Thursday, September 16, 2004

Where did the Smell of Disinfectant go? (Part II)

Operating theatres are full of identically dressed people who don’t wear name badges, forcing staff to guess whether the new colleague they are standing next to is a surgeon, anaesthetist, nurse, operating department practitioner, auxiliary, orderly or cleaner. Chatting to a new colleague today, I find she is a former cleaner who has just become a theatre auxiliary; an unqualified assistant who is able to fetch equipment, instruments and sterile supplies for the nurses and ODPs assisting the surgeon.

My new colleague and I got talking about hospital cleanliness and I shared some observations I had made as a ward nurse about how little time cleaners spend cleaning wards, resulting sometimes in truly filth conditions. Her replies were more than a little worrying and I share them with you now.

According to my colleague cleaners have on average about an hour a day to clean a busy 32 bedded ward. They will cover several wards and as well as cleaning floors and surfaces they wash up the kitchen, hand out and collect meals and do tea rounds for the patients. Feeding patients has historically been a nursing job, for the very good reason that inadequate food and liquid intake leads to malnutrition and dehydration; malnutrition being a growing problem in hospitals, or more accurately NHS hospitals. (I’d bet you money that problem started when nurses stopped taking responsibility for mealtimes, but that’s another story.)

Sadly it’s true, as I was once told, that cleaners aren’t allowed to clean up body fluids, specifically urine, faeces, vomit and blood. Possibly a reasonable proscription if you’re a cleaner in an aeroplane factory, it’s surely foolishness in a hospital where such fluids are the reality of daily life. In practice it becomes the responsibility of nursing staff to clean up the mess. Of course the nurse’s immediate responsibility is to the unfortunate patient whose clothes and bedding need changing, or who needs comforting, or who is haemorrhaging. If the floor needs cleaning it’s going to get done after the patient’s needs are met, and it’s probably going to get done in a cursory way, because by now the nurse will be behind in the other tasks she needs to be doing.

The cleaner’s one hour clean needs to be seen in this context. Moreover, as my colleague points out, that one hour clean invariably coincides with the doctors ward round, or patients being collected for theatre or whatever. Training is apparently derisory, with poorly motivated cleaners being inadequately trained by equally dispirited supervisors.

My colleague isn’t impressed by hygiene in the operating theatre either. Cleaners don’t clean equipment, only floors and fabric (presumably on the ground that the equipment is expensive and cleaners might break it). The result is that the equipment barely gets cleaned at all, and when it does it is in a haphazard and intermittent way. Perhaps what is most frightening is that we are a good hospital, well regarded, and one in which, by and large, I’d be happy to be an inpatient myself. Goodness alone knows what it’s like in the bad ones.

What can be done? I don’t see an alternative outside a significant increase in the priority given to hospital cleaning and to cleaners. There is some evidence that my hospital is beginning to see this (it came out quite badly in recent MRSA figures). Well trained, motivated cleaners are as vital to patient recovery as doctors and nurses (Certainly bad cleaners are as deleterious to patients recovery as bad doctors and nurses) Wards should have their own cleaners and they should not get sidelined into jobs more properly done by nurses. They should be trained and expected to clean up body fluids, and should be on hand to do so. They should also be trained to clean equipment and if they have to be paid more to attract appropriately intelligent staff they should. Short-termism has long been the bane of the NHS but MRSA infection rates, among many other things, show what a poor long term investment this has been. The irony is that in many cases the solution to hospital aquired infections will be a return to practice which was considered normal forty years ago.


Anonymous Anonymous said...

As always we spend 40 years coming round to the common sense solution to a problem that did not occur before the changes were made.

There again are you aure that everything else has not yet been tried? Surely there are a few more hair brained schemes to waste time on first.

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