Clean Challenges

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.
{mosimage}Looking ahead
Without a doubt working to stamp out healthcare acquired infection within the healthcare sector will continue to be a key issue. It’s the one concern that will continue to dominate all others for domestic managers.

At present the sector needs continued financial support in order to get our hospitals clean and to then maintain those high standards. Alongside this we need to ensure that we recruit and retain the right staff within cleaning services, and this can only happen if we invest in staff training to ensure that staff can do their jobs properly, and are motivated to do so! Ultimately it all boils down to the value we place in cleaning and cleaning services. Without significant investment in this area, we will not get on top of this critical issue. Patients value cleanliness; Government needs to show that they value it too. We should also be rewarding the many NHS domestic staff who work tirelessly to keep standards high, in spite of difficult working conditions and criticism.

Part of our association’s role is to continue to keep our members informed about the latest developments in particular regarding MRSA. We work very closely with infection control experts and suppliers to ensure that our members can benefit from the very latest information and research to help combat MRSA. For example, research continues to reveal that the link between general dirt and infection is very small and the main cause of infection is direct patient contact, both between nursing staff and patients and even visitors. Therefore, hand-washing is one of the key tools that can help us to maintain cleaner, safer hospitals.

We have worked closely with the National Patient Safety Agency on the “cleanyourhands” campaign, now in its second year, and hope to work with them on extending this into a robust Clean Care campaign to raise public confidence. The campaign might consider some of those areas which are poorly defined in terms of responsibility for cleaning. It might also look at how cleanliness is measured. Work has already been done on the colour-coding of patient equipment. A Clean Care campaign might also consider the idea of cleaning frequencies.

Our role
Changes during 2005 in the way in which cleaning within trusts related upwards to the Department of Health have meant that we now have policy directed via the office of the Chief Nursing Officer and operational matters via the NPSA. Although we feel there are real risks associated with a divergence of authority we do have close working links with both offices and feel that as an Association we are both respected and consulted fully. This means that those Managers who are our members have the opportunity for input at a very early stage of policy in order to develop strategies which stand a real chance of working at grass roots level.

In the last twelve months we have rekindled links with the Infection Control Nurses’ Association who co-authored our groundbreaking work at the end of 1999 “Standards for Environmental Cleanliness in hospitals” and with them have devised a basic training package for training domestic staff in infection control. This has brought together strands of training already available, identifying the strengths and weaknesses and guiding managers on what to present to staff and at which stage of their training. We hope to extend this web based training to include general training for all grades within the next six months and also to work further with ICNA on web based manuals. These will be available to all – not just to members – since we recognise that there is a void in information for managers in the NHS and healthcare sector generally. Even though we work entirely without Government funding and as a voluntary association we must offer our expertise to all, freely, in line with our mission statement which is “To provide excellence in professional cleaning management and allied services, ensuring that standards provided achieve the highest possible levels in Public and Private Sector Industries”.

We have partners in the supplier and manufacturing worlds and work closely with them. If suppliers have information, products and the like that will help our members, they let us know. In the same way we as the sector’s association need to have clear communication lines open to ensure that information is being shared. Any proven technological advances that can help to fight infection, be it bacteria resistant surfaces or ultrasonic cleaning techniques need to be shared so that we can keep our members informed.

On broader terms, we also provide on-going assistance to our members on a daily basis. We exist to offer professional support and have pioneered a massive internet support team offering practical advice on any issue that affects members.

Communication is the key. We are currently planning our 2007 Annual National Conference and Exhibition where many of the issues I have discussed briefly above will be addressed. They were also (unsurprisingly) themes of our 2006  Annual National Conference and Exhibition and in closing I would direct you to our website, where all speakers’ presentations from 2006 are posted, together with advance notice of the 32nd Annual Conference.

The Association of Domestic Management (ADM) represents over 500 individual managers of cleaning, domestic, hotel and support services across the Public and Private Sectors nationwide.

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