Today is Global Handwashing Day. Clean Hands Save Lives.

Today is Global Handwashing Day. It's not rocket science. Dirty hands can spread infections and bring suffering, or even death, to others.

It's particularly important for health professionals to be scrupulous about hand hygiene. There is a long tradition of doctors harming their patients because of not washing their hands, e.g. many years ago many poor women died in childbirth because of doctors not washing their hands prior to examining patients and the women caught puerperal fever, which killed them. - See http://www.jameslindlibrary.org/trial_records/19th_Century/semmelweis/semmelweis_commentary.html

And as recently as 2006 the Telegraph reported that thousands of hospital staff fail to wash hands correctly. In my opinion, this is medical negligence. "Health staff carrying out wound care, such as changing bandages, failed to follow hand-washing guidelines on 86 per cent of occasions, while a quarter of staff did not wash their hands after contact with human waste.

The failure of staff to follow hand-washing guidelines is hampering the multi-million pound fight to combat MRSA, which is blamed for the deaths of as many as 5,000 patients each year."

Outrage at award of £190K damages to Rose Gibb, CEO of NHS hospital where 90 patients died during superbug outbreak in overcrowded, dirty wards.

See BBC News report. In my opinion, this woman should have received a prison sentence, rather than a huge payout.

21 NHS trust hospitals are failing to meet safe hygiene standards

We read in the Guardian that 21 NHS trusts have failed hygiene standards that determine whether they are safe to treat patients. Among these dirty hospitals are Barts in London, one of the oldest medical centres in Europe, Leeds teaching hospitals and Alder Hey children's hospital in Liverpool.

Britain's dirty hospitals have long been regarded as a national scandal and there are many people who fear ever having to go into one as a patient in case they become infected by any of the so-called superbugs. Many years ago the opposite was the case, and our hospitals were very clean indeed. I personally think that as well as exhorting staff, patients and patients' visitors to wash their hands more and to use the antiseptic hand-gels, that setting limits on hours of hospital visiting would help a lot, and being stricter about the number of visitors at a time per patient.

The fight against hospital superbugs in Scotland is being hampered by doctors not cleaning their hands properly, new NHS figures have suggested.

Fight against superbugs hampered by doctors failing to wash their hands
article in the Telegraph

Extract:

"While nurses and other staff are heeding the message, doctors are still falling short of a target for compliance with hand hygiene rules.

Other statistics reveal that rates of Clostridium difficile and MRSA are falling, albeit at too slow a rate in the case of the former to meet official targets.

Nicola Sturgeon, Scottish health minister, welcomed the figures but Scottish Labour claimed a new 'superbug tsar' is needed to tackle the scourge.

The statistics were released after it was revealed police are interviewing nurses at Vale of Leven Hospital in Alexandria, Dunbartonshire, about a C. diff outbreak in which 18 people died.

They reveal that last November nurses complied with hand hygiene rules 95 per cent of the time, but for doctors the figure is only 84 per cent."

Another shocking example of lack of compassion in a British hospital: - ordeal of World War Two hero

Dying World War Two hero 'stripped of human dignity' by hospital care, family say
article in the Telegraph

Extract:

"The family of Brigadier John Platt, who won the Distinguished Service Order for his leadership in one of the fiercest battles of the Italian campaign, told how he was discharged from Salisbury District Hospital, unable to feed himself.

They said he was in a confused state and incontinent, after a stay which left him "degraded and humiliated".

During his five-day spell in a mixed-sex observation ward, his hearing aid was crushed, his false teeth went missing and soiled pyjamas were piled up unwashed in a locker by his bedside, they said.

Knowing he was dying after losing the ability to swallow food, he asked to go home. But no ambulance was available so he was sent in a taxi on an hour-long journey to the care home where he died a few days later.

When his family later complained about the hygiene issues around the soiled pyjamas, the hospital wrote back to say that it was unfortunate that he had been "unable to avail himself" of its laundry service.

