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Next generation macerator will help advance infection prevention in hospitals around the globe



The new Vortex macerator from Vernatech, part of UK owned Vernagroup, will help advance infection prevention in hospitals around the globe. For hygienic, single-use pulp disposal, it combines improved infection prevention features and ease of use with fast cycle times, reliability and excellent environmental performance.
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With Envirodri, hospitals need not be patient



Many hospitals now have carpets fitted; they deaden noise and add a cosy feel - provided they are kept clean. This can be difficult though because of the sheer volume of traffic, which means that cleaning needs to be quick and the carpet put back in commission in a short space of time.

Through using the highly popular Envirodri dry carpet cleaning method to keep carpets hygienically clean, hospitals can meet NHS National Standards of Cleanliness with ease, reduce pressure on cleaning teams and hospital budgets through using an efficient and cost effective system, and cause little or no disruption to patients or visitors in rooms, wards or entrances.
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Breakthrough in infection control

Royal Solutions has launched a new product, tested to European standards, which, it says, is as effective against C. difficile and safer to the user and the environment than the chlorine based products currently recommended for use for infection control. Sanitor Plus is effective against MRSA (tested to BS EN 1276)   and the notoriously difficult C. dif spores (tested to BS EN 13704).

"The constant fight against Healthcare Associated Infections remains high on the agenda for the care industry," says the company. "C. diff in particular is especially difficult to eradicate as it produces spores which can survive for a long time in the environment.
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It's in the bag: experience ensures economy and efficiency

As a member of the Sanitary Medical Disposal Services Association, Cromwell Polythene has been working with clinical waste professionals in the healthcare industry since the 1980s, to provide top specification and economical solutions.

The company offers the full range of sacks for clinical waste management requirements including refuse sacks, wheelie bin liners, tiger stripe sacks, (for deep landfill), yellow UN sacks (for incineration) and the orange UN sack, (for treatment). Its clinical waste sacks range from ultra strong sacks with a high tear resistance to high economy 5 kilo sacks. If more radical measures are needed, Cromwell also stocks Pira tested, UN accredited clinical waste bags which are guaranteed to carry a specific weight.
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Antibak breakthrough delivers major boost for healthcare infection control

Hospitals across the UK are winning the battle against killer bugs following a breakthrough in pathogen eradication. The launch of Chemex cleaning product AntiBak - said to be powerful enough to kill Clostridium difficile spores - has given the NHS a powerful weapon to combat the full range of superbugs.

The spray on wipe off system was successfully used in Berkshire where eight wards were closed due to a Norovirus outbreak. AntiBak was applied in the afternoon, the wards were swabbed the same evening and tests showed them to be completely clear.
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Purazone purifies perfectly

Purazone is the revolutionary UVC system that destroys more than 99% of all airborne viruses & bacteria, which is proving a real hit in the healthcare sector.

The stainless steel housed, portable air-steriliser unit was two years in development before Signature Aromas - one of the UK's leading manufacturers in the air treatment industry - submitted it to specialist independent company Microsearch Labs, for testing.   The lab confirmed that in one hour the Purazone unit processed one air pass from a room measuring 25' x 15' x 8', killing more than 99% of all airborne bacteria. Furthermore, there was no growth or mutation of bacteria after five days.
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New Health & Hygiene accreditation scheme declared open

This month the Royal Institute of Public Health launches a new accreditation scheme designed to endorse products that support health, hygiene and safety. This new scheme will enable people to see at a glance whether the hygiene claims made for everyday products are fact or fiction.

