Last update 22nd. November 2004
Hospital-acquired infection, specifically Methicillin Resistant Staphylococcus Aureus (MRSA) is a major cause of concern to the public, and therefore of great interest to Forum members.
Arthur Brill, Chair of The Royal Free Hospital NHS Trust Forum, organised an informal meeting on November 19th to discuss cleanliness in hospitals, and measures that could be taken to improve it. The meeting was attended by a dozen people including Forum members from The Royal Free, University College Hospital, Moorfields Eye Hospital, The North Middlesex Hospital, and Primary Care Trust Forums.
The main speaker was Isabella Dickie, Hotel Services Manager of the Ailsa Hospital in Ayr, Scotland, who was introduced by Heather Knox who is Director of Facilities for the group. Isabella supported her well reasoned statements with published research. She pointed out that although well cleaned and maintained entrance halls and corridors have aesthetic benefits, they have little bearing on infection control. In Scotland MRSA levels as a proportion of all staphylococci rose from 2% to over 45% between 1990 and 2002, although they do now appear to be stabilising.
There is clear evidence that poor hygiene is an important factor in the spread of these diseases. In 2002 ‘Standards for Healthcare Associated Infection – Cleaning Services’ was issued by the Scottish Executive. Keynote points included: accountability; the specification to be endorsed by each organisation; an operational policy in place; and annual review. Fourteen individual Standards were defined: final accountability would rest with CEOs and Directors; line managers must be suitably qualified; policies and procedures documented; risk assessment should be instituted and frequency and methodologies should reflect this; staff should be given appropriate training and their performance monitored. Microbiologists and other professionals should be involved.
A paper ‘Does disinfection of environmental surfaces influence hospital-acquired infection rates? A systematic review’ by Deltenkofer et al (Am.J Infect Control 2004) was quoted: none of the studies reviewed showed lower infection rates ….using disinfectants ….rather than detergents only. Evidence tends to show that infections are spread by hand contact rather than super-clean floors; however things are dropped and picked up; patients may fall or walk around with bare feet. Hand-touched sites such as door handles, bed frames, chairs, medical equipment, and radiators were demonstrated to carry the organisms. The importance of thorough hand washing and the use of gels was emphasised repeatedly. The space between hospital beds, recently in the news, was felt to be an issue.
Another study ‘How clean are hospital surfaces?’ (Griffiths CJ et al J Hosp Infect 2000) showed that while around 90% looked clean, only about half of that proportion was microbiologically clean. Stephanie Dancer has proposed standards for surface hygiene in hospitals based on standards in the food preparation industry, and is continuing to research the subject.
Isabella believes that the structured approach that she described combined with an acceptance by the medical staff that cleanliness must be a high priority, could help to ensure that all hospital-spread infections are being kept to a minimum.
Margaret Harris bears some of the responsibility for cleaning services at the Royal Free. She described the system there emphasizing that methods were broadly similar, although some differences did exist. The problems of cleaning ‘personal spaces’, such as the lockers of long-stay patients, was mentioned.
There was some lively discussion, and a number of useful points were made. Although Camden and Ayr have roughly the same number of residents, the demography is very different. Much infection is imported into London hospitals by visitors on hands, shoes and clothing. Literacy in English is far lower in Camden than in Ayr, making instructions difficult to communicate. We were reminded of strategies used during the recent foot-and-mouth epidemic. Visitors need alerting to the need to observe the same attention to hand washing as hospital staff, and to avoid direct contact with patients.
Isabella and Heather were warmly thanked for giving us their time and the benefit of their expertise. We were also grateful to Arthur for organising the occasion. Everyone agreed that much could be learned from exchanging ideas and pooling information on ‘best practice’ now and in the future.
Janet Albu November 2004