It has since apologised to Brig Platt's family for the "unacceptable" nature of his discharge in a taxi in late 2006 and vowed to learn lessons from his ordeal."

Paul Clements disagrees with Sir Richard Branson about the best way to tackle MRSA in hospitals.

Sir Richard Branson's plan to tackle MRSA will come to grief
article in the Telegraph, written by Paul Clements

Extract:

"Unless you ensure everyone who enters a hospital is clear of Staphylococcus aureus, Branson’s plan is all but meaningless.

The cheapest and simplest solution remains good hygiene – by the cleaning staff, nurses and visitors alike. Spread by contact with contaminated skin and unclean surfaces, poor sanitary procedures ensure that MRSA is a menace to the NHS.

Unless both staff and visitors are made to wear plastic gowns when at a patient’s bedside and to rub their hands with alcohol gel before and after a visit – the bacteria will thrive.

Earlier this month, I was back in an A&E ward, sat for six hours with a neighbour who had collapsed in his bathroom. Of the dozen or so staff who came to check up on him, only one used the alcohol rub before or after they had examined him. There was dried blood on the ward floor, next to scraps of unbinned surgical waste.

Rather than taking staff out of the NHS to have them disinfected, Sir Richard might do better to suggest putting in more who know their way around a mop and bucket. Either that, or start a whistleblower’s phoneline."

(Sir Richard Branson accuses politicians of failing over hospital superbugs
article in the Telegraph)

Doctors and nurses who do not wash their hands could be sacked under new "zero tolerance" rules to prevent the spread of superbugs.

Doctors and nurses to be sacked if they do not wash their hands
article in the Telegraph

Extract:

"The tough rules on hand hygiene will be applied to Scottish hospitals from January.

Those who repeatedly fail to comply with hand washing guidelines have been warned they could face disciplinary action when the new rules are implemented.

Ministers previously set a 90 per cent target for handwashing, to be met by February next year.

But they believe that target has already been achieved ahead of schedule and the health boards are being told to target the remaining ten per cent of staff who fail to keep their hands clean.

An aide to Scottish health secretary Nicola Sturgeon said it was "unacceptable" for medical staff to flout hygiene rules.

He said: "Hand hygiene is an important part of our drive to tackle healthcare associated infection. NHS Scotland has met the target to achieve at least 90 per cent compliance.

"We are now adopting a zero tolerance approach to non compliance and all Boards are expected to implement this policy from January 2009.""

I'll believe it if/when it happens! - Is this intended just for Scotland?

There is a long tradition of doctors harming their patients because of not washing their hands, e.g. many years ago many women died in childbirth because of doctors not washing their hands prior to examining patients and the women caught puerperal fever, which killed them. - See http://www.jameslindlibrary.org/trial_records/19th_Century/semmelweis/semmelweis_commentary.html

Nine out of ten NHS health trusts failed to meet hygiene standards put in place to reduce hospital infections, according to results of spot checks.

Health trusts fail hygiene tests designed to stop infections
article in the Telegraph

Extract:

"The Healthcare Commission tested 51 trusts unannounced and found that only five adhered to Government rules. Its sample represents around a third of acute health trusts in England and were part of the largest ever programme of hygiene inspections in the NHS.

While most of the failures did not pose an immediate risk to patient safety, the Commission found almost all acute trusts had more work to do to control the spread of infection.

In the areas where breaches did cause a serious risk, managers were told to take immediate action.

Three trusts were given improvement notices to tackle failures in decontamination processes.

Just over half of the 51 trusts failed to keep all areas clean and well-maintained, the Commission said.

However, it found that most had improved in relation to leadership and ensuring uniforms were clean and fit for purpose."

Seems like some really good news about reducing superbugs on hospital wards, by using copper fittings.

Copper fittings 'all but eliminate superbugs'
Article in the Telegraph

Extracts:

"The study, funded by the copper industry, found copper fittings rapidly killed bugs such as MRSA and C difficile - bugs which claim thousands of lives a year.