Products will be scrutinised by The Royal Institute's panel of experts to check that any hygiene claims made in their marketing or advertising are accurate and appropriate.
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Management of Healthcare Associated Infections: a 12-week course







The University of Greenwich, London, is staging a 12-week course on Management of Healthcare Associated Infections, from October. It has been designed for infection control link staff and allied health professionals, modern matrons, health service managers, paramedics, biomedical scientists, clinical scientists, doctors and nurses

As well as increasing delegates' knowledge of the spread and prevention of HAIs and helping them develop in-depth knowledge of HAIs in clinical practice, the course will update them on the latest infection control information and teach them what is involved in controlling an outbreak, how to perform risk assessments and how to prevent HAIs by implementing the correct principles of infection control. It will also show them how to be a role model for others, how to integrate current knowledge into practice by utilising the expertise of the Infection Control Team and how to deliver evidence-based practice to prevent HAIs.
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HefmA 2009 comes to London for international EFM perspective on future of healthcare delivery

The Health Estates & Facilities Management Association's annual conference and exhibition returns to London next year with the promise of an international estates and facilities perspective on the future of healthcare delivery. Hosted by the Association's London Branch, HefmA 2009 takes place from 20th through 21st May 2009 at the Park Inn Heathrow Hotel. Now entering its 12th year, this annual event has firmly established itself as a key forum for senior healthcare estates and facilities management professionals and commercial providers to discuss common challenges and share knowledge on innovation and best practice.
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Don’t buy badly and thus buy twice



Outbreaks of MRSA and C. Difficile in NHS hospitals have been a regular feature of national newspaper coverage for some time now. But why did the outbreaks occur in the first place? It is widely accepted that in most cases, this was due to attempts by managers to keep costs down. However, if you’ve ever heard the saying, ‘buy badly, buy twice’, it will come as no surprise that although the outbreaks have been brought under control, it has been at an inordinately high cost.

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Hospitals warned over disinfectant strength

Hospitals are being warned to ensure that their cleaners do not to over-dilute cleaning chemicals, following the publication of a US study in the journal Microbiology, which underlines the findings of previous studies that deadly bugs which survive contact with disinfectant can become harder to kill. They do this by evolving new defences which effectively enable them to 'pump' the cleaning chemicals and antibiotics out of their systems, much as humans build up a resistance to a particular disease when we have been innoculated through injection of a very small volume of the disease itself.

As long as the biocides designed to kill deadly bacteria are used in the correct concentrations, they will succeed; the bacteria will be killed outright. However, some users are over-diluting the concentrates, which is allowing the bacteria to become resistant to the cleaning chemicals involved.
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NHS Choices

Hospital cleaning in the UK is going to come under more scrutiny than ever. Care Services Minister Phil Hope and Health Minister Lord Ara Darzi are urging patients to put 'people power' into action by rating the service they receive in hospitals using a new tool on the NHS website.

The NHS Choices website allows patients to review the services they received in hospital and share their experiences with other patients, empowering patients to directly influence the quality of care they receive. Hospital cleanliness is one of five key areas on which patients are being asked to comment.

To rate your hospital experience, see www.nhs.uk

Karachi's Civil Hospital a breeding ground for germs



Many of those using Karachi's Civil Hospital have had to battle more than the usual health hazards one encounters in hospital; for the past week they have been having to wade through ankle-deep sewage that has flooded most of Dow Medical College, including the mortuary, attendants' waiting area, the hospital's entrance and the central mosque - and it's not a one-off.

According to Pakistan's Daily Times, the problem stems from council-controlled blocked sewage pipes and the hospital's 40-year old sewerage system, which is outdated. It says that most of the washrooms are out of order, with most of the pipelines leaking sewage water all the time.
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Nicola Sturgeon MSP, confirmed as Keynote Speaker at AHCP 2009



The Association of Healthcare Cleaning Professionals has announced the confirmation of Nicola Sturgeon, Member of the Scottish Parliament, Deputy First Minister and Cabinet Secretary for Health & Wellbeing, as giving the keynote address at the AHCP 2009 Conference. The Conference will take place from 3rd through 5th June 2009 at the Crowne Plaza Hotel in Glasgow; Ms Sturgeon will give her address on the first day.

