MRSA Action UK: Our reaction to the Government's response on the wearing of NHS uniforms outside of hospital

Monday, 12 January 2009 12:00 AM

Last November Penwith Older People's Forum and MRSA Action UK petitioned the Prime Minister to introduce legislation to make it compulsory for nurses to change out of their uniforms after working their shift, before leaving the hospital. We asked that this measure should be introduced to stop the spread of infectious and life-threatening illness caused by infections such as MRSA and Clostridium difficile, taking into account measures recently introduced to no longer require doctors to wear white coats.

This week the Government responded stating "it is the responsibility of each NHS Trust to have its own policy about the wearing of uniforms and these may vary across the country. Trusts' Chief Executives have responsibility for ensuring that nurses have enough suitable clothing and equipment to carry out their work effectively. Trusts are expected to keep their policies in respect of uniforms and workwear under review."

"The Department of Health's Working Group on Uniforms and Laundry put together an evidence base on the wearing and laundering of uniforms outlining the existing legal requirements and current research findings. The findings contained in the document are built on two wide ranging literature reviews. The report contained a number of conclusions for Trusts. One is that there is no conclusive evidence that uniforms (or other work clothes) pose a significant hazard in terms of spreading infection."

The guidance on laundry referred to in the Government's response provides conflicting evidence and does indeed suggest pathogens are carried on uniforms and workwear:

"Cuffs become heavily contaminated and are more likely to come into contact with patients."

"Visible soiling or contamination might be an infection risk, and is likely to affect patient confidence"

"A wash for ten minutes, at 60C, removes most micro-organisms"

"Using detergents means that many organisms can be removed from fabrics at lower temperatures. MRSA is completely removed following a wash at 30C"

"Dirty or under-performing machines can result in contamination with environmental micro-organisms."

"Ties are rarely laundered but worn daily. They perform no beneficial function in patient care and have been shown to be colonised by pathogens."

Department of Health guidance on personal hygiene for patients who are MRSA positive suggests that clothing is changed daily:

- You should not share personal towels and should change yours daily for the duration of your treatment.
- You can use your bath or shower and will probably have a special body wash and shampoo prescribed by your doctor.
- After washing, it is important that fresh clothing is worn, also that fresh night clothes are worn each night, for the duration of your treatment.
- Bedding should be changed daily for the duration of your treatment.
- Wash clothes at hottest temperature for the fabric using usual detergent. Avoid overloading the machine"

All of this advice does indeed conclude that pathogens can be carried on clothing and MRSA Action UK is not satisfied that every effort is being made to ensure patient safety with regard to the lax policy on the wearing of uniforms in the public domain.

The Government's response went beyond the issue of uniforms and made statements about work that is underway to reduce healthcare infections. Whilst this work is welcomed we do not believe it is nearly enough.

Health Secretary Alan Johnson talks of the 50% reduction in MRSA bloodstream infections and the reduction in Clostridium difficile, the trend is in the right direction but is not nearly challenging enough, the response recognises this and states:

"Not every organisation has achieved a 50% reduction; for those organisations this objective should remain their immediate goal. Those that have already done so must continue to reduce infection rates. Primary Care Trusts will agree stretching ambitions in contracts with provider organisations for reducing infection rates and improving cleanliness. Strategic Health Authorities will ensure PCT plans are robust in this respect and must be satisfied that those plans demonstrate, collectively, reduced variation in performance."

"As High Quality Care for All set out, once national targets are achieved they will become national minimum standards for all NHS organisations and a national standard for all patients. This is therefore the Government's intention with the MRSA target, but it is necessary to define how the MRSA target enters the standards framework in a way applicable to all NHS organisations."

We await the consultation on the National Minimum Standard, as we believe targets for reducing healthcare infections are not challenging enough. Lord Darzi's document "High Quality Care for All" gives a commitment on providing better information. Yet information on infection rates is not easily accessible, only MRSA bloodstream infections are accessible on the NHS Choices website. Wound infections are not given, only limited reporting is given on the Health Protection Agency website, patients are not given the true picture, Trusts who report zero MRSA do not have no cases of MRSA, they have zero bloodstream infections - this is misleading and the National Minimum Standard should take this into account.

The Government response also stated "From April 2009, the Care Quality Commission will take over responsibility for health and social care regulation. It will continue to monitor compliance against the MRSA standard, the C. difficile target and the Hygiene Code, but will be able to use additional enforcement powers and take prompt action where patients are at risk."

High Quality Care for All mentions 2 million adverse events a year and the approach to "Never Events" in the USA, whereby payment is withheld when these events occur - will avoidable healthcare infections count as "Never Events" under such a scheme in the UK?

There is a commitment to tackle central line and catheter-related bloodstream infections in Lord Darzi's document, why not wound infections, why do we have under-reporting, where is the openness and the commitment to reduce all avoidable infections?

We know there is far more to tackling healthcare infections than addressing the problem of wearing uniforms outside of hospital, does this Government recognise this though?

We believe the Government's half-hearted response on the wearing of uniforms outside of hospital is an attempt to divert the attention away from the true scale of the problem. By digressing from the issue of pathogens being carried on clothing, this has only served to draw attention to the shortcomings of those Trusts who cannot be trusted to self-regulate, either on the issue of uniforms or other measures within the Hygiene Code. We have yet to see real enforcement powers being used on Trusts who do not comply with the Hygiene Code.

Derek Butler
Chair
MRSA Action UK
07762 741114

derek.butler@mrsaactionuk.net
http://mrsaactionuk.net

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