Infection Prevention and Control

Andrea Jenkyns Excerpts

Tuesday 15th May 2018 Westminster Hall

[Andrea Jenkyns (Morley and Outwood) (Con)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate my hon. Friend the Member for Strangford (Jim Shannon) on securing a debate on a matter that is of great personal importance to me, as I lost my own father to MRSA that he caught in hospital.

In 2011 my dad, Clifford, went into hospital for a routine operation to drain fluid from his lungs. What should have been a 20-minute procedure turned out to be two and a half hours as trainee doctors practised on him. The whole event was a real catalogue of errors regarding cleanliness in the hospital. To begin with, the cleaners kept their mop buckets in the room where the procedure was done—it was not a sterile environment. Also, located in the adjacent rooms were patients infected with MRSA. So, the staff did the procedure next to rooms where people had MRSA. Also, a number of doctors and nurses came into my dad’s room and did not wash their hands. I saw some of the same nurses later, having cigarettes outside in their uniform. My hon. Friend the Member for Upper Bann (David Simpson) mentioned patients doing the same. One nurse came into my father’s room to administer some antibiotic cream that was to be placed in my father’s nose, and she used her bare hands and did not wash them afterwards.

The scale of the problem is vast. The World Health Organisation estimates that 50% to 70% of hospital-acquired infections are transmitted by hands, and that more than half are preventable through good hand hygiene. Yet, in the UK, a patient admitted into hospital has a 6.4% chance of contracting a hospital infection. In total, more than 300,000 patients are affected by hospital infections in the UK every year. There are 5,000 patients who, like my father, die from a hospital infection every year. That is 5,000 too many. For me personally, it meant that my wonderful dad, my hero, never got to meet my husband; my dad never got to walk me down the aisle at our wedding last year; and my beautiful baby son Clifford, who is named after my dad, never got to meet his amazing granddad. That is just my own personal story. There is an inadequacy in existing practice.

The Government have done a lot to move forward on hospital-acquired infections, and I know that the Secretary of State and the chief medical officer really do care about the issue, as I have had several meetings with them over the past three years and my all-party group on patient safety has worked closely with them. The hon. Member for Central Ayrshire (Dr Whitford) has also worked closely with me on this. The chief medical officer has done a great deal globally to lead the way in highlighting antimicrobial resistance.

However, it is important that this debate draws attention to the fact that the current system of hand hygiene monitoring in hospitals needs updating, and is inaccurate and outdated. There are better monitoring systems out there. The old system allows poor hand hygiene practice to spread, and can put patients’ lives at risk. The system currently in place is known as “direct observation”, and there are three fundamental flaws within it. First, many of the nurses currently performing direct observation audits on colleagues are not trained to perform such tasks. That means that audits are often incomplete, inconsistent and ineffective.

Secondly, direct observation artificially inflates reported compliance, owing to something called the Hawthorne effect. Naturally, staff wash their hands more frequently when they know they are being monitored. In 2015 I ran a hand cleanliness awareness campaign here in Parliament and 40 colleagues, cross-party, signed up to it. The Deb Group collaborated with me on my Handz campaign and I was astounded at the research that the group showed me. It has conducted peer-reviewed research that shows that the true levels of hand hygiene compliance are in fact between 18% and 40%, rather than the 90% to 100% typically recorded in UK hospitals. That means that direct observation as a means of monitoring artificially inflates reported compliance by as much as 50%. We cannot begin to address the problems of poor hand hygiene when our hand hygiene audits report figures of 90% to 100% compliance.

To increase hand hygiene standards in our hospitals, basic behavioural psychology dictates that we need accurate and timely feedback to drive behavioural changes. Yet direct observation audits are often only completed quarterly or, at best, monthly.

The Government have had a big focus on patient safety and there has been a renewed focus over the past five years, from initiatives to reduce prescribing errors to the commitment to halve gram-negative infections by 2020. If my right. hon. and hon. Friends will permit me, I must thank the Secretary of State for driving those initiatives and for his personal commitment in trying to make the NHS the safest healthcare system in the world.

Looking to the future, the Secretary of State said that the 10-year plan for the NHS must enable it to be “more teched up”, so my question to the Minister is: what role can and should technology play in raising standards of infection prevention in the NHS? Electronic hand hygiene monitoring offers the potential to improve health outcomes and save money at a time when health services are coming under increasing pressure. Improving hand hygiene requires behavioural changes that are reliant upon frequent, accurate and relevant feedback. In his review into NHS productivity, Lord Carter discussed the need to have,

“real-time monitoring and reporting at NHS leaders’ fingertips”.

Electronic monitoring can deliver real-time, accurate data to drive behavioural changes. There are currently pilots in electronic monitoring technology in two acute hospital trusts in England. The Care Quality Commission has noted the innovative practice to improve hand hygiene using technology as an area of “outstanding practice”. However, the technology is not new; it has been in use in the US for several years.

The UK has one of the safest healthcare systems in the world, but 5,000 patients a year dying from hospital infections is 5,000 too many. Does the Minister acknowledge that, to improve hand hygiene and reduce the number of infections in our hospitals, using direct observation as a means of monitoring hand hygiene is no longer appropriate or effective? Finally, does the Minister agree that using technology, if adopted in the right way, offers an excellent opportunity to improve patient safety and reduce the £l billion in associated costs of hospital infections?