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Environment Questions

Please click on each question or statement to view the response.

Yes, and we would seek to reassure all our patients and their families of this. a. Ventilation With regards to the ...

Yes, and we would seek to reassure all our patients and their families of this.

a. Ventilation

With regards to the ventilation, there was a concern regarding the number of air changes and the air pressure within rooms where patients who were immunocompromised (which can happen as a result of cancer treatment and other treatment) were being cared for.

An upgrade was carried out in four paediatric Bone Marrow Transplant isolation rooms in 2015.  Ward 6A currently has portable HEPA filters (High Efficiency Particulate Air – a type of high quality air filter) in all patient rooms and the corridor, providing additional and ongoing air cleaning. We have not identified any link between infections and ventilation.

Our priority is patient safety and we are investing £2 million to upgrade the ventilation system in Wards 2A and B to provide optimal, state of the art facilities for all our young haematooncology patients. This is to ensure we are taking every possible measure to reduce the likelihood of infection for this group of patients, who have an increased risk due to their treatments. We very much hope this will reassure the patients and the families in our care how seriously we are taking these issues.

b. Water

When the hospital first opened in 2015, there was no indication that there was a problem with the water in the RHC. We later had a spike in infections in 2018 (in Ward 2A) and on testing the environment and water, we found organisms which can potentially cause infection in the water supply. To address this, we put extensive measures in place, including the installation of a water treatment system, as well as filters on water outlets. The water was then reassessed by an independent authorising engineer, who described it as ‘wholesome’. The Public Water Supplies (Scotland) Regulations 2014 outline in legislation the requirements that are to be met for public water supplies to be regarded as ‘wholesome’. This means the water in both the RHC and QEUH is safe.

Yes, we can reassure both patients and parents that the hospital is safe, and we are sorry for the concern caused. Wh...

Yes, we can reassure both patients and parents that the hospital is safe, and we are sorry for the concern caused. Whilst we continue to investigate the issues and take action, every precaution has been put in place to ensure we care for our patients safely and fully.

Patient safety is the main priority for our organisation, and this is regulated and monitored in a number of ways, from individual clinical specialty and ward meetings, right up to formal committees of the Board.

We closely monitor clinical outcomes (which are measurable changes in health as a result of care given), and complete tests of the environment, including sampling of air and water tests, as well as wider water quality analysis throughout the site. In addition, doctors, nurses and estates staff undertake regular inspections of the environment for monitoring purposes, and from this, any issues are identified and addressed.

We are very sorry that families have been scared about the risk of infection, and we are committed to ensure that our staff provide all necessary supporting information and opportunity for discussion to anyone experiencing concerns about safety, or fears for their children.

As with the above question, yes, we can reassure parents that the hospital is safe, and we have taken every measure t...

As with the above question, yes, we can reassure parents that the hospital is safe, and we have taken every measure to ensure that each patient is cared for in the best and safest way.

We are sorry this has caused concern, as the shower floors were designed so that water drains away appropriately. The...

We are sorry this has caused concern, as the shower floors were designed so that water drains away appropriately. There are no problems with Ward 6A showers. If there ever was an issue with an individual shower (which was not a design issue), then this would be immediately reported to estates colleagues and the drainage issue would be fixed.

As part of the work underway in Ward 2A, we will be doing a refit of the en-suite bathrooms including floor and wall coverings, to ensure that this is not a subject of concern going forward. The work to refit the en-suite facilities will include a revised detail and new materials which should reduce the need for the same level of regular repair, and minimise disruption to day-to-day ward operations.

This is available online via the the following link: Summary of Incident and Findings of the NHS Greater Glasgow and...

This is available online via the the following link:

Summary of Incident and Findings of the NHS Greater Glasgow and Clyde: Queen Elizabeth University Hospital/Royal Hospital for Children water contamination incident and recommendations for NHSScotland

If any patient or family member would like us to send them a paper copy of this, we would be happy to do so (please contact Jennifer Haynes on 0141 201 4616 or [email protected]

We agree with this comment, and we would seek to assure families that a complete review of the ward environment invol...

We agree with this comment, and we would seek to assure families that a complete review of the ward environment involving infection prevention and control staff, senior ward charge nurses and estates and facilities staff takes place every week to monitor cleanliness and the general estates environment. If any issues are identified, then these are quickly remedied.

