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Mr. David Kidney (Stafford) (Lab): I support the thrust of the amendment, but we have got the law right and are about to get the code right. What is important now is ensuring that the fine words are put into practice in hospital environments up and down the country.
Before Report, I visited Stafford hospital to talk to hospital staff about protection for patients and visitors to hospitals against health care-associated infections. It was heartening to see that some of the measures that we are debating were already being used in practice. For example, amendment No. 12 suggests that a lead person on the board should take responsibility for that matter, which already happens at Stafford hospital.
The director of clinical standards at Stafford hospital, Jan Harry, is also the director of infection prevention and control. The modern matron for surgery, Naeema Khan, takes the lead as the internal champion to develop strategies on infection prevention and control, and she has sent me a note reminding me about one or two things that they are up to at the hospital. For example, the national guidance about the "Clean your hands" campaign has been taken to heart in the hospital, where there is now a network of hand-washing champions, who are role models for staff, visitors and patients.
To gain community involvementno doubt this is true of many hospitalsthere has been a competition in schools to design posters for the walls of the hospital. That is a sensible way of trying to capture the public's attention, and hopefully people will consider their
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cleanliness when they are admitted to hospital or visit other patients. Among the many documents reminding hospitals how they should behave, there is now revised guidance on contracting for cleaning. Naeema has informed me that Stafford hospital will be a pilot site for a new ward-cleaning management system and that the relevant preparatory work is under way now.
In Committee, I discussed capturing information on the level of infection in hospitals, which involves testing and early analysis. Stafford hospital has superb on-site laboratory facilities, so there is the opportunity, with the right guidance, to follow best practice in taking samples, getting assessments, making reports and collecting information. As the hospital has pointed out, however, it could do with some help in its constant fight to keep down health care-associated infections, which requires partnerships that go outside the boundaries of hospitals.
When I visited the hospital, we discussed care homes for elderly people, which provide many admissions to hospitals these days and which, like hospitals, are an environment where we might anticipate a degree of infection unless care is taken. My hospital and its partners, which include residential care providers, are willing to undergo joint screening and to export good practice from the hospital to those homes. Sadly, the hospital has found that there is a cost, and unless people feel particularly motivated, they will not incur it unless they have to. As politicians, we can take the message to potential partners and hospital trusts that there is something that everyone should do.
Adam Afriyie (Windsor) (Con): In many walks of life, best practice is discovered in the variety of ways in which different organisations operate. If the code is too prescriptive, is there not a danger that innovations in cleaning technology, detection and control will be stifled because such matters are dealt with uniformly?
Mr. Kidney: Given his intervention, the hon. Gentleman will probably like the Minister's response. The Minister will say that we should not tie ourselves down with overly restrictive legislation and that a code that can be changed from time to time to keep up to date with innovations and changes is therefore desirable. By informing partnerships beyond the boundaries of hospitals, we are inviting people to take part in the challenge of eradicating those infections. As the hon. Gentleman said, nobody has exclusive possession of the knowledge that will help us to defeat such infections, and I would welcome help from my constituents who want to contribute to the fight. How we engage people outside the boundaries of hospitals in making sure that the incidence of such infections is driven as low as possible is a challenge for us all.
MRSA rates have doubled since 1997, as my hon. Friend the Member for Westbury (Dr. Murrison) pointed out. The last time we debated this in the House, the hon. Members for Thurrock (Andrew Mackinlay) and for Wyre Forest (Dr. Taylor) spoke at length about the misreporting of figures. Although current figures suggest that we do not have a massive problem, we still do not know the true position.
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However, I am not here to lob grenades across the Table by criticising the Government. I want to look at where we are now and how we can move on to improve the situation. I well remember the NHS in the 1970s under a Labour Government, and in the 1980s under a Conservative Administration. The most fearful bug that we had to deal with in those days was klebsiella, which lived on bars of soap. Things are different now.
I am not naturally a retrospective person, but in the matter of MRSA one has to be. In the 70s and 80s, hospitals were indisputably much cleaner than they are today. However, it is not just a decline in cleanliness that has brought about MRSA in our hospitals; it is also the result of an over-reliance on antibiotics, increased movement of patients within the hospital estate, centrally imposed targets that pressurise hospital staff and administrators to hot-bed patients by getting a patient into a bed before it has gone cold or has even been cleaned properly, and dirty wards and bathrooms. A combination of those factors causes MRSA in hospitals.
There is another factor which causes me, as an ex-nurse, some embarrassment. It is easily preventable. I discussed it with the Minister in Committee and was disappointed to note that it was not addressed in more detail in the draft code of practice. It is the fact that nowadays nurses travel to and from home in their uniforms. We all know that that is the case. How often do we see a nurse outside the school gates picking up her children, going into a nursery to pick up her toddler, or leaning over the vegetable section in a supermarket while getting groceries on her way into work? We cannot blame nurses for that because changing facilities are no longer available as they used to be. One has to ask why that is.
