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Standard reveals hospital workers flouting basic rules on hygiene
Rashid Razaq, Evening Standard07.01.08
Hospital staff are breaching basic hygiene rules designed to fight deadly superbugs, an Evening Standard investigation has found.
An undercover reporter discovered doctors and nurses at a major London hospital routinely failing to clean their hands between seeing patients. The reporter, who worked as a cleaner at Barnet Hospital, also found:
Nurses and cleaners broke rules stating they must wash their uniforms between shifts, raising the risk of infection.
Surgeons wore theatre scrubs in the canteen despite signs on every hospital floor warning them not to.
Doctors failed to keep their arms bare below the elbow despite an instruction issued by Health Secretary Alan Johnson in September.
Cleaners argued with nurses about removing clinical waste despite orders that wards should work as a team.
The lapses come despite a crackdown on hygiene at Barnet and Chase Farm Hospitals Trust - the first in the country to be issued with an improvement notice by the Healthcare Commission in July. The trust's Clostridium difficile and MRSA rates have since fallen and the watchdog says it is following orders to clean up and has made improvements.
But despite halving C.diff infections to 113 in the last quarter, infection rates are still among the highest in London.
The Standard investigation raises concerns over the minimum standards applied by the Department of Health's legally enforceable hygiene code - now apparently being met by the trust.
Our reporter was employed as a £5.10-an-hour cleaner at the 900-bed hospital, which opened in 2003. It cost £40 million, funded by a Private Finance Initiative.
He discovered alcohol hand-cleaning gel dispensers had been prominently placed outside every ward with signs instructing staff and visitors to use them but they were frequently ignored.
Trusts are obliged to "educate" visitors about sanitation but cannot make them use the dispensers. Guidelines issued in 2001 say staff should clean their hands between seeing patients. Domestic staff were illequipped with uniforms. Most did not wash their clothes between shifts and travelled to and from work in their own shoes, potentially carrying infections. A hygiene code states staff clothes, including uniforms, should be "clean and fit for purpose".
Wards appeared to be clean and staff responded quickly to incidents. But other signs indicated a lax approach to hygiene. Clinical waste bins were left next to clean laundry, increasing the contamination risk. Cleaners employed by Medirest, part of the Compass Group, a large public sector catering and cleaning services provider, were thorough in their work but appeared isolated from staff in charge of cleanliness.
Rules for matrons say cleaners should be made to feel part of the ward team, to create "joint ownership" of cleanliness. But there seemed to be clear lines between nurses and matrons and the contracted cleaners who answered to non-medical supervisors. Refuse collectors said staff had been cut by up to a third to save money and cleaners complained of untrained agency workers covering staff shortages.
Medirest today said all new recruits underwent training and cleaners had not been cut back. A spokesperson said: "We have increased the number of employees by 30 in recent months to focus on minimising C.diff. It is only on rare occasions that we need to supplement our workforce with agency staff."
Barnet and Chase Farm NHS Trust said it would investigate the areas highlighted by the Standard and it took infection control very seriously. A spokesperson said: "In the last year we have spend an extra £500,000 on increased levels of environmental cleaning. We have reduced the number of new cases of C.diff from 74 in April to 16 in November."
She said the trust had made significant improvements on good hand hygiene, and hospital staff could have used personal alcohol hand gel when entering wards.
Undercover cleaner's diary: dirty uniforms and nurses who don't wash their hands
It is a tough job for low wages. The kind of work British people will not do. All the other recruits are recent African immigrants on visas. Most work 12- or 14-hour days seven days a week. Our induction is sufficiently thorough, covering health and safety regulations and infection control measures to combat MRSA and C.diff. We are told we will be provided with two sets of uniform and a pair of boots, which must only be changed into at the hospital.
Saturday 10 November
I'm told there is no uniform. Instead, I'm given a pair of dirty old overalls. I'm not provided with boots either. I have to wear my own trainers, which I wore on to the site and wear back the following day - in breach of infection control guidelines. I'm given rubber washing up gloves as there are no waste handling gloves. I'm working with Thomas Williams, a cleaner for two years, on refuse duty. We find yellow clinical waste bags and boxes of contaminated needles left by nurses on the floor with household waste instead of the locked yellow bins where they should be stored. Thomas tells me this is a regular occurrence and that it is not our job to pick them up off the floor. I see cleaners and staff going into wards without cleaning their hands with the gel dispensers at every ward entrance. I estimate only one in four visitors and staff obeys the rules. During a break I'm told by the other cleaners that there are regular staff shortages with untrained agency workers brought in to make up the shortfall. The number of permanent refuse collectors was cut from three to two to reduce costs.
