Published: 14/07/2005, Volume II5, No. 115 Page 39

Tackling infection requires clear definitions of the task ahead - and the terminology. Penny Harrison makes the case for clarity

Amid all the furore about infection, it is important to not lose sight of the distinction between healthcareacquired infections (those definitely attributable to a source within a hospital or other healthcare premises) and healthcare-associated infection (HCAI).

Over 80 per cent of the latter are caused by a combination, in a healthcare environment, of healthy but infection-carrying staff and visitors and infection-prone patients.

This can result in methicillinresistant Staphylococcus aureus (MRSA) and other HCAIs that are not caused by dirt or the lack of tools to remove the dirt. There does not seem to be a link between a grubby environment - unpleasant and unacceptable as this is - and HCAIs.

Perhaps it is best summed up as differentiating between aesthetically clean (easy to see and measure) and clinically clean (impossible to see and incredibly hard to measure in a timely and effective manner).

And it would be helpful if those professionals adding to the media debate would think before linking cleaning and infection in the argument. It is the unfortunate tendency of elements of our media to focus on good sound-bites, such as 'filthy hospitals kill patients' - and sloppy wording gives them plenty of material.

That said, regardless of links or lack of them between cleaning and infection, it would be entirely wrong to stop focusing on the need to provide all visitors to healthcare premises with a pleasant environment that looks clean and smells fresh. And the Association of Domestic Management remains as committed to this task now as throughout its 30-year history.

It would be wrong to deny that healthcare premises have at times been cleaner than some are now, and there are many reasons for this.

Some can be easily identified:

a continuing lack of properly trained, motivated and rewarded staff with clear career pathways;

an ageing workforce, unsupported by enthused young people entering the profession;

target-driven turnover of patients and beds, pressuring staff to make short-cuts in cleaning procedures;

increased throughput giving much more to clean with far less time to do so. There are similarities with the 24-hour shopping culture - but theatres cannot be cleaned with the patient on the table.

Training, rewards and recognition, together with good-quality supplies, would go a long way to addressing these issues.

Matron has been reintroduced.

This is a very popular move with the general public, but perhaps viewed more cynically in the NHS. It is excellent to have a focal point capable of creating team spirit and responsible for a given area, and matrons fit the bill admirably in this regard. But they lack technical expertise and it is essential that they are advised by professional cleaning service managers.

Matrons also have to understand the financial implications of decisions. If, for example, they feel there are good aesthetic or clinical reasons for cleaning the insides of windows more frequently, they have to make an informed choice about which part of the service can be cut back to fund the additional cleaning.

And they need to be aware which new products and services - all claiming to prevent or kill MRSA - are robust. Guidance should come from the NHS Purchasing and Supply Agency, rapid response panels, infection control experts and the cleaning manager.

So far I have not made reference to contracted services. This is because differences in the way managers and staff are perceived should not be determined by who pays their wages. They are all still individuals capable of being good (or bad) team players. A badly negotiated contract or service-level agreement should not be an excuse for a poor service - even though it may have been the original cause.

Senior management must also recognise that cleaning can, when lacking, bring the entire structure of the healthcare environment to a halt.

In this respect the guardians of our conscience in the media make no mistake, and those in charge would be wise to take heed.

Continuing change in the ways in which premises are managed mean there is no longer a clear ruling available to help non-technical staff.

There is a wealth of guidance but all of it has the caveat that it is 'only guidance', and if local practices are felt to be equally or more robust then they may set the standard.

A cynic could argue government guidance is there simply to allow the health secretary to boast of its existence. Much of it is produced by volunteers giving their own time and expertise to help slimmed-down government bodies.

While it is admirable to use technical expertise available from such bodies as the Royal College of Nursing, the Infection Control Nurses Association and the Association of Domestic Management, it is a mistake to expect those providing it to continue indefinitely at the expense of their own free time. Their jobs are demanding enough. Government secondment could and should be used to address this issue.

So let us please clear up some misapprehensions, identify the task ahead and then fund and engage in the solution. .

Penny Harrison is business manager for the Association of Domestic Management.

www. adom. demon. co. uk