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Page 1 of 2 Andrew Matthews, National Chair of the Association of Domestic Management, writes about the current challenges facing cleaning services within the NHS
 The UK’s overall infection rates are very similar to other European countries at around 9 per cent but remember that MRSA has been around for a long time. In 1979 a study in a hospital burns unit found MRSA on 33 out of 145 environmental swabs, in contrast to a surgical unit where there was a very low prevalence. Does the fact that there are pathogens in the environment give risk to the patient, or are the pathogens there because patients are ill? If we can remove environmental organisms, will it ever affect secondary cases?
What is effective?
Controlled studies have shown that the most effective disinfectant is no more effective against MRSA than ordinary detergent. There were some increases in bacterial counts with detergent use, but this resulted in no difference in HCAI rates. The only thing that makes any difference is single-room accommodation, and that’s not a cleaning issue. The role of more active relatives can improve patients’ morale, leading to reduced nursing load and reduced HCAI rates, but the answer is multi-factorial.
While HCAI isn’t about cleaning, environmental contamination can play an enormous role, and cleaning can help in reducing outbreaks. There is also a closer link between cleanliness and Chlostridium Difficile (CDiff) because of the length of time that spores live.
The power of the mind
If patients believe they are at risk of infection psychoneuroimmunology studies say they really are at risk of infection. Basically, if patients believe they’re going to get a bug, they’re more likely to do just that. There is an interaction between the brain and the lymphatic system that leads to the lymphatic system being vulnerable to suggestion from the brain. If we subject patients to league tables, this is an additional stress factor when they go into hospital.
Patient satisfaction surveys tell us that people believe hospitals are much cleaner now than they used to be. There are areas in hospitals which have a tendency to be dirtier than others, usually those that get heavy usage, including toilets off main thoroughfares. Cleanliness is still a hot topic in government. Patients tend to believe that their clinical care is acceptable until it’s proved otherwise, so they make their judgements on a variety of other things, of which cleanliness is one of the most important.
It takes a lot of effort to keep a hospital clean. It’s a simple concept, but difficult to do. How do we get people to pay attention to their own individual responsibility in keeping a hospital clean? Cleaning staff are often the most poorly paid of all healthcare staff, and this doesn’t help to motivate them.
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