The keynote address at AHCP 2009 will set the scene for discussions on all aspects of cleanliness and the management of healthcare-associated infections within the patient environment and provide the backdrop for topical and practical conference sessions. Following her address, Ms Sturgeon will be available for a short Q&A session.
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Proventec Healthcare supports RCN 3rd Annual joint conference and exhibition on Health Care Associated Infections



Proventec HealthCare, the newly created specialist division of Proventec, the parent company to market-leading cleaning and hygiene equipment manufacturers OspreyDeepclean and Contico, has exhibited at the national joint conference on Healthcare Associated Infections (HAIs) held in Harrogate.

This occasion marked the division's first conference and exhibition under the newly launched name.
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Crothall First in Healthcare to Achieve CIMS Certification 

Crothall Services Group, of Pennsylvania, US, has completed the requirements for the Cleaning Industry Management Standard certification programme, and says it is the first company dedicated exclusively to healthcare support services to receive the certification from ISSA. In addition, ISSA has granted Crothall the certification with honours.

CIMS is a rigorous programme that sets a new standard of excellence for building service contractors. It was developed by representatives of the cleaning, facilities management, and purchasing communities - in total, more than 100,000 constituents were represented in the process, which included full peer review - and was administered by ISSA and the American Institute for Cleaning Sciences.
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Groundbreaking product kills hospital infection

Purazone unit

A new product from Signature Aromas has been confirmed to kill up to 99.9% of airborne micro-organisms, including the deadly MRSA and C-difficile spores. Latest test results from field trials at The Royal Wolverhampton Hospitals NHS Trust showed at least 50% of airborne micro-organisms were destroyed in tests on side wards.

The portable Purazone unit uses ultra violet light to destroy the DNA of dangerous micro-organisms in two killing chambers and draw the air through the unit. The light destroys the micro-organisms in the air before returning the purified air to the room. The Purazone also destroys malodour and will give an improved ambiance to staff and patients through the use of natural oils.
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Elder Pharmaceuticals' tie-up with Sterisol AB improves product portfolio

Setting its sights on the fast growing infection control segment, the multi-billion turnover Elder Pharmaceuticals has formed a strategic alliance in this sector with M/s Chemische Fabrik Dr. Weigert GmbH & Co. KG, a German and European leader in equipment, services and technologies for infection control related to operating theatres, diagnostics, patient hygiene, patient handling and wound care. Elder is already well established in this segment by virtue of its existing tie-up with Ms Sterisol AB of Sweden.
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Atrix launches Green Supreme MRI/hospital equipment service vacuum
 


Atrix International has launched the Green Supreme MRI/hospital equipment service vacuum, which it believes will be a winner.
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Surface disinfection without harm from Difficil-S



Difficil-S is the exciting new low cost two-part broad spectrum daily disinfectant that unlike standard oxidising chlorine-based products such as bleach, does not give off toxic gases, nor cause long-term corrosion to surfaces, including floors and walls, equipment or utensils.

One of the most powerful broad spectrum disinfectants ever developed, Difficil-S is both safe and simple to use yet still low in cost. (click the image to view movie)
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Hospital grade antimicrobial proven inert to steel

BioNeutral Group announced today independent steel corrosion test results conducted at Criterion Chemical. Following an impartial blind testing protocol, Ygiene hospital grade antimicrobial was found to be completely non-corrosive to steel.

Many of today's commercially available antimicrobials and cleaners are corrosive to iron and steel. As confirmed by this independent test, Ygiene was found to be completely inert and not corrosive while a number of competitive products tested were found to be corrosive - including a 'green, natural' one.
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Easy clean porter's chair helps prevent spread of infection

A prototype new 'easy clean' porter's chair - part of the Design Bugs Out Challenge - was a popular attraction at Vernacare UK's stand at this year's Infection Prevention Society Conference.