Sunday 11 November
Deanne (one of the managers) says three people have not turned up for work, so the other refuse collector (Wilfrid) is reassigned to porter duties, leaving Thomas and me to do the whole hospital. I find clinical waste bins left next to clean laundry. The bins are taken out of doors next to the laundry store but as they are heavy and difficult to push they are sometimes left next to clean bedding. I see several doctors wearing stethoscopes going from the canteen on to wards despite signs telling them not to. I see nurses and cleaners going between the intensive care unit and the general Aspen Ward without cleaning their hands.
Monday 12 November
I am working the evening shift with Wilfrid. I am told we should be trying to do two rounds of refuse collections. Wilfrid tells me later that this is impossible. He complains the day shift are not doing their rounds frequently enough. He appears to be correct. We find four clinical waste bins completely full with 20 other bags dumped on top or on the floor. Two nurses finish their shift and leave for home in their uniforms. The hand gel dispenser outside Palm Ward is empty during visiting hours. Other dispensers nearby do contain hand gel.
Tuesday 13 November
A medic wearing scrubs is eating in the canteen despite signs warning staff that they will not be served if they are wearing surgical clothing. Another doctor comes in wearing a long-sleeved top and a stethoscope around her neck. A clinical waste bag splits while I'm removing it from one of the wards. It is not double-bagged or tied with an ID bracelet to identify the staff member responsible. Dirty adult nappies fall on the floor. I ask for materials to clean it but am told someone else will do it, so I leave it.
Wednesday 14 November
A nurse leaves the intensive care unit with a coat over her uniform on her way home. A surgeon in operating theatre "blues" is walking around public corridors. At visiting time I see two children in school uniform hugging their grandmother without cleaning their hands. After five days of hard work, I am leaving. Others who work here are not so fortunate - and the safety of thousands of patients is much to do with them.
Reader views (4)
Such a shame, and have seen some of the malpractice only this December gone(2008), my mother was diagnosed with breast cancer and had her mastectomy there. In the recovery ward, there was another patient who developed MRSA while there, not only did the nurses on the ward not warn anyone else they did not test the other patients who had come into contact with the patient. We learned of it when the cleaner who was throwing disinfectant where her bed had been told us. He actually said it was a good thing we had been cleaning around the beds (brought in our own disinfectant wipes and cleaned everything everyday). The cleaners wore gloves while cleaning the affected area but the nurses who had just treated her did not change their gloves when checking the other patients. We had to request that a test was carried out to rule out MRSA, the Ward nurse said she was not aware of the MRSA, just hours before she came on duty! Punishment can't be the only way, but how do you teach people to care about doing what is right? Heakth safety seems to be about "what you can get away with doing", surely it needs to be about why you should want to do the right thing. If they ever bring back the role of a Matron, I'll be the first in line for the job!
- Sally Fields, Barnet, UK
My Dad recently died(1/12/08) in Barnet Hospital.
Just a stomach complaint(constipation) and he seemed to be making good progress after 5 days in the hospital.
But he was suddenly moved to a single room on 25/11/08
and the next day I was informed he had MRSA.Thereafter he rapidly went downhill and on one occasion I found dirty nappy-like material on his tray in the room.
Every day he got worse and finally died (1/12/08).
The coroner rang me for some information which I gave and she said it was different to the hospital's version.
They had not mentioned MRSA.
An autopsy was carried out with an independant examiner and cause of death was given as Bronchopneumonia and coronary heart disease.
A CT scan was made on 1/12/08 before his death which,I was informed,had not shown a heart attack.
- Mike Herts, Barnet,UK
It is disgusting that hospitals are in this state. It appears that the situation has not improved since January as my Granpa is now in Barnet general hospital with MRSA which the hospital claim, he caught in the community - my granpa is an 87 year old man who does not leave his home often. I cried reading this article as it makes me so angry that due to the ignorance of others who are supposed to be in the caring profession, my granpa is having to suffer in this way. I have a 9 month old baby and cannot risk visiting him in hospital.
Further to my anger that he has MRSA, I heard that the room he is staying in did not have a sign warning others that he had MRSA. He was visited by many people including my dad on a daily basis who was also not told. He therefore was entering the room without taking the full precautions needed with an MRSA patient. It scares me that i could have visited my granpa, unaware of the situation, and then gone home to my baby. This is disgusting and i feel there is no excuse for such neglect in preventing the MRSA from spreading. It is my understanding that there are two other patients who also have MRSA in the rooms next to his.
- Julia, Hertfordshire
How can you expect staff to obey instructions when current Personnel Management (HR) legislation prescribes a regime of re-training, investigations and warnings for breaches of procedure and even disobedience. Managers in the public sector (where waste has been cut out) cannot allocate sufficient time to 'performance manage' staff in this way and so those who cannot be bothered or who are too stretched to do as they are told perceive that they can get away with it. Deterrent punishment is no longer allowed or practically possible unless in the most flagrant cases. And for the NHS, read education, public transport and law enforcement. Staff do not fear the consequences of poor performance.
- Peter Haldane, London
