Healthcare Associated Infections.

BMJ research* reveals that in 2016/2017, 4.7% of patients picked up an infection while in an English hospital and 3.5% of those died as a result.

The total cost of this to the NHS was about £2.7 billion – slightly more than treating smoking related illnesses.

And these figures are from six years ago. Before the pandemic, before our NHS was quite so comprehensively challenged.

Will the more stringent infection-control measures put in place for Covid have helped to reduce these figures for 2022/23? Many infection control professionals don’t think so. Indeed, they expect the situation to be worse, if anything.

Fewer doctors and nurses have less time to care for more patients. A rush to outsource so-called non-core activities means lower budgets for cleaning and sanitation. Staff absence through sickness is through the roof. And, as we see on the news every day, exhausted, unhappy people are leaving the profession.

So what to do? Well, given the many crises currently enveloping the NHS, you might be tempted to look away and prioritise one of the other ticking timebombs.

But HCAIs hurt more than patients.

We’re losing over 20% of our hospital beds

HCAIs block beds – extended stays for treatment used up an extra 7.1 million bed-days in 2016/17 – 21% of total bed availability.

They cause staff shortages – 79,700 absent days among front line Healthcare Professionals.

And their treatment, mostly with antibiotics, increases the likelihood of further infection from drug-resistant organisms such as C difficile.

Those 7.1 million bed-days, by the way, are more than cancer patients require each year. More than lung disease patients need. And about 7 times as many as heart failure patients.

This isn’t news to the NHS and its managers, of course. NICE and PHE have created authoritative guidance, protocols, strategies and monitoring schemes that every NHS hospital already takes very seriously. But despite these, we still have HCAIs.

It’s a complex problem. Everything from AMR to ventilation, artificial coughing to wound complications is currently being studied.

But one of the most important elements in infection distribution is easy to understand. It’s us. You and me.

We spread infection. We get infected. But when we change our knowledge and behaviour, we spread less infection, resulting in fewer people falling ill. Result? More available bed-days.

So what to do? We’ll get to that, but first, we must declare an interest.

Furniture that helps you fight infection

Although processes and PPE were transformed during the Covid pandemic, old-style space designs and furniture have continued to make infection-fighting harder.

For some cabinet types, more frequent cleaning actually speeds damage and deterioration, creating bacterial hotspots. Others have designs that are based on simple kitchen cabinets whose inner surfaces are rough and inaccessible and whose fittings have complex, dirt-harbouring shapes.

Hygenius furniture is different. It’s built for robust cleaning. Panels and surfaces are smoother, stronger and more resistant to damage. Hinges, handles, drawers and worktops are safe and sanitary. And they stay this way for years – helping you to fight infection for longer in every type of healthcare setting – acute, primary, mental health and even in the laboratory.

Our designs go beyond bare standards, to a level of risk awareness and reduction that is unmatched by other providers. Better space designs, stronger furniture. Thoughtful details, tougher materials. Safer spaces, safer people.

33,000 Times a week

We work with microbiologists when designing our furniture and their investigations confirm that human fingers – whether gloved or not – are among the most significant transport mechanisms for infection.

They have observed that every hospital doctor touches something 10 times a minute. That’s about 33,000 times a week – transferring bacteria from bed to bedside cabinet, canula to keyboard, door to desk, window to worktop – and so on, every minute of the day.

Handwashing helps a lot, of course. Regular glove-changes also help. But clean or not, gloved or not, a finger-touch moves infection around with frightening efficiency.

Oh, and while we’re being frightened, you know that 10 times a minute figure? It’s accurate for nurses and doctors in and around the ward, but in anaesthetic rooms, the touch-rate is 3 times higher – 30 times a minute.

The most important aim is prevention

When hospital outbreaks happen, they can be almost impossible to treat and the cost, in lives and money, as we know, is frightening.

So how do you prevent infection? The top answers are always hand-hygiene and appropriate PPE. But what does hand-hygiene really mean? Washing between patients? Yes, of course. Washing between touch-points? Not so much.

Call buttons. Door handles. Laptops. Bed rails. Washbasin taps. Bedside tables. Cupboard doors. Bed controls. Phones. BP cuffs. Every touch transfers infection to fingers and delivers infection from fingers.

So ask yourself these questions

When was the last time you disinfected your computer keyboard? How many times did the cleaners clean the bed control panels today? How about inside the bedside cabinets? Or their castors? What about the computer trolley’s touch screen?

Since hospital cleaning was outsourced, it’s been harder to train and motivate cleaners about infection control, so staff awareness plus material and surface choices have become more important.

Be an infection control vigilante

When you realise that human touch is a big problem and better disinfectability is an effective solution, you can look critically at your environment, making judgments and suggesting changes.

In furniture, for example:

• Avoid corners and castors.
• Insist on hard, smooth surfaces that can withstand plenty of cleaning.
• Choose robust furniture that won’t chip or split when a trolley hits it.
• Look out for unnecessary holes in shelving units and inside cabinets.
• Become a hinge and handle expert, insisting on smooth and simple shapes.
• Look critically at the computer trolley – when did those wires last get cleaned? Why aren’t they routed through smooth, sealed trunking?
• …and so on, in every corner of the ward or treatment room

Don’t put up with dirty furniture

Consult infection control professionals before specifying or buying equipment and furniture – in primary and acute of course, but also in mental healthcare, where infection control can often be more difficult.

And take a critical look at cleaning regimes around the hospital. Are the anaesthetic rooms thoroughly cleaned between every patient like the theatres are? Honestly?

So please accept these paragraphs as a cry for awareness. For changes to behaviour and equipment that, in their turn, will change lives.

A warning and an invitation

One last thing: if you’re ever in a meeting and someone mentions cutting the hospital cleaning budget, please explain something that every infection control professional knows (and reminds us of constantly).

Every £1 saved on the cleaning budget will add at least £5 to the HCAI treatment budget down the line.

Don’t do it!

Instead, find out more about the infection-fighting role of furniture, surfaces and informed design and hear what Healthcare Professionals, Specifiers, Contractors, Patients and Hospital Management have to say on on the subject here

Also featured in IPC update March 2023

*Guest JF, Keating T, Gould D, et al. Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England. BMJ Open 2020;10:e033367. doi:10.1136/ bmjopen-2019-033367