Select Committee on Science and Technology Written Evidence


Memorandum by the British Healthcare Trades Association

  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.

INCONSISTENCY IN APPROACH TO CLEANING AND STERILISING

  Examples:

  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 infections.

  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 surroundings.

  (Anti-microbial agents—Caution 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 agents.)

  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 matters.

INCONSISTENCY IN APPROACH TO SITUATIONS WHERE INFECTION IS KNOWN TO BE PRESENT

  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 etc."

  "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 then adopt.

GROWING FOCUS ON SERVICES IN THE COMMUNITY

  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.

CONDEMNATION AND REPLACEMENT OF PRODUCTS

  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.

  Yours sincerely

Ray Hodgkinson

Director General

December 2002


 
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