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Last Updated: Thursday, 14 July, 2005, 11:48 GMT 12:48 UK
Infection control
Like cleanliness, infection control is amongst the 'Standards for Better Health' set out by the government. One of the core standards, the minimum which patients should expect is that 'the risk of health care acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in MRSA.'

The Healthcare Commission has factored this into its new system for rating hospitals. When judging the standards of each hospital they will look at the number of positive MRSA cases, year-on-year changes in the rate of MRSA and availability of near-patient alcohol gel on wards, which should be used by staff after they clean their hands.

The second part of this Panorama special, broadcast on Wednesday 20 July 2005, was filmed by a nurse working undercover in hospital wards with a large number of elderly patients. This was a different hospital from that featured in 'Undercover hospital cleaner'. The nurse in question, Margaret Haywood, recorded a diary camera after every shift. This is what she told us about cleaning on one of the wards where she worked

"In terms of washing hands and things, there is plenty of gel around, alcohol gel for your hands but up to now I've only ever seen myself using it. I've never seen any of the other nurses using it. I've seen them washing their hands, but I haven't seen them use the alcohol gel. There are signs everywhere, over all the sinks saying 'Wash your hands.' And instructions on how to wash your hands correctly and use the alcohol gel afterwards."

Experts now acknowledge that it is hard to get people to clean their hands as often as they should when they are working under pressure. Improving cleanliness of equipment which comes into contact with patients is therefore vitally important and can also be neglected.

One of the ways of preventing the spread of infections is through barrier nursing. Barrier nursing separates a patient who has contracted an infection from other patients, or is vulnerable to infection. Special protocols should be observed by all medical staff and cleaners when they are dealing with someone who is being barrier nursed. So for example protective clothing, including gloves, should be worn by cleaners when they enter the rooms and disposed of afterwards. Nurses should also wear gloves and dispose of them. Cleaning hands should accompany a change of gloves.

The practice which should be adopted by cleaners is set out in the NHS Healthcare Cleaning manual, section five.

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Our reporter Shabnam Grewal did not find practices listed here like changing gloves, apron and cleaning equipment between rooms, well applied by some of the cleaners she worked with at Birmingham Heartlands. However, the trust featured in this programme has managed to reduce its MRSA rate since mandatory reporting began, four years ago.



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