Source · Prevention of Future Deaths
Martin Dean
Inadequate adherence to hand hygiene by visitors on a Critical Care Ward, directly increasing the risk of infection to vulnerable patients.
Date
22 Sep 2014
56-day deadline
17 Nov 2014 est.
Responses identified
0 of 1
Coroner's concerns
Inadequate adherence to hand hygiene by visitors on a Critical Care Ward, directly increasing the risk of infection to vulnerable patients.
View full coroner's concerns
During the Inquest evidence was given that a number of visitors to the Critical Care Ward where Martin Leslie Dean was a patient were not washing their hands on entering the ward. Further evidence stated that the most effective single precaution that could be taken to prevent infection was hand washing. The evidence continued by revealing that it would be possible to station volunteers at the entrances to wards particularly at the entrances to Critical
Report sections
Investigation and inquest
On 26th February 2014 I commenced an investigation into the death of Martin Leslie Dean, aged 42 years. The investigation concluded at the end of the inquest on 9th September 2014. The conclusion of the inquest was that Martin Leslie Dean died as a consequence of a naturally occurring intracerebral haemorrhage together with a complication of necessary treatment for that condition.
Circumstances of the death
On the 13th December 2013 Martin Leslie Dean suffered an intracerebral haemorrhage at his home address, Timperley, Altrincham, following which he was transferred to Salford Royal Hospital where a shunt and a feeding tube were inserted.
Similar PFD reports
Related inquiry recommendations
Scottish Hospitals Inquiry
Training for IPC professionals engineers and clinicians
Vale of Leven Inquiry
CDI infection control advice
Vale of Leven Inquiry
CDI outbreak reporting
Vale of Leven Inquiry
Ward admission responsibility
Vale of Leven Inquiry
HAI implementation strategy
Vale of Leven Inquiry
Stool records for CDI patients
Vale of Leven Inquiry
IPC policy review
Vale of Leven Inquiry
Mandatory IPC training
Vale of Leven Inquiry
IPC staff regular training
Vale of Leven Inquiry
24/7 IPC cover
Report details
- Reference
- 2014-0416
- Date of report
- 22 September 2014
- Coroner area
- Manchester West
Responses identified
Responses identified
0 of 1
1 response not yet linked
Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 17 Nov 2014 (estimated).
Sent to
- Salford Royal Foundation Trust