The infection prevention products company chose 'progress through innovation' as the theme for its stand and also unveiled the prototype for a new single-use anaesthetic tray that will provide cleaner, safer perioperative care. It contains individual channels for correct alignment of syringes and ampules and is being developed in partnership with NHS Innovations South West.
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Debut product line uses new technology to fight MRSA and other 'killer bugs'



Vestagen Technical Textiles announced this week its entry into the advanced performance textile arena with the introduction of the first of a new class of nanotechnology-based healthcare speciality textiles based on Swiss technology. The Orlando based company will provide apparel and textile products for use in environments where biological contamination of clothing can occur.

Vestex, designed exclusively for the healthcare market, made its debut at the Institute for Healthcare Improvement's 2009 National Forum.
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NHS Supply Chain provides free SaniPost hand sanitiser stations to NHS trusts

NHS trusts will find it easier and more efficient to fight infections as NHS Supply Chain offers SaniPost hand sanitiser stations to hospitals across England and Wales for free.

SaniPost stations are free to use, automatic hand cleaning units to help hospitals with their infection control. They dispense sanitiser via a sensor-operated device when hands are placed inside. This negates the risk of cross-infection as no surface needs to be touched, something vital in hospitals for staff, patients and visitors alike.
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Accusations that the Government's recent National Health Service hospital deep clean programme was simply a political stunt have come from many sources, but now claims are being made that the hospitals did not even use products recommended by the Health Protection Agency to fight the bugs such as MRSA and Clostridium difficile during the deep clean that was, effectively, put in place to combat them.













In a report published recently, the Conservatives claim to have received replies from 128 out of the 171 NHS Trusts in England following requests, (under the Freedom of Information Act) about their cleaning regimes. These replies, they say, show that 85% of hospitals did not use hydrogen peroxide vapour in their deep clean; 16% of hospitals did not use chlorine, and 18% of Trusts admitted merely using steam cleaning - which, it is claimed - is not an accepted part of the deep clean process that was specified.

Furthermore, 5% of Trusts admitted they do not carry out a daily clean with chlorine of the areas around the beds of patients carrying C.difficile, while 9% of Trusts do not clean all commodes, toilets and bathroom areas with chlorine after each use by a C.difficile patient.

Just 9% of Trusts complied with all the HPA guidelines on deep clean.



These figures show that there is a great deal of misconception about how to tackle the problem of keeping our hospitals and other buildings in the healthcare sector clean and hygienic and ensuring that they are places of healing - something that is underlined by the fact that over 30% of NHS Trusts have already breached the target of a 50% reduction in MRSA bacteraemia.

"Eradicating avoidable healthcare infections has to be an all or nothing affair; there can be no halfway house," says charity MRSA Action UK, which recently paid tribute at Westminster Abbey "to the 50,000 who have died and the many hundreds of thousands who have suffered from MRSA since 1997".

We agree that the halfway house is not an option, but how do we move on?



Making Health Care Cleaning Hygienic

Facilities throughout the world are becoming increasingly concerned that the cleaning performed in their facilities is not just clean, but hygienically clean. By this they mean that cleaning procedures and systems have been implemented to protect the health of building occupants.

This is of great concern in medical facilities. Both staff and patients want to feel safe from the possibility of contracting a disease when working in a healthcare centre or receiving treatment there. But are they safe? According to a survey by the American Nurses Association, more than a third of the respondents indicated they do not feel secure in US healthcare facilities and are concerned about being infected with a hospital acquired disease, often the result of poor cleaning.
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Hidden areas of infection in hospitals

Healthcare facilities in many parts of the world are entering a new era of 'zero tolerance' for healthcare associated infections. Could there be hidden areas of infection that are being overlooked? A new public health education programme from the production company Mission Critical attempts to answer that question. 'Hidden Areas of Infection' will be broadcast into 89,000 hospitals in 88 countries within the next month. The Medical Broadcasting Channel reaches an estimated 14 million nurses, 9 million physicians, and an additional 5 million healthcare workers.