In addition to the above described weekly walk round, infection prevention and control colleagues, along with estates staff, are on the ward regularly to ensure vigilance and ongoing review the environment. Any issues raised are immediately resolved between the nursing and estates and facilities teams.

This is a major piece of work currently underway in Wards 2A and 2B. There was extensive planning, design and procure...

This is a major piece of work currently underway in Wards 2A and 2B. There was extensive planning, design and procurement work undertaken in order to commence this work, which began in April 2019, in order to ensure we were creating the right conditions for the physical work to start. As is normal, there was a lead in time before the physical work started, which it did in October 2019.

There are a number of significant technical challenges to remove the existing ventilation systems and install the enhanced system. Whilst we appreciate the concern about the time taken, these are major works, and it is important we ensure the work is carried out to a high standard. At the moment, we would anticipate this work to be complete by March 2020, which given the level of work, is a reasonable and realistic timeframe.

All works being undertaken are being done as a preventative measure to minimise the risk of infection, and to ensure absolute vigilance in our approach to the prevention and control of infection.

In Ward 6A we have completed a number of actions to improve environmental controls within the ward, including the use...

In Ward 6A we have completed a number of actions to improve environmental controls within the ward, including the use of mobile HEPA filters (see response to Question 1) and the imminent installation of fixed HEPA filters in the en-suite areas. We have also increased the cleaning and maintenance of the chilled beams, which regulate the daily air temperature within the rooms, and have committed to a cleaning programme every six weeks. This is significantly in excess of the annual cleaning regime recommended by the manufacturer, and we have put this in place to be extra thorough.

The Chief Nurse and General Manager for Hospital Paediatrics regularly visit parents and patients within the ward, and would be pleased to answer any questions. We have also set up a closed Facebook page to ensure that the families of other haemato-oncology patients are also updated. If there are any other ways that families would find it helpful for us to communicate with them, we would welcome any suggestions that they would find beneficial.

No families should ever have to clean hospital rooms, nor bring in their own bedding, and we are therefore extremely ...

No families should ever have to clean hospital rooms, nor bring in their own bedding, and we are therefore extremely sorry where this has happened.

Sometimes family members may want to do activities, such as clean the hospital room, but this should only be if they wish to do, and absolutely not because they feel they have to.

Ward 6A has its own domestic staff and a domestic supervisor to ensure it is kept clean. There is a daily meeting between clinical and domestic staff to monitor cleaning levels. The aim is to ensure that cleaning takes place frequently and to a high standard, and we would encourage any families concerned about this to speak to the nurse in charge of their child’s care.

No patient is asked or expected to bring in their own bedding, however, if a child or young person wishes to bring in their own bedding, then we will support this. This is to help make the bedroom child-friendly and personal to the patient, in keeping with person-centred care and what matters to children.

Parents who sleep over are also provided with a bed and bedding. If this is a concern that individual parents have, we would encourage them to get in touch with us so we can make further enquiries, as this is not an issue they should have to contend with.

When a decision was made to decant Wards 2A and 2B in September 2018, an assessment was made at that time about the b...

When a decision was made to decant Wards 2A and 2B in September 2018, an assessment was made at that time about the best clinical option that would see young patients remain on site with access to paediatric intensive care and specialist services. This recognised that there would be compromise in terms of social spaces for children, families and staff.

The short term solution was for parents to use either the kitchen facilities (including microwave and kettle) in the RHC or the microwaves within the QEUH.

Both the play assistant and the Teenage Cancer Trust Activities Co-ordinator are based in Ward 6A and arrange individual and group activities for the patients. They also ensure that the children have age-appropriate toys.

As this is an issue of ongoing concern for families, we are currently creating some parent and child facilities in the ward, including a playroom and a parents’ kitchen / social space. We would welcome any ideas patients or parents may have that they would find helpful in this regard.

Yes, there are sufficient numbers of cleaners, and if there are any gaps (for example, due to sickness absence), then...

Yes, there are sufficient numbers of cleaners, and if there are any gaps (for example, due to sickness absence), then this is immediately managed to ensure appropriate cover. Ward 6A has its own domestic staff and a domestic supervisor to ensure standards of cleanliness are maintained. There is a daily meeting between clinical and domestic staff to monitor cleaning levels.

