Select Committee on Health Written Evidence

Memorandum by Dartex Coatings Ltd (PS 38)


  Dartex Coatings Ltd is a British company based in Nottingham which supplies products to over 40 countries. Dartex has 35 years of experience of premium transfer coated products and has proven expertise in infection control issues and mattress cover solutions. We are therefore acknowledged as the pioneer and global market leader in patient support surfaces.

  Dartex Coatings has joined forces with global wound care leaders, Smith & Nephew to address the market need for effective barriers to MRSA cross-infection. Together, we created a product, Silver3, a mattress coating, which we believe could be used as one of a series of effective measures to combat the prevalence and spread of hospital acquired infections in a clinical setting.

  Tests have shown that Silver3 kills 99.9% of MRSA within 24 hours and it maintains a high kill rate throughout the warranted product life which may reduce the risk of exposing bacteria to sub-lethal concentrations of silver. Silver3 does not release silver into the environment, but kills on contact, not just MRSA but the whole plethora of pathogens and virii. Extensive in vitro testing on "as made", after sterilisation, abrasion, washing and ageing has provided the confidence for Dartex to guarantee the efficacy of Silver3 mattress covers kill MRSA for FOUR years.


  Healthcare-associated infections (HAIs) are one of the most, if not the most prominent threat to patient safety. This threat is recognised by the government in a plethora of publications issued by the Department of Health. Yet, few other measures than the tried and tested cleaning and hygiene initiatives are being advocated by the government. Whereas cleanliness will always be vital to combat HAIs, other methods and products exist that can and will significantly reduce HAIs that are currently being overlooked by the government. This continues to be the case even though it is clear that HAIs are not only costly for Primary Care Trusts to treat, but also place a financial burden on the British economy as a whole.

  Silver3 is a mattress coating which can be used in healthcare settings that has been developed to kill bacteria and has the potential to significantly reduce HAIs. Despite Silver3's obvious benefits, purchasers are overlooking the infection control element of the product due to the slight increase in price its use contributes a £10 additional cost to mattress manufacturers who reasonably want a margin and therefore up to £20 on mattress selling prices. Static mattresses sell to NHS Trusts typically between £160 and £220, with dynamic (therapy) mattresses selling from £1,500 up to £4,000 and specialist ones even more. On these latter types though the uplift should not increase form the £20 indicated.

  Dartex therefore urges the government to first undertake more work to ascertain and calculate how the hospital environment as well as products like Silver3 can contribute to reducing HAIs and thereby also reduce costs for the NHS as a whole. Second, the government must ensure that Trusts and hospitals are encouraged to take a longer term holistic approach to procurement. At the moment, procurement budgets are set with little regard of the total NHS budget in mind which inhibits the take up of innovative products such as Silver3, despite its potential to bring significant cost savings to the NHS.


  1.  Infection control is recognised as a key component of patient safety as the NHS has a responsibility to ensure that its patients remain safe while using its services.

  2.  HAIs are an avoidable risk to patients safety to some extent, as system failures and human error- in predominantly cleaning- is often the cause of an increased number of HAIs. As such, HAIs are a major concern to patient's safety.

  3.  In particular, there is huge public concern over MRSA and C difficile. The Office for National Statistics published figures on the 28th August 2008 which showed that the number of death certificates mentioning Meticillin-resistant Staphylococcus aureus (MRSA) was 1,593 in 2007. This number also follows a sustained increase from 51 to 1,652 deaths between 1993 and 2006. The same figures also show that the number of death certificates mentioning Staphylococcus aureus, but not specifying meticillin resistance, have also been relatively constant over the period 1993-2007 (

  4.  As the above figures illustrate, HAIs have sky-rocketed in the last decade and ensuring the safety of everyone that comes into contact with the health services has therefore rightly become one of the most important challenges facing health care and the government today.

  5.  As it is widely acknowledged that infection control is of vital significance to patient safety, the government has put in place a range of policies designed to reduce HAIs in NHS organisations in England. Both resources and attention have been dedicated to improve hygiene in healthcare settings and to eliminating the spread of antibiotic resistant organisms.

