01.10.13
Bedding in
Dr Caroline Mitchell, consultant in infection prevention and control at Portsmouth Hospitals NHS Trust, talks to NHE about a cleaning programme with incredible results.
All hospitals have to consider how they manage, prevent and control infections such as C. difficile. Different approaches can all contribute to better cleanliness and patient safety, from hand washing to intensive cleaning. Portsmouth Hospitals NHS Trust piloted a steam-based cleaning system to all its beds, with excellent results.
NHE spoke to Dr Caroline Mitchell, consultant in infection prevention and control at the trust, about the impact of the scheme and how deep cleaning could be implemented in ‘pulses’ to maintain cleanliness and safety.
The trust implemented a six-month pilot to deep-clean its beds and reduce hospital infections. The intensive decontamination involved using chlorine dioxide with a low-pressure steam machine. Beds were then released for patient use after they achieved an ATP (Adenosine triphosphate) reading of less than 30 – a grade recognised as a catering standard.
Measure of cleanliness
ATP is “a quick way of showing how clean an object is”, and can show the level of cleanliness of a piece of furniture without having to take a swab and send it to the lab for results. Beds typically score 200 with organic matter, but can be higher.
Dr Mitchell said: “If you’ve got a nurse next to you and you want to discuss the results, you can take a swab and say ‘Look, this is a higher reading. Let’s clean it together and see if we can get the reading down.’ That’s a very powerful way of getting the message around cleaning across to staff; it’s very easy to understand.”
During the pilot, around 100 beds were cleaned each day. Mattresses were also checked and parts replaced, saving the trust the cost of replacing the entire mattress.
“We saved the trust quite a lot of money; we just changed the cover or whatever was required.”
Radical results
The pilot was funded to run for six months in 2012, and was considered a clear success. The scheme was extended across the whole trust, and Dr Mitchell described the results as “absolutely fantastic”.
Matthew Richardson, senior nurse for infection prevention, said during the pilot: “We are thrilled by the results we have seen in the short period of time the pilot has been running. Patients and staff have been very enthusiastic about the service and we aim in future to be able to guarantee every patient a super-cleaned bed. We hope this will give everyone confidence in our hospital and the care we provide.”
Speaking to NHE yesterday, Dr Mitchell told NHE: “It was a success – the numbers show that we really achieved [what we aimed for]. We ran for six months and we stopped and paused. We wanted a proper evaluation. We’d seen a massive reduction in c. difficile numbers; we were 40% below our trajectory. We almost couldn’t believe it was due to the bed cleaning.”
Sustainable change?
The subsequent evaluation took into account how sustainable the change would be. ATP levels show that there has been “a subtle but definite increase in the numbers over the months,” leading the trust to consider re-running the scheme.
“I think the trust is now, with winter approaching, looking to re-evaluate the possibility of opening the service.”
This depended on clinical need and the trust’s priorities, Dr Mitchell added. “We probably will re-evaluate this, along with our clinical colleagues, to see whether and when we open the bed cleaning service again.”
Phased implementation
Implementing the cleaning programme again would not have to mean such intensive work being carried out for long stretches of time, or very regularly.
“It could be done in pulses,” Dr Mitchell suggested. “You could run it for a few months and then aim to get 100% or 80% of your fleet in.
“The truth of the matter is, the first time you clean a dirty bed you cannot imagine how long it takes – they were almost dismantling the bed. Do you need to do that on a weekly or a daily basis? Probably not.
“But you might need to do that once or twice a year, so it would make sense for it to run sporadically at that level. On a day-to-day basis, it doesn’t have to be as intense. We could think of a more scaled-down model.”