Fears NHS could be crippled by norovirus repeat

Some staff are not heeding the handwashing message. Picture: Manchester Evening News
Some staff are not heeding the handwashing message. Picture: Manchester Evening News
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NEARLY half of the staff on some Lothian hospital wards are failing to follow crucial handwashing guidelines, raising fears of a repeat of the vomiting bug crisis that crippled the region’s NHS last winter.

Experts say if basic hand hygiene levels cannot be improved it will lead to an explosion in norovirus outbreaks, stretching hospitals struggling to meet vital patient treatment targets.

• Comment: Hospitals must get handwashing right

The warning comes following the closure of two wards – at the Royal Infirmary and St John’s Hospital – following norovirus outbreaks that signal the start of an autumn-winter spell where cleanliness and handwashing are never going to be more vital.

The vast majority of NHS Lothian staff do follow strict rules that require washing between handling patients and the removal of jewellery.

However, an internal audit has revealed that some departments are struggling to meet the guidelines.

Labour Lothians MSP Sarah Boyack has called for a more consistent approach to handwashing across NHS Lothian.

She said: “Tackling superbugs remains a real challenge for NHS Lothian and a key concern for patients. Effective hand hygiene is central to efforts to fight hospital infections but these figures show that parts of NHS Lothian are falling short. We need to see action to ensure that stretched staff are given the time to receive proper training in infection control and that where problems arise they are investigated as a matter of urgency.”

Overall NHS Lothian staff are exceeding the Scottish Government target of meeting hand-washing standards 95 per cent of the time.

But an internal NHS Lothian audit, made public under Freedom of Information laws, exposed problem areas, including one – the ERI’s orthopaedic pre-admission clinic – where staff failed to follow basic hand hygiene policies 41 per cent of the time.

The probe also revealed that many investigations into infection control incidents were delayed. A third were not started within a ten-to-12-day limit, with one taking more than eight months to begin.

The investigations are supposed to be completed within a maximum of 60 days, but at the time of the audit, one was ongoing almost 16 months after it began, raising concerns that crucial lessons are not being learned from outbreaks.

A huge surge in norovirus cases last winter, which was so severe visitors were banned from some hospitals, was largely blamed for a beds crisis that took the Royal Infirmary to 101 per cent capacity and spiralling accident and emergency waiting times.
NHS Lothian admitted that problem areas had been highlighted by the audit, but said compliance with hand hygiene standards was high overall and that action had been taken following completion of the report in June. Health bosses also insisted plans are in place to deal with an impending seasonal surge in demand.

However, the fact two wards were shut last week due to norovirus – with 15 patients struck down with the bug – has fueled fears another hellish winter is around the corner.

Senior MSP and Scottish Conservative health spokesman Jackson Carlaw said: “This is a problem which seems to get more intense each year. The fact it’s starting earlier, when we’re barely into autumn, really should have the alarm bells ringing. Given how easy norovirus can spread across wards, it’s crucial both NHS Lothian and the Scottish Government redouble their efforts to ensure hygiene is an absolute priority – for staff, patients and visitors.”

Another area of concern highlighted by NHS Lothian’s audit team was that less than 60 per cent of staff had completed or renewed mandatory healthcare associated infection training.

While NHS Lothian averaged 96 per cent compliance with standards overall, during 13 months to January a quarter of 238 clinical areas failed to hit the 95 per cent target for achieving Scottish Patient Safety Programme standards, with 20 falling below 90 per cent.

Hand hygiene audits, when inspections are done without the knowledge of staff every two months, were not carried on 25 per cent of possible occasions.

Last week, NHS Lothian was the only health board in Scotland where wards shut due to norovirus. While those have since reopened, Evonne Curran, of Health Protection Scotland, said the incidents served as a reminder that winter was approaching.

She said: “It’s about a month to go before the norovirus season usually kicks off. But everyone needs to make sure they’re ready for it and knows what to do.”

Melanie Hornett, NHS Lothian’s director of unscheduled care, said the audit had found several areas of strength and that action was taken where weaknesses were uncovered.

New measures include providing each department with information leaflets, improving education for staff and bringing in a new escalation policy for staff not complying with procedures.


NOROVIRUS was one of the key factors behind a “meltdown” in the region’s hospitals last winter.

A series of wards being put out of action meant bed spaces came under intense pressure.

Knock-on effects included hundreds of patients being left to languish in A&E for more than 12 hours.

At the Royal Infirmary, performance against a four-hour target to process emergency patients was among the worst of any hospital in Scotland. NHS Lothian said earlier this year that £13 million would be invested in a bid to avert a repeat of the crisis. New measures include hiring new staff, introduction of seven-day working in some jobs and moves to reduce the number of A&E patients.

However one of the key planks of the strategy – new beds at the Royal Infirmary – has been hit by delays.

The Evening News revealed in July that a plan to have 31 beds in place for the winter had been delayed until at least late January following a row with PFI-operator Consort.

NHS Lothian was forced to agree to a penalty-point amnesty so the project could go ahead.

Norovirus facts

• 16,000 NHS Lothian staff hold healthcare associated infection training certificates

• Overall hand hygiene policy compliance is 96%. In some areas it is 59%

• Of 238 clinical areas, handwashing compliance fell below 95% in 37 areas, with a further 20 falling below 90%

• Washing clothes at home information wasn’t found in 63% of wards and clinics

• Reviews and investigations into incidents did not begin on time in third of cases

• Three in ten investigations were not completed on time – one took 339 days