Trials at Selly Oak hospital, in Birmingham, found copper taps and toilet seats helped significantly reduce the presence of the bug.

Copper is a common constituent in medicines including antiseptic and antifungal creams."

"Professor Tom Elliott, lead researcher and a consultant microbiologist at the hospital, said: "The findings of 90 to 95 per cent killing of those organisms, even after a busy day on a medical ward with items being touched by numerous people, is remarkable.

"I have been a consultant microbiologist for several decades. This is the first time I have seen anything like copper in terms of the effect it will have in the environment.

"It may well offer us another mechanism for trying to defeat the spread of infection.'"

Sometimes comparatively simple measures are the most effective, as may prove to be the case with this. The simple measure that I know about personally is that the simplest, most reliable, safest, fastest way to reduce excess weight is to cut down drastically on salt and salty food. You can read about it here:

Lose weight, reduce your risk of most cancers, high blood pressure, type 2 diabetes, stroke, heart disease, heart attack, vascular dementia, osteopenia, osteoporosis, hypercholesterolaemia, depression, liver and kidney problems, and improve your health in many other ways without drugs or expense by eating less salt! - Try it! - You will feel so much better!

Read my Mensa article on Obesity and the Salt Connection

Hygiene standards in NHS hospitals have been called into question after it emerged they are routinely dealing with infestations of vermin.

Hospitals infested with rats, fleas and bed bugs
Article in the Telegraph

Extract:

"Outbreaks have included rats in maternity wards, wasps and fleas in neo-natal units, bed bug infestations, flies in operating theatres and maggots found in patients' slippers.

The data, uncovered using Freedom of Information rules, include hospitals with maggots, "over-run" with ants and mi.ce "all over" wards; cockroaches in a urology unit and a store for sterile materials infested with mice."

"The Conservatives asked all 171 hospital trusts in England for details of pest control incidents for the last two years.

Of those, 127 Trusts responded and almost all had experienced problems and 100 of them collected detailed information about pest infestations.

In total there were almost 20,000 reports of pest problems and seven out of 10 trusts that responded reported they had called in pest control officers more than 50 times since January 2006 - an average of once a fortnight."

"Of the trusts that collected detailed information 80 per cent had problems with ants, 66 per cent had rats, 77 per cent had mice, 59 per cent had problems with cockroaches, 65 per cent had biting insects or fleas, 24 per cent had problems with bed bugs and 6 per cent had maggots.

Shadow health secretary Andrew Lansley said: "Labour have said over and over again that they will improve cleanliness in our hospitals but these figures clearly show that they are failing. It is difficult for health service estates to maintain a completely pest free environment but the level and variety of these infestations is concerning.

"We need greater transparency in NHS infection control, and publishing data like this is one way in which we can drive up overall hygiene standards."

Eight hospitals trusts called in pest control officers more than 500 times, with Nottingham University Hospitals NHS Trust having the most severe problem with 1,070 incidents in two years."

Appalling!

The hospital trust at the centre of Britain's worst recorded hospital superbug outbreak which led to the death of 331 patients has escaped prosecution

Superbug hospital escapes criminal charges
Article in the Telegraph

Extract:

"Clostridium difficile contributed to the deaths of the patients over two-and-a-half years at three Kent hospitals a health watchdog report found.

Appalling standards of care, crowded wards, financial problems, a shortage of nurses and poor hygiene all led to the outbreak the Healthcare Commission found in a highly critical report in October.

However after studying that report, Kent Police and the Health and Safety Executive said there would be no charges over the deaths at hospitals run by the Maidstone and Tunbridge Wells NHS Hospital Trust.

Assistant Chief Constable Allyn Thomas said: "Whilst the report makes for grim and at times distressing reading, our review has not identified any information that would indicate a need or duty to conduct a criminal investigation into the Trust at this time."

Relatives of those who died in the outbreak reacted angrily to the announcement.

