Hospitals receive sharp warning for 'wide-ranging and serious' breaches of the hygiene code

Managers at Barnet and Chase Farm hospitals in North London could be fired unless they dramatically improve hygiene by the end of September.

Inspectors from the independent Healthcare Commission found 'wide-ranging and serious' breaches of the hygiene code and some of the worst rates for infection with the stomach bug C.diff. Spot checks also found that no alcohol gels were provided at patients' bedsides or attached to staff uniforms to aid handwashing.

Additionally, only one microbiologist was employed for four hours a week in infection control and there was no budget for training staff in the subject. The trust had no system for tracking MRSA infections and there was confusion among staff about when to put infected patients into isolation. The trust has been told things must improve no later than September 30 or the commission can ask Health Secretary Alan Johnson to replace managers.

Barnet and Chase Farm is the first trust to fail an unannounced inspection to determine whether hospitals are breaching the hygiene code brought in last October. Some 120 trusts will be subject to spot checks, of which 11 have been visited so far, with some asked to change practices. A survey by the commission last month showed one in four hospitals putting patients' lives at risk through poor cleanliness.

Altogether 99 trusts admitted on "self-declaration" forms that they were breaching at least one of the duties of the hygiene code. This covers increased handwashing, systems for cleanliness, risk management and staff training.

Barnet and Chase Farm, which treats more than half a million patients a year, was not officially classed among the 99 failing trusts because managers claimed it met the hygiene code.

Yet its hospitals have one of the worst rates for C. diff in the country, with 584 patients aged over 65 infected from January to September last year. There were 29 reported cases of MRSA between April and September.

The snap inspection was partly driven by patient dissatisfaction, with one in ten saying their room or ward was unclean and almost one in five complaining about dirty lavatories and bathrooms.

Anna Walker, the commission's chief executive, said: "I hope this sends out a strong message to all trusts that we will not hesitate to use our powers."

Hospital-acquired infections affect more than 100,000 patients a year. Deaths have reached record levels with two in every 500 death certificates now citing C. Diff and one in 500 mentioning MRSA.