  6.  Numerous documents have been published by the Department of Health in this area. For example, in 2004 they published a document entitled "Towards Cleaner Hospitals and Lower Rates of Infection: A Summary of Action" and this was subsequently followed by "Saving Lives: A Delivery Programme to Reduce Healthcare Associated Infection Including MRSA" in 2005, "Essential Steps to Safe, Clean Care: Reducing Healthcare-Associated Infection", in 2006, and "Saving Lives: Reducing Infection, Delivering Clean and Safe Care" in 2007. Finally, the most recent publication from 2008 on the issue is entitled "Clean, Safe Care: Reducing Infections and Saving Lives.

  7.  In short, the Department of Health has issued yearly guidance and policy documents. Yet, most of this work focuses on reporting and monitoring the rates of HAIs. Various action plans for cleaner hospitals have also been issued.

  8.  Despite all the government's work in this area, figures from the European Antimicrobial Resistance Surveillance System (EARSS) show that the United Kingdom still has one of the highest recorded rates in Europe (EARSS 2007). According to the EARSS report, the burden of MRSA is highest in Portugal, Ireland, Italy and the United Kingdom. (

  9.  As Britain has a very high level of HAIs in comparison with other countries it is therefore clear that the Department of Health's previous attempts to combat HAI's have had little success. Whereas it is commendable that the issue is high up on the government's agenda with many documents dedicated to the issue, more is needed than merely publishing yearly policy documents that focus on cleaning and monitoring.

  10.  Dartex would therefore like to urge the government to look at what can be done to improve patient safety further in the hospital environment. Dartex would also like the government to encourage Primary Care Trusts and hospitals to take into account the full long-term cost savings of being able to reduce HAIs by using alternative infection control and prevention methods.

  11.  First, whereas the government has launched several initiatives such as the deep-clean campaign in hospital—little has been done in the area of improving the hospital environment through investment in new products and tools that combat HAIs. As the hospital environment is an essential aspect of combating HAIs and improving patient safety, more work must be done in addressing this, and to go further than just looking at cleanliness and hygiene as has traditionally been done.

  12.  For example, the Journal of Hospital Infection published an article showing the results of a study, in which it was made clear that Meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are capable of surviving for days to weeks on environmental surfaces in healthcare facilities. Environmental surfaces frequently touched by healthcare workers are commonly contaminated in the rooms of patients colonized or infected with MRSA or VRE. A number of studies have documented that healthcare workers may contaminate their hands or gloves by touching contaminated environmental surfaces, and that hands or gloves become contaminated with numbers of organisms that are likely to result in transmission to patients (John M. Boyce, Journal of Hospital Infection, Volume 65, Supplement 2, 2007).

  13.  Whereas cleaning will always be essential in the fight against HAIs, this will never be enough by itself as it is virtually impossible to ensure that all areas in a hospital are clean at all times.

  14.  Studies have been undertaken to that effect, which show the hospital environment can become extensively contaminated with MRSA that is not possible to eliminate by standard cleaning methods (for an example, please see French G. L et al, The Journal of Hospital Infection 2004, volume 57).

  15.  Routine cleaning of equipment items and other surfaces does not always remove bacteria such as MRSA. As a result, improved methods of ensuring that HAIs are tackled are needed. Hospitals should be encouraged by the government to invest in products, such as Silver3, that have the ability to reduce the bioburden of bacteria at any given time to supplement the cleaning and hygiene initiatives, which are naturally still very important.

  16.  Please note Dartex has commissioned a clinical study with TrusTech and the MRI, a Showcase hospital, which should demonstrate that at all times Silver3 mattresses are harbouring a significantly lower bioburden. Thus allowing peer review to suggest that this is significant enough to lower cross infection risk.

  17.  The second issue Dartex is concerned about is that it seems as though the costs of procurement and the costs of HAIs are seen in complete isolation. Little consideration is given to products and tools that will result in a very small increase of a Trust's procurement budget, but that will ultimately significantly decrease the Trust's costs in treating patients who have acquired a hospital infection.