Steve Stroud, whose 77-year-old stepmother Doreen Ford died in Maidstone Hospital said he was "disgusted" by the decision.

Mr Stroud, husband of former Bucks Fizz singer Cheryl Baker, said: "This is disgusting. Someone has got to be held to account over all these deaths and if it is not the hospital trust, then who the hell can it be?

"Someone really should have to carry the can over this... for no charges to be pressed is really disgusting. I can't believe it".

Baker, described the death of her mother-in-law as "legalised killing".

She said: "The Trust is to blame, I know that, everyone knows it and it makes my blood boil.

"Those patients didn't die by chance, they died because they contracted C diff at the Trust because of poor hygiene and care, so they are to blame, without a shadow of a doubt."

The Healthcare Commission had found the infection probably or definitely killed 90 people and was a factor in a further 241 deaths.

It also criticised the then chief executive of the trust, Rose Gibb, who left before the findings were published and is now reported to be fighting for a payout of several hundred thousand pounds.

But police said the report held no evidence that the deaths amounted to manslaughter."

Beggars belief, doesn't it?- All those deaths. All that suffering. All that sadness. - No-one held to account...

Without accountability there is less likelihood of improvement...

More than a quarter of health trusts in England are failing to meet basic hygiene standards, official figures show today.

NHS trusts fail to meet hygiene standards
article in the Telegraph

Extract:

"The Healthcare Commission reports that no improvement has been made on a year ago.

In total, 103 out of 391 trusts admitted they did not achieve the minimum requirements, brought in by the Government to help combat the hospital superbugs, MRSA and Clostridium difficile.

Patients groups and politicians said that it was "shocking" that one in four still did not meet the standards, despite ministers' pledges to tackle cleanliness.

More than 8,000 deaths were related to MRSA and C. diff. The report shows that 26 per cent of trusts failed to keep facilities clean, did not have adequate infection control or follow guidelines on decontaminating reusable equipment.

Only 40 per cent of trusts claim to have met all the Governments standards, which include patient care and confidentiality as well as hygiene, a slight fall on last year."

The number of deaths in Britain linked to the potentially deadly superbug Clostridium difficile has quadrupled in just five years.

Deaths from hospital superbug Clostridium Difficile quadruple

Extract from the Sunday Telegraph:

"More than 6,000 people died in 2006 after becoming infected with the gut infection in hospitals across England and Wales - a more than four-fold rise compared with 2001 figures, the Office of National Statistics will say.

Meanwhile, the number of deaths linked to MRSA rose by more than one third, with the infection mentioned on almost 1,700 death certificates in 2006.

The figures, due to be published on Thursday, follow an admission by the Department of Health's most senior experts in infection control that the main reason for a 50-fold increase in cases of Clostridium difficile in less than two decades is the failure of hospitals to follow hygiene rules drawn up 14 years ago."

Infection rates in British hospitals are ten times higher than those in other countries

British hospitals 'worst for superbugs'

Extracts from the Sunday Telegraph:

"Infection rates in British hospitals are 10 times higher than those in other countries, according to a damning report.

The report, from a panel of government advisers, warns of "a fifty-fold increase since 1990", with one in five cases of the killer bug Clostridium difficile now affecting patients below the age of 65.

A leading infection expert, Prof Richard James, director of the Centre for Healthcare Associated Infections, said the figures meant Britain's death rate from the bug was likely to dwarf those of other countries. The unpublished report, seen by The Sunday Telegraph, urges hospitals to improve hygiene, testing and isolation procedures to slow the spread of the infection, which was caught by more than 50,000 people last year."

"A television programme tonight warns that C. difficile infection is becoming increasingly resistant to treatment.

• 'Panorama: How Safe is Your Hospital?', BBC1 10.20pm, Sunday April 27th."

You can improve your resistance to infection by eating less salt/sodium and salty food.

Lord Mancroft condemns poor nursing and poor hygiene at Bath's dirty Royal United Hospital.