The programme documents how an acute care facility in Virginia, US, is solving this enormous infection control problem through planning, education, and the right equipment - including the widespread use of disposable products. Prime targets for disposable technologies are reusable products that see use on thousands of different patients, which can dramatically increase the risk of cross-contamination. Examples include blood pressure cuffs, pulse oximetry sensors, and electrocardiogram (ECG) wires.
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Superbug hazard as medics 'stopped from cleaning ambulances'

Patients are being exposed to potentially lethal superbugs because ambulances aren't being cleaned properly, it was claimed on Monday.

Paramedics' leaders and those working on the frontline - including a crew member from West Lothian - have hit out at bosses, claiming their requests to deep clean vehicles after patients have been sick or had diarrhoea have been turned down. They say they are not allowed to spend time cleaning the vehicles in case they compromise response targets. From April 2009, paramedics will have to answer 75% of life-threatening emergencies within eight minutes.
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Matron numbers doubled and given more powers designed to improve cleaning

There are now more than 5,000 modern matrons working in the National Health Service to drive up standards of cleanliness and care. Figures released by the Department of Health show that there are 5,538 modern matrons in post. This follows a commitment the Prime Minister made last September to double the number of modern matrons to more than 5,000 by the end of May this year.

Matrons are responsible for improving standards of care, ensuring wards are clean and patients properly fed. They help set and monitor standards for cleaning and catering and have authority to take action where these are not met.
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Latest campaign to improve the hand hygiene of all NHS staff

From this month, primary care, mental health, care and ambulance NHS trusts across England and Wales have committed themselves to promoting hand hygiene to all healthcare workers.

They have signed up to the National Patient Safety Agency's (NPSA's) award-winning cleanyourhands campaign, which has up until now predominantly focused on acute trusts.

The campaign aims to reduce the spread of preventable healthcare associated infections, such as MRSA and Clostridium difficile, by improving the hand hygiene of healthcare workers. Staff are prompted to clean their hands using either alcohol handrub or soap and water at the critical time and place - where and when patient care is provided.
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US: Medline launches nationwide hand hygiene compliance programme for healthcare facilities

In an effort to spark a change in healthcare professional hand hygiene practices in the US, Medline Industries used last month's 35th Annual Association for Professionals in Infection Control & Epidemiology Educational Conference, to announce the nationwide launch of its Hand Hygiene Compliance Programme to hospitals and healthcare facilities.

"Most healthcare-associated infection is spread by direct contact, especially via the hands of health workers, and data continues to support hand hygiene as the single most important way of reducing such infections," said Infection Prevention Advisory Board member Linda S. Johnson, M.S. N., R.N., C.I.C., infection control manager for the University of Missouri. "This programme will be an important part of a healthcare provider's strategy to improve patient outcomes and reduce hospital costs related to HAI."
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The hospital steam cleaning trial that never ended

It sometimes seems that there are not that many good stories coming out of the UK healthcare sector these days, with one national media announcement following another, of 'failing' hospitals, and lethal outbreaks of C. Difficile.

Against this depressing background, Weston Area Health NHS Trust commenced a 60-day trial of steam cleaning on the wards of Weston General hospital using Steam & Vac Pro machines from OspreyDeepclean.

The result has seen a dramatic reduction in instances of both MRSA and C. Diff.

Taken with other measures, the rate of C. Diff has dropped by 25% so far, while incidences of MRSA have fallen by 34% since 2003/4 when improved hygiene measures were put into place. This makes Weston General one of the best performing hospitals, so much so, that a recent inspection accredited the hospital as a 'Site of Excellence'.
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US nationwide progress poll reveals increased efforts by hospitals to control MRSA... but there's still room for improvement

More than three out of four (76%) US infection prevention and control professionals polled, indicated that they have implemented additional measures to prevent the transmission of MRSA in the last year, but 54% said their institutions are not doing as much as they could and should be doing to prevent the spread of this virulent pathogen, according to an online survey conducted by the Association for Professionals in Infection Control & Epidemiology.

