Letters

What are the manager's obligations to avoid dirty wards?

Armed with the support of the microbiologist, clinical nurse specialist and the hospital engineer they must examine the air flow in the hospital, wards and departments.

What filtration systems are in place and how often are they changed and tested? What temperature and humidity are maintained over every 24-hour period? What needs to be done to achieve minimum standards and reduce cross-infection risk?

Expensive? Yes.

The domestic cleaning contract/practices do not adequately clean the hospital - improve the specification and also add more frequent toilet, curtain and blinds cleaning, wall washing and an annual ward closure for a complete clean.

Expensive? Yes.

Staff hand-washing is the best defence against cross-infection.

Check location and number of hand-wash basins; do they all have hot/cold water, soap and a drying method at all times and forever? Boring, but effective.

Write a hand-washing policy for all staff who go into wards and departments. Medical staff on rounds are just as liable to transfer bacteria as nurses working between patients.

Get the microbiologist and the clinical nurse specialist to review all ward and departmental procedures that promote crossinfection. Decide how to police these policies - empower the ward and departmental manager.

Staff appearance and uniformchanging arrangements: is long hair a cross-infection risk? Is wearing your work uniform in your home a risk to your family?

Are patient cross-infection rates kept for every ward and every consultant? Do these statistics include fatalities? Is the microbiologist and the appropriate clinical manager given this information on a regular basis? Do they have the authority, the inclination and the nerve to follow this up and take remedial action?

A McDougall Liverpool