The crucial role of hospital cleaners is being underestimated to the detriment of our patients
21 August 2006
"Nail technicians required immediately" said the huge advertisement in the shop window in Donnybrook. Dear heaven, I thought, it's from the Department of Health! The Tánaiste is getting young ones with nail clippers into the hospitals in the effort to improve hand hygiene. I had just been reading the latest report on hospital cleanliness and, while hand hygiene had improved, there were still criticisms. It's getting so that Pontius Pilate will shortly be declared the patron saint of hand hygiene and perhaps even hospital cleanliness, too.
Low standards of hand hygiene in hospitals are to be deplored because this is an important way in which infection is spread. While there are improvements reported in the "The Second National Acute Hospital Hygiene Audit" the assessors do note that some medical personnel wear rings with stones, watches and bracelets. Nurses do not, in general. The gender of the medical personnel is not mentioned but I guarantee to you this will be one of the main criticisms addressed in the press.
Glad as I am to see these improvements, a recent discussion with a Swiss colleague on the subject made me well aware that this is not just an Irish problem and that even the Swiss who seem so clean and well ordered constantly need reminding of guidelines, too. I had this notion that once the Swiss health worker was programmed he or she would be as reliable as a cuckoo clock. Not so, they are just as human as us.
The hand washing improvement may have been closely associated with the provision of hand basins, or their increased availability. If it is difficult to get to hand basins, or soap and paper towels are not provided, it is going to be difficult to get proper practice instituted. Repair of wash hand basin surroundings should be automatic and not noteworthy, as happened several times in this report. From past experience I am well aware that to get such reparations may have taken quite an effort. It's often extremely difficult to get those features in hospitals which seem mundane fixed when they break, even if the repairs cost little.
General cleanliness in hospitals had improved too, although cot sides and beds were dirty and dusty in some places. It could be argued that beds are rarely cold enough to clean them properly such is the bed occupancy - 105 per cent it is said to be in some hospitals, whereas 85 per cent is considered optimum. High bed occupancy is associated with hospital acquired infections and with MRSA, both of which are high on the political radar. Positive correlations between high bed occupancy and MRSA cases identified have been reported internationally, even as close as Northern Ireland, but it is not a popular topic to address in this Republic.
As a historic fact I can tell you that in the Good Old Days wards were not as crowded as they are now. Not to mind A&E departments, where even the laws of decency have surely been breached whatever about good clinical care. And remember, the solution from on high to crowded A&E departments with patients on trollies was to tell hospital managers to put an extra bed into each ward. The association between overcrowding in wards and infection has obviously not been made plain enough.
Another thing that strikes me about cleanliness in hospitals is a certain lack of information on the number and calibre of the cleaning staff. The cleaning staff in the Good Old Days "owned" wards. It appears from the reports that contract cleaning or in-house cleaners makes little difference, but are there enough cleaners, how well are they trained and how well paid? Are they made well aware of their value to the hospital? Too often I read articles or reports which talk about "Even down to the cleaners and the porters." Hospital life is a corporate effort, folks, and all of us are involved in it. Poor nurse-to-patients ratios are frequently cited in the reports on infection spread. Is there such a report on cleaners? Also, the hours cleaners are rostered must be extended, to hell with the expense.
One of the most repulsive of modern inventions surely is the disinfective wipe and to my horror I discovered they were being used in some hospitals. How did they get in there? It is well known that bacteria dote on them. Not only should they be banned in hospitals or other institutions but I wish people in general knew more about how undesirable they are. This brings me back to antibiotics and their abuse and inappropriate use. Some of the most well educated members of the public still think they are magic bullets which can cure everything. What about a campaign on this issue, Tánaiste?
It is essential our hospitals appear clean, as well as are clean, and I am sad to see that only half the bathrooms passed the assessors' tests. Only half the baths had cleaning materials within easy access and this would not encourage much endeavour in this area. And toilets - the majority had wash hand basins available. If this was in a factory making cars one would be horrified, but to find it in a hospital makes us all realise these hygiene audits were not before their time.
Some people keep harping back to the Good Old Days with the nuns or eagle-eyed matrons, but while the brasses were sparkling and the loos clean it is obvious they did not have adequate hand basins then.
So my list of recommendations or queries are: more beds, so that bed occupancy can be reduced to allow better cleaning of same; the staffing levels of patients to nurses was not addressed. I would like to know more about the staffing ratio of cleaners, their rosters throughout the day and their pay rates. Is long and loyal service rewarded? There should be an excess of hand basins, soap and paper towels in all hospitals; a public campaign regarding uselessness of antibiotics in many situations; and general encouragement to all in acute hospitals to continue their good progress and hope that our long term facilities are getting ready for their inspections.
Senator Mary Henry, MD