APIC's 2007 MRSA prevalence study found rates to be eight times greater than previously estimated. The 'Pace of Progress' poll was conducted among APIC members from April 25th - May 15, 2008 to determine if news about the escalating rates of MRSA has led to increased efforts by healthcare institutions to combat the spread of this organism in the one year since the prevalence study results were released.
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NHS seeks new technology to beat hospital bugs

Cleaning businesses which have products or technologies that could help prevent the spread of MRSA or similar infections are being asked to come forward to take part in a new NHS programme.

The NHS is seeking the most effective new solutions from across all industry sectors to help in the fight against healthcare associated infections. The Smart Solutions for HCAI programme offers businesses the chance to have their products assessed by a team of independent experts, with a view to then having them evaluated in a hospital setting and - if the evaluation is a good one - potentially supplying the products across the NHS.
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MRSA down; C. difficile up

There was good news and bad news last Thursday when the UK's Health Protection Agency published its latest quarterly figures on MRSA bloodstream infections and C. difficile infections. These relate to the January to March 2008 period, the final quarter in the 2007/2008 financial calendar - providing annual figures for both infections - and show that while we seem to be getting to grips with MRSA, we are finding c. difficile harder to tackle successfully

The latest figures on MRSA bloodstream infections show that there were 966 cases reported in England during the January to March quarter of 2008. This represents an 11% decrease on the previous quarter (October to December 2007) when 1,088 reports were received.
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CSSA criticises trade unions for playing politics with people's lives

The Cleaning & Support Services Association has strongly criticised the Trade Union movement for demanding that the Government bring all hospital cleaning back in house.

Speaking last week, Andrew Large, Chief Executive of the CSSA, said:

"This is a blatant attempt by the Unions to exploit the Government's current difficulties. It is quite literally playing politics with people's lives. There is considerable evidence that bringing hospital cleaning back in house will reverse the progress that is being made in combating Healthcare Associated Infections."
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Inconsistency a major ailment in the NHS

by Jan Hobbs

Regular readers are fairly up-to-date with the position regarding healthcare cleaning in the UK, so when asked to contribute something specific to the Australian publication Inclean's healthcare issue, I thought I would contrast two success stories - Golden Service Award winning contractors and in-house teams - while also talking to healthcare cleaning specialists to see if I could get a different angle on the old story: 'General public and Unions slate contractors and demand that cleaning be brought back in house; contractors argue that they cannot clean hospitals without sufficient money and with the budgets keep being cut.'

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Pests in Hospitals; the Patients Association's view

Commenting on the Conservative Party's Freedom of Information request into pest controls in hospitals, the Patients Association said:

"Such findings are truly revolting. How can patients be safe amid bed bugs, fleas and rats? Once again safety is just rhetoric and not a reality for patients, particularly the elderly and those with suppressed immunity.

"Some of the Trusts listed are famous names. Some are Foundation Trusts with more independence than ever. All are used by patients who assume the Trust Board take such findings seriously.

"But what about those Trusts who ignored this Freedom of Information request and said nothing? If these are the standards of those "coming clean" what does it say about those who stayed silent?"
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Organisations must take responsibility for HCAIs warns RCN

The Royal College of Nursing has called for organisations and management as well as individuals to take responsibility for the management of healthcare associated infections. The College warned that concentrating on issues such as hand washing alone will not address the situation and called on the Government to invest in more infection control nurses.
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Benefits of NHS deep cleans "in danger of being lost," reveals CSSA's snapshot poll of cleaners

Four months after the end of the Government's £57 million Deep Clean programme, a snapshot poll of cleaners by the Cleaning & Support Services Association indicates that the deep cleans are in danger of being a waste of money.

There are three key findings from the poll:

1. The deep cleans made a significant difference to the perception of cleaners about the cleanliness of their wards. Some 46% of cleaners thought that their hospital was very clean before the deep cleans - rising to 89% after them.

