago. Pauline will lead the work to ensure all issues raised by the HCC are addressed and will be assisted by a number of people in this including our newly appointed Nurse Consultant for Infection Control. Nancy Hallett, John Coakley and Pauline Brown have all worked at Homerton for many years.

We are proud of the excellent care provided in the hospital, and will do everyting necessary to resolve the problems highlighted by this inspection.