An infection control audit is an opportunity to implement changes and to introduce
remedial measures in collaboration with various departments and services. A standardized
approach to the audit allows benchmarking of practices across the institutions and enhances
standards of care.
A number of observations were common to all the hospitals:
1) Structurally, the operating Theatre suites were built many years ago and hence the
layout of the operating rooms, sluice rooms, recovery rooms etc are not ideal.
However, in some instances the layout needs a review, and if possible changes
implemented to facilitate patient, staff and supplies flows e.g. at BHC sterile
supplies and instruments have to be taken through the “dirty” sluice room to get to
an operating “clean“ area.
In addition, the demarcation of access areas for traffic flow through the theatre
suite is non-existent. As such, there is difficulty ascertaining the levels of restriction.
The Theatre doors at the majority of facilities need urgent replacement. It is quite
easy to see through the space between the doors when they are “closed”,
compromising sterility in the rooms. Some doors have holes, hinges are rusted and
others are infested with termites. Subjectively, the operating theatre lights are dull
and some fixtures have absent and non- functional bulbs. In general, the operating
theatre suites need to be assessed by the engineers to check on structural integrity.
2) The preparation of the cleaning and sterilising solutions is too individualised. The
requirements for mixing and the required concentrations are not documented
hence the level of cleanliness achieved after cleaning is questionable. Ideally, there
should be standardisation of the types of solutions/ agents to be used for cleaning,
sterilisation and hand-washing. The decision on the compounds to be used should
require the input of the Medical Microbiologist at the National Public Health
Laboratory. The materials safety sheet needs to be made available to staff.
3) The Janitorial Staff generally, are not provided with utility gloves as required and
the buckets and mops provided by the contractors are inadequate in quantity and
quality. The Contracts Monitoring Officer in each institution needs to have a
monitoring schedule for the cleaning activities and document the findings.
4) Training for the Janitorial Staff throughout the system is essential if infection
prevention and control standards are to be adhered to and be properly managed.
5) The SOPs developed by the RHA for Cleaning and Portering were not seen in any of
the institutions visited.
6) Bacteriological swabbing of the clinical units on a regular schedule needs to be
institutionalised. Currently, there is a disconnect between the hospitals and the
National Public Health Laboratory on the matter of the receiving and processing of
these swabs. A meeting with the Director of the NPHL is necessary.
7) It was noted that the reuse of disposable tubes and airways was a common feature
throughout the region. While it is recognised that this is a cost saving measure it
must be acknowledged that chemicals will disrupt the surface of the plastic tubing
and create pockets for organisms to attach and multiply. A number of these items
were seen hanging to be dried after “cleaning” and then just placed unwrapped in
drawers or hung on hooks.
8) There was a general lack of the appropriate containers for the disposal of sharps and
an apparent shortfall in the provision of correctly coloured bags for the storage and
disposal of waste. This compromises staff and patient safety.
9) Maternity/ Obstetrics Units are extremely short of small items of equipment
particularly for the delivery process e.g. thermometers, forceps, foetal stethoscopes,
episiotomy scissors, kockers forceps, cord clamps and large kidney dishes.
10) Linen and gowns are also in short supply.
11) Enema is no longer provided by the pharmacies hence women are delivered without;
the result being foul odour in the delivery room, staff health being affected and
possible infection of the neonates.
12) The provision of lavatory facilities for patients and their relatives is imperative
therefore a process must be found to protect the facilities from vandalism and soap,
tissue and hand towels or a hand drier are necessary. In some institutions toilets had
no seats, soap or a hand drying method available.
13) Fire drills, disaster and emergency simulations were noted to be absent. Staff need to
be familiarised with these procedures in order to prevent mayhem and unnecessary
deaths in the event of a disaster.
14) There are clinical meetings and category meetings but there was no evidence that
general staff meetings are being held. Communication and the sharing of
information enhance team-work and promote identification with an institution.
These should be mandated
15) The Client Complaint mechanism is not well known by the majority of staff. There
needs to be in-house sensitisation sessions at the institutions. The practice in most
places is to send the complainants to the Patient Affairs Departments.
16) The orientation process for recruited staff needs to be formalised. The orientation
should include both administrative and clinical staff.
17) The MOH manuals for Infection prevention and control and for the Accident and
Emergency Departments are in short supply and therefore not easily accessible.
Additional copies need to be produced.
18) The National Health Fund’s supply of drugs and particularly antibiotics needs to be
reviewed as the majority of facilities are experiencing critical shortages. This is
currently compromising patient care