2. However, in the four months since the end of the deep cleans, the percentage of cleaners viewing their ward as being very clean has dropped back to 75%

3. Only 44% of cleaners polled are aware of any changes to daily cleaning routines since the deep cleans finished.
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Irish pressure group calls for more honest recording of hospital acquired infections worldwide

Figures indicate that Ireland has one of the highest MRSA infection rates in the world. But newly-formed group SIN, (Stop Infection Now) believes the figures are even higher than is claimed. It says more thorough records regarding HAIs are needed, together with legislation to enforce hospital hygiene standards if hospital-acquired infections are to be reduced. To back up its claims, it is conducting research that will show the full picture and it has formed links with similar organisations in other parts of the world.

"We are asking people to register a HCAI diagnosis with us because the official records are not complete," says Dr.Teresa Graham (formerly of MRSA and Families Network) who set up the group. "MRSA blood stream infection is a notifiable disease, but MRSA infections in the bone, wounds or respiratory are not, and we need to have a complete picture.
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'Match.com' for NHS and suppliers launched

An online advertising service that will help 'hook up' NHS providers with healthcare suppliers was announced on Tuesday by Health Minister Ben Bradshaw.

Speaking at the Laing and Buisson Independent Healthcare Convention, he set out how the new website, NHS Supply2Health will make it easier for Primary Care Trust commissioners to advertise health and social care services they require and for suppliers to identify business opportunities within the NHS.
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Auditor-General criticises Ontario hospitals over C.difficile casualties

Jim McCarter, Auditor-General for Ontario, Canada, has criticised poor housekeeping and hand hygiene in the province's hospitals, saying they were instrumental in the spread of the recent C.difficile epidemic, during which 75 patients died because of the bug at one facility alone.

His report, which was released yesterday, reveals that hospitals do not always ensure that rooms occupied by patients with the infection are adequately cleaned and that surgical instruments are not always properly sterilised. It also finds that many physicians and nurses do not wash their hands often enough.
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Scotland secures matrons for the 21st century

Senior charge nurses throughout Scotland will in future have the same responsibility for ward hygiene as matrons used to have.

Their new responsibilities - set in the context of a 21st century environment - will be critical in enforcing vital hygiene standards, and helping to tackle healthcare associated infections as one part of their expanded leadership role.

That was the message from Health Secretary Nicola Sturgeon as she spoke to senior charge nurses about the implementation phase of Scotland's Senior Charge Nurse framework, on Tuesday.
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New compendium to combat healthcare-acquired infections will be US trial Lawyers' Bible!

Suing hospitals for damages just got easier with the US Joint Commission's release of the compendium on combating healthcare-acquired infections.

Dr. Betsy McCaughey, Founder/Chairman of the Committee to Reduce Infection Deaths and a former Lieutenant Governor of New York State, says: "It adds to the growing evidence that infections are preventable when hospitals adhere to proven best practices. Hospital infection is the next asbestos, the next major cause of class action lawsuits, and the compendium will be the trial lawyer's bible."
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UK Clostridium difficile infections fall significantly

The quarterly figures for April to June 2008 regarding Clostridium difficile infections were published by the UK's Health Protection Agency at 11.00 am today - and it's good news.

The latest C. difficile figures for England show that between April and June 2008 there were 8,683 cases recorded in patients aged 65 years and over. This represents a fall of 18% in this age group from the previous quarter, January to March 2008, when the total was 10,608. This also represents a fall of 38% from the same quarter in 2007 when 13,924 cases were recorded in patients aged 65 years and over between April and June.
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Report shows high C.difficile infection rates in US hospitals

The Consumers Union called on hospitals on Tuesday to take more aggressive steps to protect patients from Clostridium difficile infections in light of a new report showing that they are much more common than previous estimates had indicated. As the rate of hospital acquired C.difficile infections has jumped in recent years, an increasing number of patients have developed antibiotic-resistant strains of the infection that are more difficult to treat and more deadly.

