You have to feel some sympathy for Ignaz Philipp Semmelweis. Back in 1847 he discovered that he could stop mothers dying in childbirth simply by getting doctors to wash their hands. Despite seeing mortality drop dramatically from 13% of women to 2% his idea only really took on years after his death, leaving Louis Pasteur – the pioneer of germ theory – to gain fame and a place on GCSE science syllabuses.
He does make it, however, onto the training agenda at Bupa’s Cromwell Hospital in London where I’ve been invited to join a session on infection prevention and control. And it turns out that over a century later, Semmelweis’ practice remains a gold standard.
“Hand hygiene is the most important practice healthcare workers can undertake in preventing the spread of bugs from one person to another,” says Jackie Portsmouth, the hospital’s consultant nurse in infection prevention and control.
Minutes later I find myself practising the six step hand washing technique (developed by Ayliffe back in 1974) in Bupa’s training centre’s kitchen. Apparently most people forget to wash their thumbs but it’s the nails that catch me out when Jackie carries out her inspection under UV light. Back to the sink.
It is clear that infection prevention is a major priority at The Cromwell. The chief executive has overall responsibility while all staff – from receptionists to porters to doctors – are involved in mandatory training sessions. Later on in the day I visit a ward with Jackie, who spends as much time as possible liaising with staff, including her 16 infection control link nurses, ensuring that her training is translated into practice. During the morning’s session she points out that patients need to see staff adhering to the policy, particularly by washing their hands.
There is no doubt that so-called ‘superbugs’ are a major concern for people going into hospital. Earlier this year a poll carried out by General Healthcare Group (owner of BMI hospitals) found that the risk of infection and hospital cleanliness is the public’s biggest concern about NHS treatment. Bupa’s 2008 Health of the Nation survey found that anxiety about cleanliness had become the number one reason for considering private medical insurance (PMI).
The risk of acquiring a hospital-acquired infection is undoubtedly lower in a private hospital that in the NHS. Jackie tells me that there have been no cases of MRSA at The Cromwell in the last 18 months and just one case of C.difficile brought across from a nursing home. Other independent providers report similarly low rates, highlighted on websites and in marketing material. The story in the NHS is one of steady progress blighted by some high profile tragedies that persist in the public’s consciousness. In the last two years there has been a 59% decrease in the number of MRSA cases, which fell to 444 in the last quarter of 2009 and a 58% decrease in cases of C.difficile. Nevertheless, events such as those at Maidstone and Tunbridge Wells NHS Trust where more than 500 patients developed C.difficile and 60 died as a result between October 2005 and September 2006, highlight the dangers of failing to maintain the highest standards of prevention and control. The regulator’s report found that the trust had no effective system for the surveillance of C. difficile and that the clinical management fell short of an acceptable standard.
Improvements have since been made at the trust but it remains a touchstone for the public’s concerns about cleanliness. AXA PPP healthcare’s poll of 2,282 people this year found that 49% are not confident that their local hospital has managed to get hospital-acquired infections under control.
It is important to remember that the NHS will always have higher rates of infection than the private sector. A major factor is that it receives emergency admissions while independent hospitals take elective patients who can be screened for MRSA prior to admission. The NHS also receives a higher proportion of elderly patients who are much more susceptible to C.difficile for example. Much has been done in recent years to tackle infections and all elective patients are now screened for MRSA before admission, something that also happens at The Cromwell. Jackie herself has recently moved to the Cromwell from her post at Brighton and Sussex NHS Trust and points out that all hospitals, both private and NHS are subject to a single code on infection control and prevention.
In addition to a very different patient population, The Cromwell also has the advantage of single rooms, something that the Conservatives pledged to expand in the NHS while in opposition but which looks unlikely to materialise in the current economic climate. Single rooms mean that patients found to carry an infection can easily be isolated and there is no sharing of toilets or bathrooms.
It’s a constant battle to keep infection at bay in all hospitals. During the training Jackie points to advances in medicine that have influenced the rise in hospital-acquired infections in recent years, from the development of chemotherapy (which depletes the body’s immune system) to the use of medical devices that breech the skin, such as catheters. Nevertheless, it’s a war that The Cromwell is winning and one in which the staff’s attitude is crucial.
“You should treat each patient as if they were your own mother,” Jackie concludes.