Lord Mancroft attacks 'grubby, drunken' nurses

Extracts from the Telegraph:

"A Conservative peer has delivered a devastating attack on nurses who looked after him during a stay in hospital describing them as "grubby, drunken and promiscuous"."

"He told peers: "The nurses that looked after me were mostly grubby. We're talking about dirty fingernails, slipshod, lazy.

"It's a miracle I'm still alive. But worst of all my Lords they were drunken and promiscuous.

"How do I know that? Because if you're a patient and you're lying in a bed, and you're being nursed from either side, they talk across you as if you're not there.

"So I know exactly what they got up to the night before, and how much they drank, and I know exactly what they were planning to do the next night, and I can tell you, it's pretty horrifying.""

NHS Trust hospital is warned about poor hygiene and infection control practice

NHS trust warned over hygiene breaches

Extract from the Telegraph:

"An NHS trust has been given a warning after inspectors found filthy commodes and bloodstains on a bed rail and wall.

The Healthcare Commission served Bromley Hospitals NHS Trust with an improvement notice over poor practice in tackling infection control.

Thick layers of dust and evidence of poor decontamination procedures for surgical equipment were also found by investigators.

The trust runs three hospitals in south London: the Princess Royal University Hospital, Orpington Hospital and Beckenham Hospital.

The commission carried out an unannounced inspection at the Princess Royal University Hospital on Jan 21 and 22.

It found that the trust was "failing in its duty to provide and maintain a clean and appropriate environment for health care".

Geoff Martin, of the campaign group Health Emergency, said: "Bromley Hospitals has one of the biggest debts anywhere in the country, of almost £100 million.

"They are cutting corners on cleaning because they have been effectively bankrupted by the cost of a PFI deal at the Princess Royal. This is the harsh reality of PFI coming home to roost.""

Female Muslim medics 'disobey hygiene rules'

Female Muslim medics 'disobey hygiene rules'

Extract from the Sunday Telegraph:

"Muslim medical students are refusing to obey hygiene rules brought in to stop the spread of deadly superbugs, because they say it is against their religion.

Women training in several hospitals in England have raised objections to removing their arm coverings in theatre and to rolling up their sleeves when washing their hands, because it is regarded as immodest in Islam.

Universities and NHS trusts fear many more will refuse to co-operate with new Department of Health guidance, introduced this month, which stipulates that all doctors must be "bare below the elbow".

The measure is deemed necessary to stop the spread of infections such as MRSA and Clostridium difficile, which have killed hundreds.

Minutes of a clinical academics' meeting at Liverpool University revealed that female Muslim students at Alder Hey children's hospital had objected to rolling up their sleeves to wear gowns.

Similar concerns have been raised at Leicester University. Minutes from a medical school committee said that "a number of Muslim females had difficulty in complying with the procedures to roll up sleeves to the elbow for appropriate handwashing".

Sheffield University also reported a case of a Muslim medic who refused to "scrub" as this left her forearms exposed.

Documents from Birmingham University reveal that some students would prefer to quit the course rather than expose their arms, and warn that it could leave trusts open to legal action.

Hygiene experts said last night that no exceptions should be made on religious grounds."

Up to 20 hospitals had higher levels of clostridium difficile last year than the health trust at the centre of the superbug outbreak that killed 90+

Twenty hospitals worse than superbug ward- Telegraph

Extract:

"Up to 20 hospitals had higher levels of clostridium difficile last year than the health trust at the centre of the superbug outbreak that killed at least 90 people, new figures reveal.

List of problem hospitals

Iraq soldier Jamie Cooper latest superbug victim

At the weekend it emerged that 18-year-old Private Jamie Cooper, the youngest Briton to be injured in Iraq, could be one of the latest victims of the disease which causes severe diarrhoea and is spread by poor hygiene.

