Two-thirds of hospitals in Abu Dhabi fail inspections

ABU DHABI // Most hospitals and clinics in the emirate failed initial inspections last year, mainly because of poor hygiene.

The most serious problems are at small private clinics, which often ignore new practices, the Health Authority-Abu Dhabi (HAAD) said.

In one, doctor's desk inspectors found a dirty syringe, which he was planning to reuse days later.

Officials attribute many of the lapses to the widely differing backgrounds of health staff, and say the challenge they face is bringing them all up to standard.

HAAD inspectors made more than 1,300 visits to health facilities last year. Two-thirds of existing facilities, 315 in total, failed the test, with only 156 passing first time.

New facilities were better, but fewer than half - 55 out of 126 - passed their initial inspection. Facilities that failed were given 45 days to improve, then re-inspected. The inspections have been stepped up this year, with 1,500 visits so far.

Despite marked improvement over the three years in which the inspection regime has been in place, the same five key problems remain, according to HAAD's annual report for 2009. Besides poor hygiene and infection control, there is often no maintenance of medical equipment. Medical records are not kept, clinical practice guidelines are not observed, and facilities are not regularly maintained or kept up to fire and safety standards.

Dr Khalid Fulad, the director of health system compliance at HAAD, said these problems are most common in small private clinics and health centres. Larger hospitals "have a big budget that allows them to hire qualified staff of a high calibre", he said.

Health workers' diverse backgrounds - both geographically and educationally - create an immense need to impose standards, Dr Fulad said.

He was speaking at a three-day workshop on healthcare auditing that began in the capital yesterday. "Healthcare workers from Asia are trained differently from those from Europe or the US," he said.

"That is the huge challenge for us: they employ different practices in hygiene or in infection control, and we need our high standards to be met by all.

"There has been a huge improvement in the past few years, but we are still seeing some of the same problems."

Common problems included lab technicians working on blood or urine samples without protective gloves, equipment being stored in unhygienic conditions or not being properly sterilised, and syringes being disposed of incorrectly, Marwan al Marzooqi, HAAD's head of health audits for hospitals and clinics, said.

Inspectors had also "unfortunately come across" dirty sinks in examination rooms, toxic and chemical cleaning products stored alongside medical equipment and dentists reusing ampules on different patients, he said.

"There are several reasons for this: smaller clinics take procedures for big hospitals and try to implement them without amending them for their specific conditions, or a lack of policy at the facility or a lack of adherence to policy, and of course a stubborn mentality as well."

Some staff have become used to practising medicine a certain way for decades, and are reluctant to change, he said.

"There have been instances of a doctor using a syringe on a patient, then saving that same syringe in his desk drawer to use on that same patient in a later visit.

"Perhaps that doctor came from a country where there was a lack of syringes. We have to educate these people.

"Our challenge is getting people to obey our rules, which have been set in order that we provide the best service at international standards, and protect our patients."

Poor record-keeping is also a seriously concern, he said. "In medical records, doctors have to note down the date the patient came to visit, the diagnosis, the treatment prescribed, the drug name and dosage and so on."

When one or more of the criteria is missing, or when doctors do not bother recording this data when it is still fresh in their mind, the patient suffers, he said.

"Doctors are always complaining that they don't have enough time to do this, but we tell them they have to find a way, whether hiring a secretary just to type during a patient visit, or giving each appointment more time," he said.

The inspectors also found staff performing tasks for which they were not qualified or licensed. "We might find a GP working as a gynaecologist, or a receptionist doubling as a nurse," Dr Fulad said. "It is our duty to report these things."

To address these problems, HAAD has been arranging a series of workshops for healthcare directors and managers. Audit teams are also concentrating more on education, rather than enforcement.

"Our teams show the healthcare facilities what they are doing wrong, and teaching them the right way of going about things," Dr Fulad said.

"So when we come to check on them, we do so knowing that they have been informed what our standards are.

"Most people tend to hate change, and our job is to convince them that change is for everyone's benefit, whether the doctor or the patient or the clinic or the hospital," he said. "We need these changes to happen for the good of health care in Abu Dhabi."