  18.  It is clear that HAI's are very costly to the NHS, Trusts and hospitals. A study funded by the Department of Health estimated that HAIs cost the health sector in England almost £1 billion a year, with patients remaining in hospital an extra 3.6 million days. According to this analysis, a patient who contracts a HAI stays in hospital on average 2.5 times longer than a patient who does not, increasing their time in hospital by 11 days. The cost of treating a patient with a HAI is 2.8 times more than treating a patient without one, imposing an average additional cost of £3,154. Patients with a healthcare-associated infection identified in hospital and post-discharge also take an average of 17 extra days to return to normal daily activities. At the national level, this amounts to 8.7 million additional days (Plowman et al 1999).

  19.  A more recent review of these figures concludes that the costs of HAIs have been underestimated in this study. MRSA alone is calculated to result in an annual loss to the UK economy of £3-11 billion (Gould 2006).

  20.  Both of these studies show that controlling HAIs is highly cost-effective. Yet, new technologies and products, such as Silver3, that Dartex manufactures are not taken up by the NHS. This is despite its clear ability to reduce the number of HAIs and deliver cost saving benefits to Trusts and hospitals.

  21.  The cost savings of a product such as Silver3 can easily be calculated by using the two studies mentioned above. Utilising the lower £3billion (Gould 2006) figure and assuming the cost ratios to be the same as the (Plowman et al) 1999 study, the mathematics would show that if a 473 bed hospital paid an extra £20 for each of it's mattress covers it would break even on cost if only one cross infection was prevented in four years. It would also be able to treat another 2.5 patients per HAI reduced.

  22.  Silver3 is a mattress coating which has been developed to kill bacteria. This mattress coating has been shown to maintain a high kill rate throughout the four year warranted product life which may reduce the risk of exposing bacteria to sub-lethal concentrations of silver. For example, tests have shown that Silver3 kills 99.9% of MRSA within 24 hours. As high bed occupancy and patient to patient contact in that way is one of the reasons of higher MRSA rates—Silver3 therefore has the potential to reduce HAIs.

  23.  Silver has a very long history of use as an antimicrobial agent and unlike in the case of antibiotics, resistance to silver has not appeared. Whereas antibiotics generally have only one very specific mode of attack, silver attacks cells in many ways. Silver will alter the structure of the cell wall, damage the bacteria's DNA and interfere with vital cell processes. It is thought that this complex attack makes developing resistance to silver more difficult than developing resistance to an antibiotic, as more than one mutation may be required. This is particularly beneficial as the spread of many HAIs particularly C difficile and MRSA, is associated with the (over)use of antibiotics.

  24.  Silver3 does not release silver into the environment, but kills on contact. Because the silver is not released, it may minimise the risk of exposing bacteria to low silver concentrations in the care of the environment. Silver ions are held in a soluble carrier on the surface of the material. In the presence of moisture the carrier slowly dissolves and silver is available to come into contact with any bacteria. Once bacteria and silver interact the bacteria is killed off and more silver moves to the surface of the material.

  25.  Silver3 is currently on the NHS supply chain purchasing catalogue and can be purchased by Trusts. However, due to the slight increase in price (around £20) purchasers are overlooking the infection control element which makes it a much more cost effective purchase over the longer-term.

  26.  In order for patient safety to be improved and HAIs to be tackled, the government must put in place measures to encourage Trusts to take a wider, more holistic approach to their budget so that short-term increases in their expenditure do not inhibit take up of products such as Silver3, as this investment ultimately leads to a long-term overall saving for the Trusts.


  In summary our recommendations are:

    —  In addition to its work focusing on hygiene and cleanliness, the government should undertake wider work in the area of hospital environment to ascertain to what degree and how other methods and products can reduce HAIs and thereby increase patient safety.

    —  The government should also encourage the procurement of products that can lead to long-term cost savings for the NHS as a whole by ensuring that Trusts adopt a more holistic approach to their total budget.

September 2008

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