The list of hospitals with a poor C.diff record emerged as the Government was accused of ignoring an internal memo in 2006 that warned that the infection was becoming endemic in NHS hospitals and suggested that £270million was needed to tackle it. "

NHS superbug board should have been sacked, say Tories - Guardian reports today

NHS superbug board should have been sacked, say Tories - Guardian

Extract:

"Government ministers were last night accused of aggravating the NHS superbug scandal by failing to take charge of the hospitals where 90 people died as soon as the scale of mismanagement became clear.

Andrew Lansley, the Conservative shadow health secretary, last night said the three hospitals of the Maidstone and Tunbridge Wells NHS trust should have been brought under direct departmental control.

In a report on Thursday, the Healthcare Commission said scores of patients died from infection by Clostridium difficile bacteria in Britain's worst outbreak of a hospital superbug. It blamed the trust board for a catalogue of safety lapses that caused the death toll between April 2004 and September 2006.

Mr Lansley said the government should have acted to suspend or sack the trust's board as soon as it received an advance copy of the commission's findings in the middle of last week.

Instead, it allowed directors to agree a package worth more than £250,000 for Rose Gibb, the chief executive, who quit her job on Friday last week without any announcement or public explanation.

Mr Lansley said: "This devastating report should have precipitated the immediate removal of those responsible on grounds of gross negligence. Normally employees are entitled to written warnings, but in circumstances of gross misconduct most contracts allow for summary dismissal. I do not know why that did not happen in this case."

The commission accused the trust of "significant failings in infection control". When inspectors went into its hospitals after the C difficile outbreaks were contained, they found patients being provided with bedpans that were visibly dirty with faeces. Bedding and equipment was left on the floor, fire doors were blocked and needle and sharp instrument disposal bins were overflowing on four wards. Staff washed cups in treatment room sinks and stored food in the clinical refrigerators.

Mr Lansley said: "The Department of Health could and should have removed the entire board and any directors with a contribution to make could have been appointed to a new one. The power exists when ministers have no confidence in a board. It is difficult to imagine what might be a graver offence than the one they perpetrated." Sacking the board would have forestalled any payoffs, he added.

After media criticism of the payoff on Thursday, the health secretary, Alan Johnson, instructed the trust to withhold the severance payment, pending legal advice. The department said yesterday its lawyers were still considering the matter."

More about the hospital hygiene problems, C Diff and MRSA...

The Big Question: Why can't we keep our hospitals clean and protect patients from infection? - Independent

Extract:

"Yesterday an investigation by the Healthcare Commission revealed an astonishing litany of failings at three hospitals in Kent run by the Maidstone and Tunbridge Wells NHS Trust which allowed the lethal bug Clostridium Difficile to spread unchecked. Between 2004 and 2006 it infected more than 1,100 patients, directly causing the deaths of 90 and contributing to the deaths of 345. The commission found appalling standards, akin to a Third World health service, including beds crammed together, wards dirty and understaffed, and patients with urgent diarrhoea told to "go in the bed" because nurses were too busy to take them to the lavatory.

Is this just an isolated case?

Sadly not – though it is the worst to have come to light. Last year an investigation into a similar outbreak at Stoke Mandeville hospital, where 334 patients were infected and 33 died from C Difficile between 2003 and 2005, painted a very similar picture of a poorly run hospital operating under extreme pressure where doctors and managers had failed to heed warnings about the threat from the bug. Last July, the 900-bed Barnet and Chase Farm Hospitals NHS trust in north London became the first in the country to receive an official warning from the commission for putting patients at risk of infection. Serious breaches of the Hygiene Code, introduced in October 2006, which sets minimum standards for all trusts were found at the hospital.

But can we assume that hospitals are generally clean?

No. In June the Healthcare Commission reported that 99 NHS trusts admitted failing to meet minimum hygiene standards. That is one in four of the total in England. Worryingly, Barnet and Chase Farm was not among the 99. It had claimed it was meeting minimum standards but a spot check revealed poor provision of gels for cleaning hands, inconsistent and confusing messages to staff and inadequate isolation facilities. If other trusts are similarly deceived about their performance then hygiene problems may be even more widespread than the one in four figure suggests."