UK Nursing
RCN calls for major reforms to combat MRSA
Apr 28, 2005 - 12:44:38 PM

The next Government will need to invest in hundreds of thousands more nurses' uniforms, require employers to build adequate staff changing and laundry facilities and introduce 24-hour cleaning teams in all acute hospitals if they are to successfully tackle MRSA and other healthcare associated infections (HCAIs), according to the Royal College of Nursing (RCN).

The RCN, in partnership with Nursing Standard, the Infection Control Nurses' Association (ICNA) and Kimberly-Clark[i], is today launching its 'Wipe it Out' campaign, to lobby for a range of practical improvements to help reduce rates of healthcare associated infections. The RCN is challenging the next government to publicly support ten minimum standards for infection prevention and control.

General Secretary of the RCN, Dr Beverly Malone, said:

"There has been a terrific amount of work to highlight the importance of hand washing in combating MRSA. This commitment must not waver, but we also need to extend the debate and recognise the importance of other factors."

These factors include ensuring the supply of sufficient clean uniforms for all healthcare staff, the provision of staff changing and laundry facilities and the availability of 24-hour cleaning teams.

New research published today in Nursing Standard journal confirms the importance of sufficient clean staff uniforms in combating MRSA and other HCAIs. Less than half (47%) of all trusts who responded to a survey[ii] provided their nurses with a sufficient number of uniforms to allow a clean uniform per shift. The RCN believes this should be the absolute minimum. Nearly half (43%) of all trusts questioned in the survey provided only three or four uniforms per nurse, making it difficult for nurses to change uniforms daily or if the uniform became grossly contaminated.

The importance of adequate laundry and changing facilities for healthcare staff cannot be underestimated. The survey found that just a quarter (26%) of trusts had adequate on-site changing facilities for staff, despite current guidance from NHS Estates (2003) that says that 'changing facilities should be provided for all staff, to encourage them to change out of their uniforms in the workplace.'

Two-thirds of the trusts questioned in the survey also provided no laundry facilities for nursing staff. In a further quarter (26%) of trusts, nurses did not feel able to use a service they thought was inadequate. In total, around 90 per cent of healthcare staff had to take sole responsibility for the cleanliness of their uniforms.

Beverly Malone said:

"It's common sense that healthcare staff should have a separate uniform for every shift they work, but we know that this often isn't the case and the implications for infection control are obvious.

"If the next Government committed to providing just one extra uniform for each nurse working in the NHS today, they would need to provide 400,000 more uniforms. But extra uniforms are just the beginning. We also need to make sure that hospitals provide laundry and changing facilities so that staff know their uniforms have been washed at a high enough temperature and that they are not forced to travel to and from work in them. Some of our nurses report having to change in and out of their uniforms in ward toilets. This is totally unacceptable."

Editor of Nursing Standard, Jean Gray, said:

"Nurses, and particularly infection control nurses, have been warning about MRSA, healthcare associated infections (HCAIs) and dirty healthcare premises for years. As far back as 1991, Nursing Standard ran a campaign called 'Operation Clean-up' which revealed the extent of the problem at that time."

Jean Gray continued:

"Today's campaign aims to give nurses the support they need to help combat MRSA and other HCAIs. Nurses are working in partnership with patients and others in the healthcare team to wipe out this danger to patients. But they need to be given the resources and the facilities to do the job effectively. The research we are publishing this week shows they are being hampered in those efforts when it comes to safe practice around uniforms."

The importance of a clean hospital environment is fundamental to tackling MRSA and other HCAIs and although the NHS is a 24-hour service, many senior clinical nurses do not have access to mobile cleaning teams outside normal daytime hours. The RCN is calling for the introduction of 24-hour cleaning teams in all acute health care facilities so that senior nurses can rapidly deploy cleaners to high risk areas such as ICU and emergency care settings.

Matrons and senior clinical nurses are ideally placed to help lead the fight against MRSA. The RCN believes that matrons need to be given the necessary power and authority to ensure health care establishments are clean and decontaminated in line with UK standards. Their advice, and the advice of infection control teams, must be paramount in determining how MRSA outbreaks are managed.

Chair of the Infection Control Nurses Association, Jean Lawrence, said:

"The ICNA recognises the importance of collaborative working in the fight against healthcare associated infection including, but not exclusively MRSA. We support the campaign that is aimed at reducing infection and enabling nurses to work towards successfully achieving this."

The RCN is also calling for:

* Mandatory infection control training for all staff at time of induction with protected study time to allow staff to attend yearly updates. This needs to be for everyone, including medical consultants, cleaners, physiotherapists, reception staff, managers and chief executives.
* Employers to be mandated to introduce straightforward, confidential and highly visible systems which allow patients, visitors and staff to report incidents and mistakes involving infection control and cleanliness.

* Employers to ensure that there are appropriate, easily accessible and widely available evidence-based infection prevention and control policies for all staff groups, and appropriate and understandable guidance for all patients and visitors.

Beverly Malone said:

"In the run up to the general election we've heard an awful lot about how the different political parties would tackle MRSA. But we know it will be nurses and other healthcare staff who help wipe out MRSA, not politicians.

"This is not a simple debate, and everyone in society has their part to play, but nurses have always known that it will take a combination of practical measures to really make headway in the battle against MRSA and other infections. The measures we are announcing today will only work if we implement them all rigorously. It will not be easy, but it is no less than patients deserve."

Graham Landi, Kimberly-Clark's UK Managing Director, commented:

"As a company which specialises in products designed to help health professionals maintain a hygienic clinical environment and control the spread of infection, we are delighted to be working with the Royal College of Nursing on this powerful campaign which will help stamp out MRSA".

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