Memorandum by the British Healthcare Trades
Please find below the areas of most concern
to our members, and for which we believe we may be able to add
to the evidence submitted to the Science and Technology Sub-committee.
There are a number of issues that are fundamental to containing
and reducing the potential for the spread of infection.
In the UK, procedures tend to focus on the cleaning/sterilising
of instruments used in operations, but ignore the trolleys that
they are carried on. (Trolley washers and bed washers are commonplace
in Europe but not in the UK.)
Disposable bedpans are destroyed in macerators
and flushed into the water system. Not only is this environmentally
questionable, but over time the machines themselves can store
Products such as hoists and patient transfer
systems are moved around wards and departments, but are not cleaned
and the risk of cross infection is greatly increased. Cleaning
of these products should take place both in sterile and non-sterile
(Anti-microbial agentsCaution needs to
be exercised when considering the use of such agents, which may
work, but over a period of time that is simply too long for products
such as slings, where the sling needs to be used swiftly for the
next patient. The Federal Drugs Agency in the USA will not allow
any claims to be made about protection to public health by anti-bacterial
Across the board, we see the need for greater
thought and review of procedures. Use of one EU Standard for cleaning
and sterilisation for various product groups, driven by the commercial
sector, and audited by the Department of Health would improve
I quote from one of my members "As an observation
from me with my Orthotic hat on, I see huge variation in standards
of infection control within the various hospitals I attend eg
in one hospital when I see a patient with MRSA, I have to work
in gloves and gown in a room which is closed off when I am finished.
All equipment has to be both washed and cleaned and alcohol wiped
before exit. Any absorbent items which are non-cleansable have
to be thrown away, and we have been instructed by the hospital
that our staff when they are handling these products should wear
masks and gloves when they are taking action such as grinding
"In other hospitals we are told no precaution
is necessary. We see a patient in a standard room and are advised
there is no need to observe any cleaning procedure as long as
the wound remains covered. I have absolutely no idea which is
correct as it is not my area of expertise but we comply with each
Trust's request and seek information from the Trust how they wish
us to handle such issues."
It would seem sensible if there were national
guidelines based on clear evidence, which all hospitals should
Increasingly, products are loaned to patients
for use at home. The ability to track and trace these products,
let alone ensure proper cleaning when they are recycled for use
by another patient varies widely and fragmentation seems set to
continue as Primary Care Trusts develop their own services. There
is a major initiative by the assistive technologies industry to
bring in wider use of bar coding to assist in putting systems
into place, but a willingness by the NHS and Social Services to
become involved is in doubt.
Track and trace technology will be fundamental
to reducing risk in this arena.
Strikethrough, a problem persisting in hospitals,
where mattresses become cut, holed by needles or abrased by poor
handling is an increasing issue. Body fluids, blood and urine
etc collect in the devices harbouring all sorts of bugs. The responsibility
for condemnation of such products is often unclear and subject
to budgeting pressure.
This is clearly a logistical and money issue
and needs to be reviewed.
I trust this is helpful and I will be happy
to provide more information if necessary.
There is much evidence that management of the
cleaning of wards is haphazard and that supervision of this aspect
needs to be at ward level.