PERFORMANCE: Serious shortcomings in infection control have been discovered at Mid Yorkshire Hospitals Trust, including nurses having to carry out routine cleaning due to a lack of cleaning provision.

The report of an independent review, commissioned by the chief executive and reporter to the trust’s board, says: “Our overall observations are that the actions you are focusing on from a senior management perspective are, in fact, the correct ones; however there are a number of areas where these actions can be strengthened, particularly to achieve implementation of your policies at the front line of operations. We would, therefore, make the following comments and recommendations.

“Your principle risks are related to: 1. Prudent prescribing and antibiotic stewardship 2. Cleaning provision 3. Assuring competence for ANTT and associated invasive procedures.

“There are three further issues that you need to be assured are being addressed which are: 1. Prompt and appropriate isolation 2. Addressing levels of MRSA colonisation/carriage with a focus on reliable decolonisation procedures across your health economy. 3. Applying RCA as a cross-professional learning exercise rather than aimed at deciding on avoidability.”

In relation to cleaning, the report says: “This is an area of risk that requires urgent attention. Whilst you have a keen, willing Facilities Manager who appears to be attempting to utilise the resource he has effectively and creatively, there is not sufficient funding to provide a 24/7 cleaning service on all sites.

“The PFI sites are working to the 2003 Cleaning specification which has been replaced with three further specifications in the intervening years to achieve provision of a good quality service. At Dewsbury the in-house service is working to the 2004 standards, but for two days a week 24/7 is not provided. This means:

  • Nurses are required to do the “green and red” discharge cleans.
  • Nurses have not been trained to do this.
  • The “Eco-lab” project showed that the cleaning by nurses was less effective than that done by the domestic staff.
  • Pressure on beds pushes staff to clean more quickly and anecdotal feedback indicates staff believe bed areas are not being cleaned thoroughly at these times.
  • Nurse staffing is already “tight” so taking them away to clean must impact on their time for patient care.
  • Even within the current specification with your PFI provider, the time allocated for a post-discharge clean appears to be less than the 45 minutes that is generally regarded as necessary for an effective clean.”

It follows problems controlling infection rates at the trust.