INFECTION CONTROL
wet myself. I looked down and there was a lot of blood gushing out of me.” Three of the people that were
contacted had ended up being 999 admissions. The feedback from these patients, on their experiences, prompted the team’s next project. “We are now working with tissue
viability nurses to establish how we can provide support for patients in the community with developing symptoms,” concluded Prof. Tanner. “The Royal College of Surgeons says there are £4.2 m operations performed in England each year. Based on a conservative estimate of a wound infection rate of 5%, this means one patient is diagnosed with an SSI every two minutes, in England. “In the time it has taken to give this
presentation that is ten people whose children wake up in the middle of the night screaming, ten people who cannot pay their mortgage, ten people who just want to die... This has been our journey at Leicester. Where is your journey going to take you?”
Too posh to wash? Also high on the agenda at Infection Prevention 2012 was the issue of cleaning in hospitals and whether nurses should be responsible for any cleaning duties and, if so, whether training should be given. Addressing this issue, Martin Kiernan,
nurse consultant, infection prevention, Southport and Ormskirk Hospital NHS Trust, delivered a presentation entitled: Too posh to wash. He pointed out that there is a growing consensus that cleanliness and infection rates are linked, which is now supported by a significant body of evidence. “What we know is that many
pathogens survive extremely well in the environment.We are also able to demonstrate a significant route to the patient. MRSA, for example, can survive in the environment for a couple of hundred days,” said Martin Kiernan. He stressed that, to be effective,
cleaning in healthcare settings must be thorough; undertaken by motivated staff,
‘1 in 10 still believes that the environment is only possibly linked to infection – we are still to convince some people that it is important to clean the environment.’
42 THE CLINICAL SERVICES JOURNAL
who are trained to undertake this role; and should be subjected to monitoring for assurances purposes. Cleaning tasks are often undertaken by
a variety of staff groups – yet, for many, this aspect is not the primary component of their role. Martin Kiernan pointed out that concerns have been raised that some staff groups are not formally trained to undertake cleaning duties and are poorly motivated to do it, with many feeling that this should not be part of their duties. Nurses in particular often perform cleaning activities, yet monitoring of the effectiveness of this is not often undertaken in a structured manner.
Division of cleaning duties He cited a paper by Nseir et al on the Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit.1 The study found that successive people, who went into an ICU room, were at risk from organisms from previous occupants. The study found: • Independent risk factors for ICU- acquiredMDRP. aeruginosa included: a prior occupant withMDRP. aeruginosa, surgery, and prior piperacillin/tazobactam use.
• Independent risk factors for ICU- acquired A. baumannii included: a prior occupant with A. baumannii, and mechanical ventilation.
• Independent risk factors for ICU- acquired ESBL-producingGNB included: tracheostomy and sedation.
An interesting aspect of this study was the fact that a quality audit showed that around half of the rooms had not been
cleaned correctly. The types of items not cleaned included high-touch areas such as: door knobs, monitor screens and bedside tables. “Who is going to clean these items?”
Martin Kiernan questioned. “Sometimes it is the hotel services staff, sometimes the domestic cleaners, or – if the department is under pressure – it may be the nurses. But do they always think to clean all of these areas?” He went on to point out that there are
“bizarre divisions in cleaning duties” in hospitals, which present challenges: “The hotel services staff will clean the bed up to a certain point, but the nurses may have to do the rest – because it is deemed to be ‘clinical’. The nurses may be responsible for the mattress and bed base, for example, while others will have to do the frame – it is ludicrous!” he exclaimed. Martin Kiernan also highlighted the
fact that there is often discussion over who is responsible when there is a spill of body fluids on the floor: “Ultimately, who is better trained? Cleaning is a very technical task – are nurses trained as well as other staff?”
Impact of hospital pressures Martin Kiernan highlighted the findings of recent research, reported in Nursing Times, which showed that cleaning duties are often undertaken by nursing staff. A survey of over 1,000 nurses and
healthcare assistants found that over half believed that cleaning services were inadequate and a fifth said hospital managers had cut back on cleaning. Forty per cent of nurses said they had cleaned toilets and 25% had cleaned bathrooms in the last 12 months. However, 75% said
NOVEMBER 2012
‘Nine out of 17 patients with deep wound infections did not know that they had had an SSI. Patients were not always informed by staff, while the significance of the infection, in some cases, was reported to have been underplayed by the clinician treatingthe patient.’
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72