Prevention is the best medicine

The antibiotic resistance crisis leaves little margin for error. Ten per cent of patients develop healthcare associated infections (HCAIs) while in hospital, leading to an average 5,000 deaths a year. For the NHS, the annual cost of HCAIs is £1 billion. 

As Nigel Grinstead, co-founder and CEO of healthcare consultancy Open Junction, told attendees at West Suffolk Hospital on 22nd November: "Infection control has dropped the ball in anti-microbial resistance. Antibiotics are failing in the field so the implication is that healthcare facilities need to be cleaner and we need to be more in control of our environments than ever before."

'Back to basics' with infection control 

Katheryn Hobbs, senior infection control nurse at Mid Essex Hospitals, and Sue Simcox, healthcare support manager at Gojo Industries Europe, told delegates that approximately 60% of men and 40% of women don't wash their hands after using the toilet. Hand hygiene, however, is one of the most important procedures along with equipment and environmental cleaning in preventing HCAIs.

"We touch a huge amount of things in our daily lives without even thinking about it," Katheryn said. "All microorganisms found on hands are capable of colonising susceptible sites such as wounds and intravascular devices as well as equipment and the environment."

It is therefore important to educate staff, patients and visitors on the NHS protocol for hand washing. The process of washing hands should take at least 20 seconds, making sure that the hands are washed correctly - wet hands with water, apply enough soap to cover all surfaces, rub palm to palm and carefully scrub fingers, back and front of hands and each thumb. Rinse with water and gently dry.

"What many people don't realise is that there's no point in washing your hands if they're not dried thoroughly too, as if your hands are warm and damp they will harbour bugs and breed more germs," Sue said.

Wet skin can also become sore, while drying hands too roughly with paper towels can lift skin cells. As having irritated skin can put people off washing their hands, skincare becomes ever more important.

A more hardline approach to improving hand hygiene in healthcare was suggested with the use of signage such as "Don't move past this point unless you are prepared to wash your hands".

Deep and discharge cleaning 

Karen Older, support services manager at Cambridge University Hospitals NHS Foundation Trust (CUH), and Anna Hallas, national domestic manager and infection control lead, Compass Group, looked at how CUH has taken a practical approach to deep and discharge cleaning. 

CUH carries out up to 6,000 discharge cleans, carried out after a patient vacates a bed, every month. The type of clean required is based on three categories: 'Red' the highest priority, followed by 'Amber' and then 'Green', which indicates the lowest priority. To carry out a 'Red' clean costs up to £135 and takes up to four hours, which can create a backlog of patients in A&E, while a Green clean costs approximately £15 and takes up to 20 minutes. 

To improve the flow in A&E, avoid the duplication of cleans and improve quality, CUH is going to review these cleaning categories. Cleaning schedules have also been changed to allow more cleaning staff to be on site to carry out cleans during peak times when patients are discharged.

In 2004, CUH had 60 cases of Clostridium difficile (C.diff) per month. In response, a deep clean programme was implemented on all wards at Addenbrookes Hospital. The week-long process involves the removal of an entire ward to a decant ward. C.diff numbers have since been reduced, however, with the pressure on space increasing, the challenge moving forward will be to develop a system of deep cleaning without having to move patients. 

To assist with this and speed up the decontamination process, CUH is looking to bring in new cleaning technologies such as UV, HPV and steam. Working closely with clinical teams to determine which patients can be moved and the risk they pose will also be vital to improving quality and productivity. 

Communication is key

A panel of experts – including facilities management (FM) and cleaning managers, outsourced service providers and industry association representatives – discussed cleaning and hygiene challenges presented by government measures to move more surgical procedures into primary care settings. 

To meet the standards required and prevent the spread of infection, it was suggested that there needs to be an upscaling of staff awareness as, even if a GP surgery is spotless, standards can be let down by dirty uniforms and poor hand hygiene. Cleaning and hygiene concerns were also seen as an estates management problem as a number of GP surgeries are not fit for purpose for the kinds of medical procedures that are being suggested. 

One delegate questioned why the sector isn't legislating to raise the standard of infection prevention. The response was that healthcare professionals do have the same 'Duty of Care' obligations as set out in health and safety law but that we're not so good at enforcing it.

To tackle this, it is vital for cleaning professionals working across all hospital and healthcare facilities to communicate regularly with clinical, nursing and administration staff and to educate them on best practice. But how do you get the message across, especially when doctors don't have time to attend meetings on cleaning procedures or feel that "they operate to different standards"? It was felt that we need to find a different way of educating doctors as this is part of basic patient care. 

However, it was agreed that explaining to staff why it is important do something – rather than simply telling them do it –  is vital in helping to improve compliance, and emerged as a constant theme throughout the day.