A quarter of health trusts failed to meet standards over hospital infections while five were warned over blood-spattered walls and mouldy instruments under a toughened regulatory regime.
Of particular concern was the state of ambulances, which were inspected for the first time. Investigators found dirty forceps stored in some vehicles as well as bloodstains.
The Care Quality Commission (CQC) used its sweeping powers last year to assess how well NHS trusts were coping with hospital infections – which affect 300,000 patients a year.
Of the 167 trusts inspected, 42 were found by the commission to be in “breach” of NHS registration requirements by not meeting standards.
All 11 ambulance trusts in England were assessed – and four found to have violated the terms of their NHS contracts.
Things were so bad that ambulance services in the north-west, east of England and east Midlands received formal warnings for the state of vehicles and stations.
The CQC, derided by critics as a toothless watchdog for “naming and shaming but not paining”, revealled that it has been granted the power to impose tough sanctions that could see failing hospitals warned, prosecuted, fined up to £50,000 and ultimately closed down if they fail to comply with the regulator’s edicts.
As a test-run of this regime the commission was authorised to examine the risks in the NHS of healthcare- associated infections and the results revealed that a minority appeared to take a cavalier approach to safety.
The reasons for failure were worrying: 36 trusts were not providing areas to decontaminate instruments; in three trusts there was a failure to regularly flush unused water outlets – crucial for the control of legionella infections; and 13 trusts were criticised for not keeping clinical areas clean.
Nigel Ellis, the CQC’s head of national inspection, said: “Good infection control takes constant vigilance – and meeting that every day, for every patient, is an ongoing challenge for the NHS.
“We have found evidence of a direct risk to patients and have intervened using our new enforcement powers to ensure swift improvements were made.”
Of these failing trusts, five had to be issued with a warning notice – the first step towards losing the right to operate in the NHS. Investigators pinpointed several serious transgressions, especially in ambulances.
In the north-west vans were stocked with dirty neck braces that were continually reused despite health guidelines urging disposal after one patient’s use.
At Stockport ambulance station, vehicle interiors were “seen to have stains (which appeared to be bloodstains) on the walls as well as visible dirt on the floor and walls”.
In Essex “hand wipes were not available” and “poor levels of cleanliness” were found in 22 out of 23 vehicles inspected. Ambulance equipment in the East Midlands was singled out for being “visibly dirty, including suction units, defibrillators and the tips of forceps”.
The hospitals highlighted for poor practice were both foundation trusts: Basildon and Thurrock university hospitals, and the world-famous Alder Hey children’s foundation trust in Liverpool.
In Basildon, where the commission’s old ratings system had come under fire last year for labelling the hospital “good” weeks before it emerged that dozens of patients might have died after receiving substandard care, investigators found a dismal scene: “Procedure trays used by staff to carry equipment when they take blood samples or give injections had blood spattered on them … a commode soiled under the seat.” Out of date equipment was also found in the emergency stores.
In Alder Hey, one of Europe’s largest children’s hospitals, the inspection revealed dirty toys, hair stuck to medical equipment and “nappy changing mats stored on the floor next to a toilet … and a dirty baby bath was inside the full-size bath”. The water “ran brown” from taps in rooms ready for patients to be admitted.
The commission said the threat of further measures had pushed the offenders into cleaning up their act. Hospitals and ambulance trusts were forced to set up better procedures, buy new equipment and “deep clean” wards and vehicles – or face a rolling wave of inspections. The last of the conditions imposed for infection control was removed only last December.
Under the new regime CQC can send teams of investigators, accompanied by groups of patients, to hospitals to see whether they match “client” expectations. The bolstered regime is capable of 2,000 unannounced visits a year – three times the current level. “We want to put the patient at the heart of what we do,” said Dame Jo Williams, acting chair of the commission. “Doesn’t matter if it’s the health service, the banking system or Tesco, there is something about the way you are treated as a patient or a client or a customer.”