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Last Updated: Wednesday, 13 July, 2005, 18:05 GMT 19:05 UK
Are you in 'safe hands'?

hands being washed in a hospital
[A clean hospital] is a physical manifestation of the health of the NHS. The message it gives spreads far beyond infection to say to patients "You are in safe hands"
John Reid, Health Secretary in foreword to 'Towards cleaner hospitals', July 2004

Improving cleanliness in hospitals has been a government priority for the NHS ever since research behind the NHS plan, showed that 'getting the basics right' in terms of cleanliness and food were amongst the top ten things which the public wanted to see.

Extra resources have been put into making this happen. 68 million had been spent improving cleaning in the NHS up to July 2004.

An annual cleanliness inspections regime was put in place in 2000 and these results are now factored in to the star ratings of acute trusts as well as being published separately trust by trust. New national cleaning standards were published along with a new NHS cleaning manual. Ward 'housekeepers' and Modern Matrons were given roles which included keeping watch over cleaning.

Improvement on a national level as a result of these changes is fairly difficult to judge. The ratings system for cleanliness was revised in 2004 from a three point 'traffic light' system to a five point scale. For this reason it cannot be easily compared with earlier results. Certainly between 2000 and 2003, the government could claim some success. The first round of visits by Patient Environment Action Teams in Autumn 2000 found that over 35% of hospitals had poor standards of cleanliness but by 2003, every hospital surveyed was either 'acceptable' or 'good'.

Birmingham Heartlands was rated as 'excellent' in these ratings in 2004, and prior to that was consistently in the top band of hospitals for cleanliness.

For more information on PEAT ratings system and to see how your hospital rates follow the link below.

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The problem, however, is that these encouraging signs contrast with less positive patient views of cleanliness. In the 2004/2005 outpatient survey 7% fewer patients than in the previous year describing the department they visited as 'very clean'. Similarly fewer inpatients rated the toilets and bathrooms on their wards 'very clean'.

The critical public view of cleanliness was put down in part to the publicity surrounding hospital acquired infections and MRSA in particular which hit the headlines in Labour's second term, and became a high profile issue in this year's general election campaign.

However, the public may think the link between cleanliness and MRSA is stronger than it is. In fact this issue is the subject of ongoing debate in the scientific community, as two specially commissioned articles on this site show.

The government accepts that environmental factors, such as dirty instruments, floors and walls have a part to play in infection control but only amongst a long list of other factors.

Behavioural factors are also on this list. These include inadequate and infrequent cleaning of hands by hospital staff - something which the government is trying to remedy.

The National Patient Safety Agency (NPSA) has been running a 'Clean Your Hands' campaign which now involves 99% of hospitals in England and all hospitals in Wales. The campaign's cornerstone is placing disinfectant hand rubs near to where staff have patient contact and reminding staff and patients of the importance of clean hands.

The NPSA estimate that 450 lives and 140 million a year could be saved if the campaign works as well nationally as it did in pilot studies.

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Birmingham Heartlands was one of the first trusts to get involved in this campaign.

Nonetheless our undercover reporter did gather evidence that, at Heartlands Hospital, nursing staff and cleaning staff were not always following the government recommended procedures in terms of protecting patients from the spread of germs.

According to 'Winning Ways', the government's report into controlling infections

"Infection control must be everyone's responsibility, from clinicians, cleaners and ancillary workers to patients and relatives, but evidence that this message has been adopted is scarce."

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Coinciding with this NAO report, a document called "Towards cleaner hospitals and lower rates of infection" was published by the Department of Health. It proposed a number of changes which they hoped would improve the adoption of measures to improve infection control. Chief amongst these were proposals for greater patient involvement. The accompanying press release stated:

"NHS patients should demand the highest standards of hygiene, and since human contact is a major way infection spreads in hospital, to feel happy to ask staff if they've washed their hands."

It also promised that bedside phones being introduced to NHS hospitals would have a pre-programmed housekeeping button so patients and visitors could be put through to the hospitals cleaning service straight away.

It is now mandatory that MRSA rates from each trust are reported every six months. In the first three years, the number of cases of MRSA rose nationally from 7247 in 2001/2 to 7684 in 2003/4, however last year saw a downturn to 7212. The government has set a target of reducing that figure to under 4000 cases by 2008.

MRSA is not the only hospital-acquired infection though it is widely feared because it cannot be cured with antibiotics. Recently the government has come under criticism for not requiring hospitals to report the rates of other infections.

This criticism was contained in a report by the House of Commons, Public Accounts Committee.

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The chairman of that committee, Edward Leigh MP, told the BBC's Today Programme:

"Everybody knows hospitals are not as clean as they should be. We must have mandatory reporting of all infections. The government must get a complete grip on this."

Certainly the government has not stopped trying to rectify the problems of hospital acquired infections or the linked issue of hospital cleanliness. This summer the government begins consultation towards a new hygiene Code of Practice for all NHS bodies which will include sanctions on hospitals who fail to live up to standards. Allowing Trust's to be taken to court for failing to adequately protect patients from infections like MRSA is an option. Measures will be included in a new 'Health Improvement and Protection Bill.' Meanwhile the Healthcare Commission has promised to conduct spot checks on 100 hospitals to find out if they are meeting standards.

Four other infections are now subject to mandatory reporting, though the results have not yet been collated or published. These include Clostridium Difficile, which contributed to 13 deaths at the Royal Devon and Exeter hospital this year.

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