INFECTION CONTROL


they had not received adequate training for these tasks. “If it needs to be done, nurses just roll


up their sleeves and do it,” said Martin Kiernan. However, he also highlighted the fact that nearly 40% said the bed would not be closed if it had not been cleaned properly: “There is pressure to get someone out


of A&E in a short space of time and from one ward to another. Sub-specialisation of wards have added to this problem,” he commented. “In the past, patients either went from casualty to general medicine or general surgery. Today, there is so much specialisation that patients may go from casualty to the emergency admissions unit, then go to a short stay unit; they may be moved to a medical ward as there is an available bed, but because it isn’t the right sub-specialty they may end up somewhere else. How much extra cleaning does this create?” Martin Kiernan added that he had seen


instances where there had been an outbreak of norovirus, but there was pressure to open the bay. As there was no one around from hotel services, due to the time of day, five matrons had to clean the bay. “Have they received any training in


Florence Nightingale was quoted as saying that the root of all evil is ‘the division of responsibility and


reluctance to assume it.’ Florence Nightingale.


cleaning? No. Do they know exactly what they are supposed to be cleaning? No – they just need to get the bay ready for the next patient,” he commented.


Audit of nurse cleaning Florence Nightingale was quoted as saying that the root of all evil is ‘the division of responsibility and reluctance to assume it.’ Martin Kiernan commented that this is often the case with cleaning: “The problem is, when we say that cleaning is everybody’s job, is that it ends up being nobody’s job – this is where it falls down. “How do you know that effective


cleaning has been undertaken? At least cleaning by hotel services’ is subjected to


HPV technology highlighted at IPS


The benefits of hydrogen peroxide vapour (HPV) technology were featured in a series of independent assessments at this year’s Infection Prevention Society (IPS) conference. One oral paper and three scientific


posters were presented that highlighted the effectiveness of Bioquell HPV technology in the healthcare setting. The oral paper, entitled ‘Is deep cleaning sufficient to decontaminate isolation rooms?’, detailed an assessment from Guy’s and St. Thomas’ NHS Foundation Trust into the use of HPV for the disinfection of rooms vacated by patient with pathogens. It found that C. difficile, MRSA and VRE were cultured from surfaces after deep cleaning (using Dificile-S) but not after HPV. The other scientific posters included


a study into the use HPV for disinfection of unused supply packaging, the introduction of a change in practice for management of environmental hygiene and a comparison of the safety of two hydrogen peroxide-based room decontamination systems. The collaborative study between


Johns Hopkins Hospital and Bioquell into the use of HPV for the disinfection of unused supply packaging demonstrated that 9% of 100 sampled items were contaminated with multidrug-resistant


NOVEMBER 2012


organisms (MDRO); none of 100 paired items were contaminated after HPV. A service improvement abstract from


Guy’s and St. Thomas’ NHS Foundation Trust examined the use of HPV for the disinfection of rooms vacated by patient with pathogens. It showed that since the introduction of HPV as one of the control measures, the rate of CDI has fallen from 68 per 10,000 occupied bed days (Q2 2011/12) to 37 per 10,000 occupied bed days (Q2 2012/13). Finally, a poster was presented by


Scarborough and NE Yorkshire NHS Trust on the evaluation of the safety of Bioquell HPV and Oxypharm Nocospray aerosolised hydrogen peroxide. Here the findings were the Oxypharm Nocospray system could not be operated due to lack of remote control and leakage of hydrogen peroxide in excess of health and safety limits when the device was operated using the instructions of the manufacturer. The Bioquell HPV system was operated without incident and has since been adopted Trust-wide. The IPS presentations also coincided


with the publishing of a briefing pack on Bioquell’s technology on the NHS website. This pack can be found at http://www.innovation.nhs.uk/pg/cv_blog/ content/view/31728/network


some audit procedures – nurses’ cleaning is rarely audited.” Martin Kiernan further highlighted a


paper by Dumigan et al, entitled: Who is really caring for your environment of care?2


The authors found that, although


there were procedures in place for cleaning patient care environments, there was confusion over the division of labour when it came to cleaning responsibilities. The systems that had been put in place to monitor cleaning were suboptimal. However, after implementing ATP monitoring, they reported significant improvements in cleaning standards. Another paper, authored by Havill


et al, looked at Cleanliness of portable medical equipment disinfected by nursing staff.3


The study used ATP hygiene


monitoring, as well as cultures, to assess the cleanliness of portable medical equipment disinfected by nurses between each patient use. The authors found that the equipment was not being disinfected as per protocol – highlighting a need for education and feedback to nurses. Martin Kiernan also stressed the need


to address nurse attitudes, following his findings from a survey of trained nurses via Twitter and the RCN network: “Interestingly, 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.” The survey also asked whether


cleaning was a routine and expected part of nurses’ duties. Some 70% said they had to clean commodes and 70% said that cleaning the environment is an expected and routine part of their duties; 90% were responsible for cleaning of clinical equipment. Most of the nurses also believed that cleaning should be a part of their duties.


‘A study looked at 27 items cleaned by clinical staff – 89% failed the benchmark for cleaning.’


THE CLINICAL SERVICES JOURNAL 43


www.historical.ha.com H Lenthall


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