Department of Health Workshop
Patient-Led Inspections of the Hospital Environment

The Government is committed to a more central role for patients and the Prime Minister has announced that a new system of Patient-Led Inspections will replace Patient Environment Action Teams from 2013. The results of the new inspections will be reported publicly to help drive up standards of care.

This is an important development that we hope will provide public assurance and protection, to help restore public trust and confidence in the action being taken to prevent and control healthcare associated infections, in what should be a caring environment.

We believe a clean environment is important but should not be looked at in isolation. Staff attitudes and behaviours need to be considered. Targeted cleaning where high impact interventions could make a significant difference to the safety of the patients' environment should be undertaken. ATP testing using swabs of high touch areas, should be requested, before and after cleaning, you can't see bacteria or spores that may be harmful for the vulnerable patient.

The halo effect will be present during inspections and as such there should be some consideration given to remote video auditing, you can observe staff behaviour and cameras need not be focused on patients, but you would see evidence of hand hygiene practice and the way staff clean an area, this is very effective and is being used in UK and US hospitals. We are asking for the opportunity to feed into the final guidance that comes from this exercise as this should be about real involvement, and prevention of infections should be high priority in giving safe care.

Andrea Jenkyns represented MRSA Action UK at the workshop which included members of the Department of Health's Patient Environment Team and representatives from the Health and Social Care information Centre.

Findings from the consultation with third sector organisations

The recent survey of patients that was developed as a result of the workshops shows just how important a clean environment is to them. The survey findings, designed to inform the Patient-Led Inspections are available on our website at
http://mrsaactionuk.net/PledSurvey.pdf

The questions in the survey were devised by the Department of Health. In setting the questions, the team drew on the outputs of workshops and consultations. An internet link to the consultation survey was emailed to a total of 95 third sector organisations, including MRSA Action UK, LINks and active patient representatives.

Community care providers were encouraged to release staff time to assist service users in completing the surveys where necessary. The survey was also adapted to allow children and young people to participate in the survey. Several groups including MRSA Action UK hosted the survey link and publicised it on Twitter.

Almost 3,000 people who considered themselves eligible responded to all of the questions in the survey.

MRSA Action UK had given some feedback on the questions, including areas of significance in terms of infection control. It is our view, and a view that is held by a growing number of healthcare professionals, that high touch areas should be the focus of environmental testing to check that micro-organisms that can cause life-threatening infections.

Although our opinions on the importance of environmental testing have been summarily dismissed by the Department of Health, we did suggest a suite of questions to be added to the consultation if selected by those people responding to the questionnaire, would demonstrate how important these areas that are frequently touched by both patients and healthcare professionals were.

Not surprisingly these areas did rank high in terms of priority, with medical equipment being the second highest priority and high touch areas seventh out of twelve options - respondents could only pick five:

- The toilets or commodes I use are clean: 2580

- Any medical equipment I use (eg drip stand, heart monitor) is clean: 2318

- The treatment areas are clean: 2217

- The bathroom or shower I use (including any equipment) is clean: 2152

- The part of my ward where my bed is located is clean: 1789

- Any furniture I use (eg bed, chair) is clean: 977

- Items that are frequently touched by a range of people (eg light switches, door handles, telephones) are clean: 863

We believe that the Department of Health should take the opinions of those taking part on board in terms of cleanliness. You cannot see bacteria, therefore ATP testing, a simple technology used to test the environment, should be part of the hospitals' checks. We also believe that the checks should not be solely self assessment, there must be some independent audit, Patient-Led Inspections should be just that, it's not just about asking patients to design the areas of importance for hospitals to focus on, we want some independent audit too.

Patients who are frail and need feeding

We were disappointed that the questions relating to food did not include the option to ask if patients could reach their food, or if they needed help with feeding, it was available. This is one of the most frequent items of complaint that we here from relatives, and one that a lot of our members have experienced in terms of poor treatment, frail patients not able to reach their food or able to feed themselves. There was an option to pick regarding having access to water which rated highly, "I have cold water available at all times" ranked third, which to us suggests the questions on being able to reach your food and be assisted if needed should have been asked.

In our opinion this was either an oversight on the part of the Department of Health, or perhaps something they did not want to hear. It should be noted there were no opportunities to give additional feedback at the end of the questionnaire, only the tick box option.

We hope the Department of Health will consider this vitally important in the inspections.