Undercover hospital cleaner
Wednesday 13 July 2005
19:00 BST, BBC One
Every year three hundred thousand people contract MRSA and other hospital acquired infections. Some 5,000 will die as a result. Hospital hygiene has become such an issue that hospital cleanliness and hygiene recently loomed large in the general election campaign.
Only recently, the Health Care Commission announced a hit squad of inspection teams which would turn up unannounced to inspect standards of hygiene and cleanliness in Britain's hospitals. So, across the country, urged on by the government, hospitals are pulling out all the stops to rid their wards of these potentially lethal infections.
BBC's Panorama programme sent Shabnam Grewal undercover in one of the country's biggest 3-star hospitals, Birmingham Heartlands (now Heart of England NHS Foundation Trust), to see what's happening on the front line of hospital hygiene. And the results are frightening.
She met cleaners who are great at making things look clean - without actually cleaning them as they should; cleaners who routinely break basic rules designed to stop infections spreading; and some medical staff who ignore isolation room procedures and risk spreading serious infection around their hospital.
She tells BBC News Online about her experiences and the background to the programme.
How did this film come about?
As an Assistant Producer on Panorama, I was originally sent undercover to help film a nurse, who was working on a programme which will be shown next week and which looks at the standards of care on an acute medical ward. Although we had always planned to film cleaning in whichever hospital our nurse would work in, we were not initially planning a whole programme about it.
Once I had been cleaning for a while, filming as I worked, I began to realise there was a lot more to say about cleaning than I thought. I saw that best practice was not always being followed and was shocked at some of the things I saw. We talked about it as a team and decided that because cleaning was such a major area of public concern we should make a whole, separate, programme about that aspect of hospital life
It was at that stage that I began looking for work independently of the nurse who had initially agreed to take in a camera for Panorama.
Why did you pick Birmingham Heartlands (now Heart of England NHS Foundation Trust)?
We would never decide to go undercover in any hospital without having very good grounds to do so. We had already received several complaints from people whose relatives had been there, saying that they thought the same wards were very dirty. Our nurse also became concerned about cleaning standard when she visited. So we had a pretty good idea of what we might find before I even applied for a job.
It was interesting journalistically because Heartlands was a hospital that had an above average MRSA infection rate though they seem to be getting it down. Working here was partly about trying to see Infection Control in action.
Can you summarise what you discovered at this hospital?
In my few weeks working at this hospital I've realised that it's a real mixed bag when it comes to the cleaning. There are some wards that are really clean. There the cleaners are very thorough, the nurses and the staff are very aware of issues around cleaning and make sure that they stay clean.
In other areas it's as though no one cares, you know, the minimum is done; the priority is getting stuff done in time, not properly. So if you can't do it in time, then you just do the bare minimum and that's it.
I also got the impression that some of the cleaners I worked with thought that if something looked clean, it was clean. Obviously in a clinical environment that's just not true. Germs can be living happily on things which look clean. The fact that this message had either not sunk in or was being ignored was worrying.
Stephen, one of the cleaners who I worked with told me how to clean a patient's room. I had thought that we would do a thorough clean when the patient wasn't there but I was wrong. Kexxing which he referred to, is just using a soft wide brush to sweep a floor. It is great for sweeping up dust but not for killing germs.
And did you see anything which really alarmed you?
One of the things that I kept seeing again and again that really worried me was to do with barrier rooms which are supposed to stop the spread of infection from patients who are infected to those who aren't or to protect people who are vulnerable to infection, from others .
I was taught during my training that for a barrier room you have to put on new disposable gloves and a new disposable apron and start with everything clean - clean water, clean cloths, the whole lot; you use them once and then you throw them away. You wash hands before going in and after coming out. Now that is not what some people were doing.
It wasn't just that I was seeing cleaners going into barrier rooms without following barrier procedures but that sometimes I was seeing healthcare professionals like nurses working in barrier rooms with no gloves, no aprons and no hand washing when they came out .
If nurses don't follow procedures on something so important its easy to see why cleaners might think they are not very important .
Can you tell us about the week when you worked long hours. Why did you decide to do them and then what happened in the course of that week?
After I'd been working in hospital for a while I became aware of the incredibly long hours that some of the other cleaners were doing. There were people working 12 hours a day, five days a week and also on Saturdays and Sundays, and they were doing this just to make a decent living. I decided to try and emulate what they were doing, just to try and get some feeling of what it was like working those hours.
So I started working for a week from 8 in the morning till 8 at night with a few hours off in the afternoon, and very quickly I started feeling really tired. Working these long hours I did start to get an insight into why you would slack at work, why you would create space to just have a rest or to just chat to people. In fact on one occasion I felt so fed up and tired I sneaked into the staff room and took an extra tea break. I knew I shouldn't but I felt too tired to care.
If you aren't told how important what you are doing is, and how important it is to clean properly; if you just feel devalued and the bottom of the pile (and lots of cleaners do feel like that, they do feel the doctors and nurses just ignore them or they're invisible or they're not important), and you work long hours for low pay , it's really easy to understand why you would just think, 'No, I can't be bothered."
Tell us about the disparity between what you're told in training and what actually happened on the wards.
On the training course you're taught to be really thorough and just clean everything properly. You're taught to use the right equipment, to use new Jay cloths, to use the right chemicals, to change your water frequently, to wash your hands, to use alcohol gel. You're taught that all the areas of the patient's room needs to be cleaned properly; the cabinets, the bed, the windowsills, high dusting and low dusting. You are told that all the chemicals are available and you should use them in exactly the amounts you need. You're taught to change the water in your mop bucket regularly so that it's clean and you're not just spreading dirt around.
Now the difference between that and the ward itself is that on some wards, the stock isn't easily available. Once I found it locked up in a cupboard or I had to go and ask somebody how to get to it, and I saw people not throwing away Jay cloths. So in these places people were re-using their cleaning materials again and again. People were not changing the mop water as frequently as our guidelines suggested. They say that if they did everything according to the training they wouldn't get done what they're expected to in the time available and that's the priority.
Tell us about you talking to the team and trying to do it properly and what happened?
I always tried to clean the way that I was trained to. I tried to change my water as often, I tried to use fresh clothes when I was supposed to but that was really difficult because there was pressure not to. It wasn't on every ward, but with one team in particular, I kept being told again and again that I was too slow. I kept being told that I didn't need to do those things. I didn't need to change my gloves all the time. I didn't need to change the water in the mop bucket. And when I persisted I could see my colleagues getting more and more annoyed with me. I mean they couldn't actually say 'No. You can't do it." But they would say "You're too slow. We haven't got time. We're not going to be finished and you're going to make everyone late."
Eventually I actually sat down in the staff room when we were having a break and talked to them about it, and I said that I was really worried about this. I was worried about the patients. I was also worried that I was going to get into trouble if I didn't doing things the way I'd been taught to because that was what I was trying to do." And they said that "we do lots of things here that we're not supposed to by rights" but in the end they admitted that you've just got to do it because of time.
You've been working with a camera in hospital wards secretly filming people who are extremely vulnerable. How do you justify what you've been doing?
I know that going into a hospital with a secret camera and filming people is an invasion of their privacy, and it is something that we were really concerned about. We felt that it was the only way that we could show what things are really like from the inside out. We wanted to show what it's like being a cleaner in a hospital. That means what a cleaner actually does, how little and how much and what the conditions are like for the patients. It was only by secretly filming that we could show the true picture.