One also has to ask on what this casual behaviour of travelling around in nurses' uniforms is based. Is it based on the premise that nurses believe that the uniform is there to protect them, or doctors, from patients and to keep them clean? If so, that is extremely misguided. The purpose of the uniform is to protect the patient from the nurse or the doctorthe patient who, as a result of being in hospital for procedures or from illness, needs to be protected from anybody who enters their vicinity, including nurses and doctors.
My amendments relate directly to that situation and are simple and to the point. Hospital staff with direct responsibility for patients should not place them at risk by wearing their uniforms to and from work. That is wrong, and it is undoubtedly a direct contribution to MRSA in hospitals.
Sandra Gidley (Romsey) (LD): I am listening to the hon. Lady with interest. She will surely accept that many staff do not wear uniform, including doctors and, most particularly, consultants. How would she address that situation given that they probably go from one patient to another much more frequently than nurses?
Hospital consultants and doctors wear white coats and tend to put them on when they go into hospital. Having worked as a nurse in the NHS for 10 years, I know that most doctors certainly did so to protect themselves from patientsconsultants perhaps
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not so much, but they were a law unto themselves at the time. That does not mean that they should be excused from this. The practice of cleanliness in hospitals needs to be upgraded at every level to include nurses, doctors, consultants, hospital staff and everybody who has contact with the patient. Doctors usually wear white coats, and if they do not that is unforgivable.
The practice of nurses wearing their uniforms to work and back and in the home environment indubitably contributes to MRSA, which costs the NHS about £1 billion a year. I received a copy of the draft code of practice this morning. One 10-word sentence on page 6 relates to staff uniforms. It says that they should be clean and fit for the intended purpose. We know full well that bacteria cannot be seen by the naked eye and that we cannot see a virus. If we could, there would be no MRSA in hospitals. We would not have search and destroy policiesthey would be seek and destroy policies because we would be able to see them. As we cannot, how do we know whether a nurse's uniform is clean? How can a ward manager know whether a uniform is clean? How do we know that the uniform that a doctor or nurse comes into hospital wearing was not the uniform that they wore to collect a child from school? How do we know whether that child has washed their hands all day? How do we know that they have not been sick or in contact with another child who has viruses or bacteria? How do we know that the nurse did not collect the child and get into a car that had been used by the family pets? Did the nurse then walk on to the ward in that uniform after collecting that child from school and driving in that car to a patient who is critically ill and in a vulnerable, immune-suppressed state?
As we know, 25 per cent. of hospital infections are brought from communities into hospitals, and there is no doubt that a large proportion of that percentage is brought in by staff who use their work uniforms to go home. If there was an overall stipulation that staff who had direct contact with patients did not travel to and from work in their uniforms, I am sure that the figure of 25 per cent. would reduce dramatically. Prohibiting staff from travelling to and from work in uniform would be simple to introduce. It would have no cost implications for the Government and I am sure that it would save lives.
Amendment No. 37 proposes that washing instructions should be made available to staff with regard to the safe home laundering of uniforms. That is based on my own research. I asked a number of staff who work in hospitals how they launder their uniforms. Replies varied from, "I bung it on a wool wash because it's navy and it runs", to, "I bung it on a wool wash because it's white and falls to bits on a hot wash", to, "I'm a member of the Green party and I do all my washing on a cold wash." According to the guidelines for washing uniforms, none of those is correct. A cold wash is nowhere near sufficient to kill bacteria or viruses on uniforms. Would it not be easy and cost-effective, and would it not save lives, if notices in utility rooms and staff cloakrooms stated the correct washing instructions for nurses' uniforms?
The draft code of practice for the prevention and control of hospital-acquired infections is 28 pages long, and it is an improvement on the original version. Florence Nightingale had no such document when she
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went to the Crimea, yet she halved the death rate of soldiers from bacterial infections within weeks by raising standards of cleanliness and sanitation. Some things never change. We are facing exactly the same enemymutating bacteria in hospitals.
If we had a policy of search and destroy and effective cleaning solutions that worked when they were used on wards, if we brought back state enrolled nurses and allowed no uniforms to be worn on the way to work, and if uniforms were laundered safely at home with proper instructions, I am sure that that would make a huge difference to MRSA rates. However, that is up to the Government and the Minister.
I end on a note of caution. Yesterday, I met a lady who, unlike everyone else, will not accept the out-of-court settlement that she has been offered for contracting MRSA. She is taking the matter to the High Court. She realises that the cash settlement she gets will be less than that which the hospital trust has offered, but she wants to set a precedent so that others can litigate when they contract MRSA. I hope that the Minister will not let the problem reach the point when people are rushing to the courts.
We can do better than a 10-word sentence about staff uniforms. From speaking to nurses, those who have contracted MRSA and people in the community, I know that they do not want nurses to go home in their uniforms. Nurses do not want to wear their uniforms to and from work and they readily say, "If we were told not to, we wouldn't." They said that changing rooms were not absolutely necessary. One nurse told me, "I'd go to the cloakroom where I hang my coat and leave my bag." There is no reason for not imposing such a provision. I hope that the Minister will reconsider the draft code and what happens to nurses, their uniforms and the cleaning of those uniforms at home.
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