…observations from my summer vacation
Jim McEachran is president and founder of Wilshire Works Solutions. He is passionate about patient safety and used a recent trip to the UK to continue his research…
For any busy manager, short stints travelling abroad provide a great way to pull away from the office, refresh the mind, experience new sights… and hopefully learn a few things. On my recent two-week trip travelling the UK by rail, I was able to explore new regions of England, lower my blood pressure, reduce my resting heart rate, lose half a stone, and best of all, visit enough hospitals to conclude that NHS facilities and North American hospitals still have very similar infection control, ligature and ergonomic shortcomings in their bathrooms and washrooms.
I am a Canadian entrepreneur engineer, and the inventor of a niche infection control product used to support hospitals and long-term care homes for almost 15 years. My SME has successfully implemented our niche Sanipull retrofit infection control solutions into 4,000+ North American healthcare facilities. Working with our exclusive UK distributor Radal Technology Ltd, we also have Sanipull in the vast majority of UK healthcare facilities too.
Solid introduction to the UK
The 2009 Harrogate-hosted HefmA trade show is where I first introduced our flagship Sanipull to UK estate managers and various facility stakeholders. Sanipull, at that time, was our newest design of an innovative, cleanable, ribbon-profile retrofit pull system. It was also engineered as the world’s first anti-ligature pull solution for bathroom ceiling-mounted nurse call and patient controlled light fixtures. It was designed to easily replace soiled pull strings, pull cords and plastic wands, while providing a significant improvement in aesthetics, infection control and patient safety.
It was rewarding to receive enthusiastic responses from HefmA delegates discovering our unique pull solution. This encouraged me to partner with a Burnley-based technical healthcare product company to become our Sanipull master distributor for the UK healthcare market.
Radal Technology President Brent Dunleavey believed that his client estate managers would appreciate the benefits of replacing unsanitary braided pull strings with our cleanable, user-friendly pull alternative. His intuition was solid. Despite rocky economic conditions, managerial inertia and lean budgets continually challenging our UK Sanipull initiative, I was perennially pleased with Radal’s success in implementing our products into progressive estates throughout the UK. Our exports to the UK now represent our second largest market after the USA.
During my recent trip to England, I took the opportunity to do walkabouts at random urban NHS hospitals along my travel route to gauge how well Sanipull was embraced as a retrofit cleanable pull in publicly accessible lavatories. Was our product installed correctly? Were they being cleaned? Were they providing good service? If our Sanipull was not found, what type of pull strings or cords were attached to the nurse call and light fixtures? My hospital visits provided very interesting insights that I would like to share with UK hospital managers and supervisors.
The bathrooms and washrooms I saw in my randomly chosen NHS hospitals mirrored what I have seen in many hundreds of North American healthcare facilities. It was great to see our Sanipull installed in many of the places visited. Unfortunately, there were more facilities where I saw soiled, damaged and tired looking OEM pull strings that didn’t meet patient safety requirements.
I believe there is a universal chink in the armour of patient safety consideration in too many hospital public and patient bathrooms. Ubiquitous ‘part of the woodwork’ shortcomings are being ignored or overlooked. This situation has represented the status quo for decades. I have frequently observed that most hospital facilities escape diligent monitoring and supervisory attention. For a variety of fuzzy reasons, these areas, even if well serviced from a cleaning perspective, tend to be overlooked for patient safety risks, challenges to infection control, poor fixture maintenance and equally unacceptable ergonomic deficiencies. Cleaning staff and environmental managers tend to allow small issues to fester into multiple concerns, which in turn tend to be left unaddressed by the hospital Brass. “Not My Department Syndrome”, I suspect.
Inferior pull strings are a challenge to patient safety
In most bathroom and washroom facilities on both sides of the pond, one would likely find visibly soiled braided pull strings on nurse call and patient controlled light fixtures near the door. The germ loading on nurse call strings hanging near flushing toilets would be off the charts. Braided poly-fabric pull strings are not designed to be sanitized. Housekeeping staff know this and therefore ignore them on their cleaning rounds, enfeebling facility infection control initiatives. Why are traditional OEM pull strings allowed to remain in a healthcare setting?
