Delivering under pressure

The Forum host was TV presenter Dr David Bull, a qualified medical doctor who practiced within the NHS for three years and is an enthusiastic campaigner for better healthcare outcomes, including improved cleaning. He set the tone for the event, saying: "Unless everyone works together you actually don't get anything done. As a doctor I can prescribe antibiotics, but if I’m doing that in an environment that isn’t clean, that isn’t sterile, and the patients gets a Hospital Acquired Infection, that is no good for anyone."

MROs (Multi-Resistant Organisms) 'biggest challenge' 

Rachel Thaxter, Lead Nurse Infection Prevention and Control, Cambridge University Hospital Trust, was unequivocal about what she believes is the single biggest challenge for infection control in the future: Multi-Resistant Organisms (MROs). 

It will be vital for cleaning and housekeeping staff to engage with infection control teams to tackle future problems. MRSA and C.diff are here to stay, she said, Norovirus and Flu are constantly changing, but the big problem will come with resistant organisms such as Acinetobacter Baumanni (MDRAB) and CPE/CRE (Carbapanem-Resistant Enterobacteriaceae and Carbapenemasse Producing Enterobacteriaceae). Developing new antibiotics takes a long time and is expensive. 

Antibiotic resistance is growing and is all around us. Carbapanems are antibiotics of 'last resort', relied on by doctors to treat difficult infections when other antibiotics have failed. If CPE/CRE becomes a problem in the healthcare community we will lose Carbapanems and we can't afford to let that happen, warned Rachel. She recommends cleaning teams should start now to plan for an outbreak so they are ready to deal with it if (and when) they receive a call from infection control to alert them of a case.

Bacteria 'very resilient'

Derek Butler, Chair of MRSA Action UK, continued the debate over the battle with ever more resilient bacteria. He lost his stepfather to MRSA in 2003 and has lost two further family members to HCAs. Since then, through MRSA Action UK, he has campaigned for improved cleanliness in Britain's hospitals and the need to challenge healthcare staff to do their job properly the first time every time. Bacteria, he said, are the best bio-chemists on the planet; they are very resilient and very quick to change. "The easiest way to build up resistance to bacteria is prevention," he says.

Derek urged healthcare employees to communicate and not to be afraid to shout up if they see something that they know is not right. Everyone has the right to challenge and there should be no hierarchy for safety. "My job here is to stop people getting avoidable infections."

We need to be cleverer in our use of antibiotics, he said, and called for 'rapid-testing' to establish quickly whether a patient has a virus or a bacterial infection. This would enable doctors to prescribe the most effective treatment without delay and avoid prescribing an antibiotic that will not be effective.

The cleaning professional is key

Deep cleaning technologies were also scrutinised, with the ‘pros and cons’ of different methods evaluated. Steam, HPV, UV, chlorine and simple microfibre were assessed and voted on by delegates. Summing up this session, ahcp patron Mike Rollins concluded there is no right or wrong method; the most important factor is the cleaning staff and their knowledge of what they must do to keep patients safe whichever system they use.

A final case study-style presentation looked at how Cambridge University Hospitals NHS Foundation Trust has taken a practical approach to discharge and deep cleaning. Their system uses a decant ward but it was accepted that moving forwards, with pressure on space increasing, the optimum solution would be to develop a system of deep cleaning without having to move patients from the ward. It is hoped that new technologies may help with that.