The cleaning bug

6:36pm Wednesday 10th December 2003

Britain is losing its battle against the deadly superbug MRSA. Health correspondent Ian Lloyd examines how Barnet Hospital is tackling a new crisis for the NHS

It should be second nature - like a lawyer's natural instinct is to argue. But, remarkably, some NHS doctors and nurses are still not aware of the importance of washing their hands after treating patients.

League tables released by the Department of Health last week, highlighting the increase in the deadly hospital superbug MRSA, should act as a wake-up call.

The bug is believed to kill around 5,000 patients a year in the UK, and in 2002/3 the number of cases rose to 7,384 from 7,281 in 2001/2.

For Barnet and its sister hospital Chase Farm in Enfield, as well as the Royal Free Hospital in Hampstead, the tables make bleak reading. Of the 49,000 patients treated by Barnet and Chase Farm Hospitals NHS Trust in 2002/3, 94 had the MRSA infection in their bloodstream, compared with 62 the previous year - an increase of more than 50 per cent.

There were more cases than that at the Royal Free Hospital, despite the number of infected patients falling from 122 in 2001/2 to 101 in 2002/3. A spokeswoman for the Royal Free said this was largely because it dealt with very ill patients who had the bug on admission or who were consequently more susceptible to infections like MRSA.

Journalist Harriet Sergeant, author of Managing Not To Manage: The Story of Failure at the Heart of British Hospitals, said dirty hospitals were a direct result of an NHS in crisis.

"It doesn't surprise me that MRSA is prevalent on the wards because no-one has the authority to make sure it isn't there," said Miss Sergeant, who spent 11 months at six UK hospitals researching her publication.

"If hospitals were kept clean as they used to be and you could get staff to wash their hands, it would make a huge difference. I think it is the responsibility of the people who are meant to be managing the staff to make sure that they enforce these rules, and make sure staff understand their importance. Hospital staff are very busy and overworked and they really need to be managed better."

Miss Sergeant said a general increase in Hospital Acquired Infections (HAIs) was the prime example of hospitals being unable to manage at every level, from chief executives and middle management, through to modern matrons and nurses.

"I sat in on a board meeting at one of the hospitals and the directors said they couldn't get their staff to wash their hands.

"In catering, for example, if you don't wash your hands, you get sacked. But in a hospital when people's lives are dependent on carers washing their hands, no-one has the authority to say: Do it or you are out.' They consider that harassment."

Miss Sergeant said different layers of management, with private contractors being brought in to clean many hospitals, meant responsibility for maintaining standards was often blurred. "One woman who was head of a very busy A&E department in London had a patient who was sick in the waiting room, but that was not part of the cleaners' contract. So the cleaners would not take it on and she had to go and clean it up herself," she explained.

"That A&E manager would want that cleaner working for her rather than a private firm and she wants to be able to tell them what to do. But every time she wants to make a complaint about the cleaner she has to phone up the cleaning manager."

Nick Samuels, director of communications at Barnet and Chase Farm hospitals' trust, denied that its managers had no authority over cleaners. But the trust this week confirmed it was bringing in a different external company to clean the wards because contractor Ecovert had not been doing a good enough job. Mr Samuels admitted this was a last resort. "We have clear standards within our contracts that are enforceable. Obviously, if a member of staff sees an individual not behaving or performing appropriately, we don't want to run to the contractor every time. If we can resolve individual issues, matrons and members of staff have the right to do that."

The same applied to nurses and doctors, he added. "It is entirely within matrons' authority to ensure and enforce the professional standards that we expect of every single nurse who works in our hospitals.

"Standards of hygiene and cleanliness are a matter of basic training, which you learn in your early days as a nurse, and it is entirely appropriate that those standards are enforced."

With the new figures confirming that the UK has the worst MRSA record in Europe, Health Secretary John Reid announced last week that infection czars' would be appointed to every hospital in the country. The NHS will also launch a new drive to ensure staff realise the importance of washing their hands.

But Miss Sergeant was less than impressed. "John Reid is now getting in another layer of management, which is the infection czar. How many managers does he think it takes to make nurses wash their hands?"

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