As described previously in this document, a complete review of the ward environment, involving infection prevention and control staff, senior ward charge nurses, the domestic services manager and estates and facilities staff, takes place every week to monitor cleanliness and the general estates environment. If any issues are identified, then there are quickly remedied.

We are sorry that parents were told that Ward 6A would have a play room, when it did not, as we appreciate that this ...

We are sorry that parents were told that Ward 6A would have a play room, when it did not, as we appreciate that this would have had a negative impact on experience.

We set up a play space and this was approved by infection prevention and control colleagues, however, when the incident occurred, it was agreed that this should be removed.

Both the play assistant and the Teenage Cancer Trust Activities Co-ordinator are based in Ward 6A and arrange individual and group activities for the patients. They also ensure that the children have age-appropriate toys.

As this is an issue of ongoing concern for families, we are creating some parent and child facilities in Ward 6A, including a playroom and parent space with kitchen facilities. We would anticipate that to be ready in early November 2019.

We are sorry that these issues have impacted negatively on care experience, particularly as we recognise that patient...

We are sorry that these issues have impacted negatively on care experience, particularly as we recognise that patients and their families spend a great deal of time in their rooms. These issues relate to previous concerns raised about Ward 2A and 2B, which is undergoing an upgrade, and issues with the TVs and blinds will be addressed as part of this. This will be completed for the ward reopening in March 2020. We are committed to take action whenever we receive feedback about anything that impacts negatively on care experiences, and encourage anyone with any concerns or suggestions for improvement in this area to make these known to staff.

When a decision was made to decant Wards 2A and 2B in September 2018, our absolute priority was where the best and sa...

When a decision was made to decant Wards 2A and 2B in September 2018, our absolute priority was where the best and safest place was to deliver care to our patients. We are sorry that patients and families have been worried about this, as we would have been keen to allay their concerns.

At the time of the decision, an assessment was made about the best option that would see young patients remain on site with access to paediatric intensive care and specialist services.

This recognised that there would be compromise in terms of social spaces for children, families and staff, but that this was necessary in order to be able to deliver the best care. We are sorry that we did not explain this as well as we could have to families.

All of these issues were considered at the time, but we hope we have explained that patient safety was of the highest clinical priority, as it is now.

The new family room will have a ‘What matters to me’ board that families can use, which we hope will act as a good communication tool in ensuring our staff know what is important to families.

Our staff have advised the Director of Estates and Facilities that there are enough electrical plugs with rooms for a...

Our staff have advised the Director of Estates and Facilities that there are enough electrical plugs with rooms for all the medical equipment that is needed to provide safe, effective and person-centred care. More electrical plugs can be fitted if these are required. We would appreciate any questions or suggestions for improvements that can be made to ensure that concerns about the number of electrical plugs are addressed.

In order to keep batteries fully charged we recommend that they are connected to the electrical supply when they are ...

In order to keep batteries fully charged we recommend that they are connected to the electrical supply when they are not mobile or being used. We expect this to be monitored by staff so that the batteries do not run out. We also expect that any concerns about the functioning of batteries to be reported so that they can be replaced, and encourage anyone with any concern at any time about battery performance to raise this with staff in order that action can be taken in response.

It is not acceptable for any equipment involved in the provision of care to be defective. We expect any such defects ...

It is not acceptable for any equipment involved in the provision of care to be defective. We expect any such defects to be reported in order that these can be repaired. If any patient or family member has any concern about whether trolley wheels (or any piece of equipment) is defective, please report this to a member of staff so that action can be taken in response to this.

All equipment defects or failures, if reported, are repaired through routine maintenance. We are sorry for the concern that has been caused by any defects in equipment that have been noted as not having been repaired.

We think this question may relate to Wards 2A and 2B prior to the move when we put in place temporary measures whilst...

We think this question may relate to Wards 2A and 2B prior to the move when we put in place temporary measures whilst we dealt with investigations into water safety. Wards 2A and 2B are currently undergoing a full refit prior to reopening in April 2020. The toilet, sinks and showers within Ward 6A had filters added to the water outlets as a precautionary measure to be sure we were minimising the risk of infection wherever possible.

As previously described, patient safety is our priority, and has been our primary consideration throughout all of this.