For elderly patients with vision difficulties and/or arthritis, small diameter pull strings are a bane. White pull strings for WC lights are difficult to see against a white wall and strings without properly positioned grab handles can certainly be a challenge to grasp. To meet the ergonomic needs of elderly patients, a well-designed pull should be highly visible and easy to grab for any patient.
Why, in facilities with high suicides rates, are strong pull strings and plastic cords allowed to be attached onto ceiling mounted fixtures? Perhaps estate managers, lead hands and cleaning staff are not familiar with the array of problems associated with OEM pull strings; issues that cry out for a solution. Some well-meaning managers do acknowledge that braided pull strings are unacceptable and arrange to replace the offending strings with aftermarket cleanable plastic pull cords. Some of these cords come with grab handles, others not. Plastic cords do address the cleanability factor, however, they are even stronger than braided strings and present an accessible and effective strangulation device for vulnerable patients. I was told by paramedics that a plastic cord tied around a victim’s neck becomes buried under the folds of their skin. This makes it impossible to release the cord without cutting through their skin. Plastic pull cords do not belong in a healthcare environment. A quick Google search would reveal that credible aftermarket anti-ligature pull solutions are available that mitigate the risk of strangulation.
Installing, maintaining and cleaning bathroom nurse call fixtures and light switches often fall under the blended responsibility of various departments; typically, biomedical engineering, housekeeping and building services. Infection control departments have the authority to cite soiled pull strings as a patient safety issue, but rarely do. Risk Managers are becoming more aware of the many safety shortcomings in a patient bathroom.
Hospital management, as well as NHS inspectors, risk analysts and ICPs must not allow bathroom or washroom facility shortcomings to become ‘part of the woodwork’. Nurse call system manufacturers can be proud of their technology, however £1 OEM pull strings or plastic cords are strictly functional and not at all suitable in a hospital or nursing home facility. Stakeholders must consider the many issues created by unhygienic OEM washroom pull strings, super strong plastic pull cords and problematic tube wands.
Isolate the problem, initiate the solution
The answer seems simple: when tendering for new nurse call systems, insist they be supplied with a patient-friendly pull system. For existing systems, consider the many benefits of retrofitting existing pull fixtures with a quality, well-designed cleanable pull system. It’s a straightforward equation – protect your patients, staff and visitors by minimizing risk.
From my perspective as a serial hospital visitor, I believe building services technicians are well positioned to proactively hunt down problematic shortcomings. They can address the scope of the issue and work with colleagues to decide on best practices toward remedial action in a timely way.
One suggestion would be to speak with ward managers or encourage staff members to share their pet frustration or most irritating facility shortcoming. You’d be surprised at the number of long standing problems that can be quickly resolved, which also goes a long way to enhance the working environment and improving staff morale. Everyone appreciates being heard. Issues can be triaged, with fixes decided upon by brainstorming – including researching best practices and looking for available aftermarket products that may provide an amazing, easy to implement and cost-effective solution. However, don’t forget that a formal product evaluation may be required prior to implementing some product solutions.
Now, for the next big common facility-wide problem. Whose department budget will pay for the solution or retrofit product? Now, that’s a tough one only you can answer.
As a final thought, working in a busy healthcare environment doesn’t really lend itself to be searching-out even more problems. Nevertheless, knocking down irritant shortcomings found in all departments of a hospital should be part of a continuous improvement process that will reduce frustrations and inefficiencies.
Please make time to take a closer look in your patient and public bathrooms and washrooms to determine if some of the issues I outlined in this paper haunt your facility. Addressing these will result in improved patient safety, reduced HAIs and happier patients and staff. All good stuff! Good luck.
This has been a great vacation and I’m certainly looking forward to my next Brit Rail adventure. For a relatively small land mass, you sure have a lot to experience… can’t wait to come back!