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Monday, 21 January, 2002, 17:30 GMT
Controlling hospital infection
Operating theatre
Levels of hygiene are causing concern
They may be designed to treat the sick, but hospitals are also a good place to pick up an infection.

Figures compiled by the National Audit Office suggest that 5,000 people a year die from an infection they contracted while in hospital.

Part of the problem is that hospital patients tend to be more vulnerable to infection.

Because they are ill to start with, their immune system is often run-down and less effective at fighting infection than it would ordinarily be.

Perversely, the over-use of antibiotics and cleaning agents in hospitals has aided the creation of powerful new forms of disease.

This onslaught may ensure that weak forms of disease are wiped out, but the stronger variants survive and go on to replicate themselves.

Basic standards

Department of Health guidance
The hospital environment must be visibly clean, free from dust and soilage
Where a piece of equipment is used for more than one patient it must be cleaned after every use
Hands must be decontaminated before each patient contact, and after every activity where contamination may take place
Hands that are visibly soiled must be washed with liquid soap and water
Remove all hand jewellery at the beginning of a clinical shift
Cuts and abrasions must be covered with a water-proof dressing
However, the biggest problem has been the failure of hospitals to meet basic hygiene standards.

Although there is no hard evidence linking dirty hospitals with the spread of hospital acquired infections, common sense suggests the two are related.

The Royal College of Nursing warned in 2000 that hygiene levels had deteriorated in recent years.

It said there were a huge number of vacancies among cleaning staff, who were difficult to recruit because pay rates were so poor.

In addition, the policy of contracting out cleaning services meant that ward sisters no longer had any direct responsibility for keeping wards clean.

Health Secretary Alan Milburn responded in July 2000 by announcing a multi-million pound programme to raise levels of hygiene.

All hospitals were told that they would have to have effective systems in place to prevent and control hospital acquired infections.

They would also have to meet national standards covering such basic matters such as changing the curtains around beds, cleaning the floors and cleaning bathrooms.

Potentially fatal infections such as MRSA are carried in dust mites and a study has shown that improving ward cleanliness can reduce infections.

However, a survey conducted in April last year found that 42 hospitals had failed to meet the standards laid down by the Department of Health.

Hygiene was so poor at 10 hospitals that they were publicly named and shamed, and hit squads of experts from the best trusts were sent in to supervise a clean up.

When spot-checks were carried out six months later, all 42 hospitals were found to have reached an acceptable standard of hygiene.

On-going problems

Department of Health guidance
Gloves must be worn for all invasive procedures
They should only be used once, and disposed of as clinical waste
Disposable plastic aprons should be worn when there is a risk that clothing may exposed to blood or body fluids
Full body, fluid repellent gowns should be worn where there is a risk of extensive splashing of blood or body fluids
Sharps, such as needles, should not be passed from hand to hand and handling should be kept to a minimum
However, several recent studies have suggested that there is still considerable room for improvement.

A Patients' Association survey published in November suggested that some hospitals were still failing to adhere to national regulations.

It found that some units were still re-using surgical equipment that is supposed to be discarded after one use.

In fact, the number of respondents who admitted their hospital was re-using single use devices had actually jumped to 12% from 8% in a similar survey carried out in 2000.

A separate survey of NHS Trusts commissioned by the government and published in December found that, in 106 out of 249 trusts, facilities or procedures for decontaminating surgical equipment after operations did not meet "acceptable standards".

In each hospital responsibility for minimising the risk to patients rests with an infection control team of doctors and nurses.

See also:

21 Jan 02 | Scotland
Hospital virus' impact spreads
21 Jan 02 | Scotland
Doctors 'cut corners' over hygiene
05 Apr 00 | Health
Clampdown on hospital hygiene
31 Oct 01 | Health
Hospital clean-up success
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