No patients are currently in Wards 2A and 2B. The water in the hospital is safe to drink. Our on-site water plant en...

No patients are currently in Wards 2A and 2B.

The water in the hospital is safe to drink. Our on-site water plant ensures all water coming into the hospital has a low dose of chlorine dioxide, which keeps it clean and safe. In addition, any patient cared for high risk areas have point of use water filters in place as an extra precaution.

The safety of the water was then confirmed to be safe by the external Authorising Engineer, a specialist engineer who acts, and is employed, independently of NHS Greater Glasgow and Clyde. The Authorising Engineer has rated the water supply as ‘wholesome’, meaning it is safe.

We are sorry for the concerns that have been caused. Signs at the sinks within the single bed rooms advise that the sinks are for handwashing only. This forms part of our infection prevention and control standards. Patients and their families are discouraged from drinking water in the rooms as these sinks should be dedicated to handwashing only.

If any patient or family member has any concerns about the use of water, they should speak to the nurse in charge.

The QEUH campus is safe. We would like to assure all our patients and their relatives that the hospitals on this site...

The QEUH campus is safe. We would like to assure all our patients and their relatives that the hospitals on this site are safe, and that we strive to deliver safe care at all times.

We continually monitor and test to ensure the safety and integrity of the water and ventilation systems.

As previously described, the water in the RHC and QEUH is safe. This has been confirmed by the Authorising Engineer, ...

As previously described, the water in the RHC and QEUH is safe. This has been confirmed by the Authorising Engineer, a specialist engineer who acts, and is employed, independently of NHS Greater Glasgow and Clyde. We will always consider all options and resilience plans, but we hope we have reassured that the position is that there is no issue with the water. Please see our response to Question 20.

Yes. Please see our response to Question 21.

Yes. Please see our response to Question 21.

The domestic water supply to the local population and to Ronald McDonald House is the responsibility of Scottish Wate...

The domestic water supply to the local population and to Ronald McDonald House is the responsibility of Scottish Water.

The water supply to the hospitals is safe – please see our response to Question 20.

When Healthcare Improvement Scotland undertake an independent HEI inspection, this is part of their role. They will v...

When Healthcare Improvement Scotland undertake an independent HEI inspection, this is part of their role. They will visit a number of wards and areas, but not necessarily all wards within a hospital site. During an inspection, they will then carry out a range of checks to ensure hospitals are meeting national standards, guidance and best practice. Healthcare Improvement Scotland have been asked by Professor White from the Scottish Government to provide details on their process for deciding which wards to visit.

Find more information about Healthcare Improvement Scotland inspections.

 

Professor White from the Scottish Government will provide details of a named contact at Healthcare Improvement Scotla...

Professor White from the Scottish Government will provide details of a named contact at Healthcare Improvement Scotland for any families who have further questions on their decisions and approach.

When considering the decant to Ward 6A, infection prevention and control experts, with clinical teams and estates sta...

When considering the decant to Ward 6A, infection prevention and control experts, with clinical teams and estates staff, agreed that the best area for the day care waiting room would be the former adults’ day room, which would maintain the waiting area within the day care area. Other options were examined, but this was considered the safest and best choice due to the practicalities and available options, in a way that does not elevate the risk of infection in an unacceptable way. Putting the day care elsewhere in the ward would have meant no proper reception area for the families.

The filters were installed in the theatres in June 2019 as a preventative control measure to make sure that the full ...

The filters were installed in the theatres in June 2019 as a preventative control measure to make sure that the full patient pathway had sinks with filters.

Before June 2019, point of use filters (i.e. filters on water outlets) were not installed in theatres on the advice of infection prevention and control colleagues, because patients in theatre were not in direct contact with water.

As part of the current Incident Management Team investigation in June 2019, the decision was taken to install point of use filters as an extra precaution at every stage along the patients’ clinical pathway within the RHC, including the theatres.

Yes. All cladding meets current safety standards, and is therefore safe.

Yes. All cladding meets current safety standards, and is therefore safe.

This particular staff kitchen was shut because a leak (not fungus) was noticed within the staff kitchen on 27th Septe...

This particular staff kitchen was shut because a leak (not fungus) was noticed within the staff kitchen on 27th September 2019. The leak was as result of a faulty tap connector on a recently fitted tap. The leak has been repaired, and the kitchen is now in use again.

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