Health watchdog finds two thirds of hospitals are dirty

The Healthcare Commission challenged hospitals to regain the confidence of patients on cleanliness by bringing all services up to the standards of the best. The regulator made the move when publishing the findings of the first independent inspections of hospital cleanliness in England. Inspectors visited 99 NHS and private hospitals between July and September, arriving unannounced to prevent a late clean up operation.

They found a third of the hospitals visited achieving the highest standards in cleanliness across the board. But two-thirds were not, with mental health hospitals performing particularly poorly out of those in the sample.

Dividing the hospitals into four bands, the Commission found:
* High standards of cleanliness were being achieved in a significant proportion of organisations with 33 hospitals in band one.
* But too many hospitals failed to perform as well as they could with 44 being in band two, indicating they have room for improvement.
* There was evidence of systemic problems in the 23 hospitals that were in bands three and four, indicating that cleanliness was unsatisfactory for an environment in which clinical care is being provided.
* Standards were markedly poorer in NHS mental heath hospitals visited. These made up all six hospitals in band four, indicating serious and widespread problems, plus 18 of the 22 hospitals in bands three and four.

Simon Gillespie, Head of Operations at the Healthcare Commission, said: “ We have found some excellent performance. It is a myth to say all our hospitals are dirty.

“Among the highest scores were hospitals of all types. This shows that Healthcare managers can achieve the highest standards, and all should on behalf of patients. Nevertheless, the findings show that too many hospitals are failing to perform as well as they could. And some have particularly poor standards of cleanliness.”

He added: “Concern about cleanliness has been driven by the prevalence of hospital associated infections and the assumption that poor hygiene is contributing to this.

“If a hospital has dirty and poorly maintained facilities, patients will have little confidence that it can implement the more sophisticated precautions that are needed to prevent infection. It is not unreasonable to expect hospitals to aim to be at the higher spectrum of standard on cleanliness. Our results suggest that this should be achievable.

The Commission carried out the inspections in response to heightened public concern about the cleanliness of hospitals.

It aimed to:
* provide a snapshot of cleanliness in different types of organisation
* send a strong signal that poor standards of cleanliness are not acceptable
* identify next steps for healthcare organisations and national policy makers.

Until now the main information sources on cleanliness have been Healthcare Commission surveys of patients and data from the government’s patient environment action teams, the latter collected by self-assessment at a time agreed in advance.

Commission inspectors looked at: 37 NHS acute hospitals (72 wards and 64 outpatient areas, including 29 A&E areas); 33 NHS mental health and community hospitals; 11 independent acute hospitals (18 wards and 11 outpatient areas); and 17 independent mental health hospitals (21 wards and two outpatient areas).

The Commission chose the hospitals by using data to identify a selection of apparent poor performers and some good performers. It aimed to get a better understanding of good practice, as well as identify poor practice.

Items looked at included medical equipment, beds, sinks, bedpans and toilets. Inspectors also looked at outpatient departments, and where appropriate A&E department areas, for spillages, blood, general stains and debris and dust.

The Commission acknowledges that there are differences in the environmental priorities between a clinical environment such as an acute surgical ward and an environment such as a mental health ward.

But the Commission says mental health service users should have the same rights as other healthcare services users to be cared for in safe and clean environment

The Commission also looked at the management and systems in place for cleaning. It found that good management of cleaning services were crucial to delivering good standards. Nearly all the sites inspected indicated that they have a housekeeper role in their cleaning services. They also reported that they regularly audited their cleaning services, reported back to staff and had schedules for cleaning.

All hospitals inspected by the Commission received detailed individual results to help them make improvements.

The Commission will now use the information collected to carry out further inspections of the hospitals rated as performing poorly to ensure that the actions agreed with local management have been implemented successfully.

The Commission will emphasise cleanliness as a priority in its “spot check” inspections under the new annual health check for NHS organisations.

The Commission will work with the Department of Health and National Patient Safety Agency to ensure that the data collected each year on cleanliness in hospitals is consistent and available.

The Commission will build on the evidence for best practice. It will use these results in its more detailed longer-term study of healthcare associated infection that it will undertake early in 2006. The study will enable further analysis of the association between performance on cleanliness and the prevention and control of infection.

http://www.healthcarecommission.org.uk/NewsAndEvents/PressReleases/PressReleaseDetail/fs/en?CONTENT_ID=4021832&chk=OVjS7C