MRSA Action UK and Penwith Older Peoples' Forum approved the proposal to create a petition to reintroduce the former NHS uniform policy in April 2008. We called on the Prime Minister to introduce legislation to make it compulsory for nurses to change out of their uniforms after working their shift, before leaving the hospital. This measure should be introduced to stop the spread of infectious and life-threatening illness caused by disease such as MRSA and Clostridium difficile, and takes into account measures recently introduced to no longer require doctors to wear white coats.
On Friday 9 January the Government responded:
"It is the responsibility of each NHS Trust to have its own policy about the wearing of uniforms and these may vary across the country. Trusts' Chief Executives have responsibility for ensuring that nurses have enough suitable clothing and equipment to carry out their work effectively. Trusts are expected to keep their policies in respect of uniforms and workwear under review.
In order to support and advise Trusts in the review and maintenance of such local policies, the Department of Health's Working Group on Uniforms and Laundry put together an evidence base on the wearing and laundering of uniforms outlining the existing legal requirements and current research findings. This document, Uniforms and Workwear: evidence base for developing local policy, was published in September 2007 and a copy is available on the Department of Health's website at www.dh.gov.uk (enter 'uniforms and workwear' in the search bar).
The findings contained in the document are built on two wide ranging literature reviews carried out by Thames Valley University, plus empirical research work done by University College London Hospital NHS Trust (UCLH). The work also had input from professional healthcare groups and trade unions.
The report contained a number of conclusions for Trusts. One is that there is no conclusive evidence that uniforms (or other work clothes) pose a significant hazard in terms of spreading infection. Generally, nurses and other staff use aprons and gloves to prevent soiling of their uniforms. Individual hospital Trusts are best placed to set and monitor policies on wearing and changing uniforms and can use the evidence base the Department has provided in doing so.
The Health Act 2006 Code of Practice for the Prevention and Control of Healthcare Associated Infections (revised in January 2008) places a duty (4) on specified healthcare providers to provide and maintain a clean and appropriate environment for healthcare. Sub duty 4(h) of the Code makes the specific provision that Trusts' uniform and workwear policies should ensure that clothing worn by staff when carrying out their duties is clean and fit for purpose. The document is also available from the Department of Health website (enter 'prevention healthcare associated infections' in the search bar).
More generally, and looking beyond the specific issues of the policy on uniforms, Health Secretary Alan Johnson has paid tribute to NHS staff for their significant success in going beyond the Government's target of halving MRSA blood stream infections across England. The quarterly figures on MRSA bloodstream infections, published by the Health Protection Agency in September, showed that the number of MRSA infections had fallen by 57 per cent compared to the base level in 2003/4 when the target was set. The figures showed that the risk of becoming infected with an MRSA bacteraemia was at its lowest for 5 years. This was achieved by a package of measures including higher standards of clinical practice and cleanliness, an increase in matrons and hospital deep cleans.
In addition, the figures on C. difficile infections published by the Health Protection Agency in October showed a big drop in the key over 65 age group in which cases had dropped by 18 percent on the previous quarter and 38 percent since the same quarter in 2007. Overall, the figures showed a 21 percent decrease on the 2007-08 average and meant that the NHS was well on its way to delivering its target to reduce C. difficile infection numbers by 30% over the three years to 2011.
Whilst the NHS has achieved the ambitious 50 per cent reduction of MRSA nationally, not every organisation has achieved this yet; for those organisations this objective should remain their immediate goal. Those that have already done so must continue to reduce infection rates. Primary Care Trusts will agree stretching ambitions in contracts with provider organisations for reducing infection rates and improving cleanliness. Strategic Health Authorities will ensure PCT plans are robust in this respect and must be satisfied that those plans demonstrate, collectively, reduced variation in performance.
From April 2009, all elective admissions must be screened for MSRA in line with Department of Health guidance. This should be extended to cover emergency admissions as soon as possible and definitely no later than 2011.
As High Quality Care for All set out, once national targets are achieved they will become national minimum standards for all NHS organisations and a national standard for all patients. This is therefore the Government's intention with the MRSA target, but it is necessary to define how the MRSA target enters the standards framework in a way applicable to all NHS organisations. The new National Quality Board will commission a consultation in the New Year with the NHS, public, regulators and relevant experts about how to define the national minimum standard for MRSA, based on reasonable tolerance from best practice. We expect that this will mean that those organisations that are performing poorly, with higher MRSA-rates, will have to make further significant improvements to achieve this national minimum standard.
The current inspection programme by the Healthcare Commission provides reassurance to the public and patients that the required standards are being met on infection control. It also reassures organisations that they are taking the necessary measures to prevent and control infections, highlighting any steps that need to be taken to improve their services and patient care.
From April 2009, the Care Quality Commission will take over responsibility for health and social care regulation. It will continue to monitor compliance against the MRSA standard, the C. difficile target and the Hygiene Code, but will be able to use additional enforcement powers and take prompt action where patients are at risk."
Thank you to everyone who signed the petition. Our Press Release and response can be found here, following publication on Google News, Penwith Older Peoples' Forum received media interest from BBC Radio Cornwall and were interviewed on their reaction.