The report, released by the Association for Professionals in Infection Control and Epidemiology, found that 13 out of every 1,000 patients or approximately 7,178 inpatients on any one given day were infected or colonised with C.difficile (94.4% were infected). The rate is 6.5 to 20 times higher than previous incidence estimates that were based on more limited data. The report estimated that on any given day these infections cost between $17.6 million to $51.5 million and kill between 165 and 438 patients.
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Scotland's hospitals to be subjected to random cleaning and hygiene inspections

Tuesday marked the announcement of a stringent, independent inspection regime and more single rooms, as part of the Scottish Government's continuing drive to crack down on superbugs in hospitals.

Health Secretary Nicola Sturgeon said that every hospital in the country would be subject to random inspections to ensure the highest possible standards of infection prevention and control and environmental cleanliness are adhered to.
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APIC accused of covering up extent and causes of C. difficile in US

The Committee to Reduce Infection Deaths has accused the Association for Professionals in Infection Control, of covering up the extent and causes of C. difficile in the US, (see 'Report shows high C.difficile infection rates in US hospitals' in last week's Cleanzine. If you missed it, Click here to read).

"Unfortunately, APIC failed to connect the dots," suggests Betsy McCaughey, Ph.D., Chairman of the Committee to Reduce Infection Deaths. "The new data show that approximately 329,196 patients contracted C. difficile in healthcare facilities this year."
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EU gets involved in fight against healthcare-acquired infections

The number of patients in the EU with at least one hospital-acquired infection is estimated at 4.1 million patients - equivalent to one-in-20 hospitalised patients. These infections are often difficult to treat due to antimicrobial resistance of the micro-organisms causing them, and with the increasing mobility of populations within and between healthcare systems and the freedom in the European Union to seek medical treatment outside the country of residence, resistant micro-organisms can rapidly spread between countries.

Most efforts to improve patient safety at Member State and EU levels have so far focused on specific causes, for example, minimising the risk from antimicrobial resistance. However, most adverse events are caused by a combination of factors which together result in harm to the patients... it's all very well running a campaign to remind healthcare workers to wash their hands between patient visits, for example, but if the hospital is dirty then germs will quickly be spread anyway when people pick them up from surfaces they touch.
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C. Difficile infections: NHS on track to achieve annual reduction of 30% by 2010/11

C. difficile infections are continuing to fall, the latest quarterly statistics from the Health Protection Agency (HPA) showed today.

There were 8,947 C. difficile infections in in England between July and September 2008. This represents a 33% reduction compared to the same quarter last year and a 35.5% reduction compared to the average quarter in 2007/08. The figures show a drop in C. difficile cases across all age groups for July to September 2008.
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Jonmaster and OCS join forces to combat infection at Ipswich Hospital

Working in partnership with Ipswich Hospital NHS Trust, service provider OCS has introduced the Jonmaster ultra microfibre trolley system for cleaning all wards, clinics and other areas as part of a wider strategy to control infections. The system has reduced the reliance on chemicals while additional management procedures introduced by OCS have made cleaning more effective and well organised.

"The relationship with JohnsonDiversey has been very good," says Adrian McRitchie, Domestic & Training Services Manager for OCS at Ipswich Hospital NHS Trust. "We like the products and the company has been really supportive and responsive to our requirements. Infection rates have dropped but ultra microfibre is just part of the reason why."
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New study shows infectious bacteria growing in 98% of hospital baths

Hospital patients may be opening themselves up to infection as a result of bathing practices applied in hospitals. According to a study published in the January 2009 American Journal of Critical Care, baths are a significant source for the transmission of hospital acquired infections, especially to patients that are immune-compromised and those at high-risk. It is estimated that 1.75 million to 3.5 million patients admitted to US hospitals, or 5 to 10% of all patients, contract nosocomial or HAIs leading to approximately 100,000 deaths annually.
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Technology the next front in battle against healthcare associated infections

The fight against Healthcare Associated Infections must continue on all fronts, Health Minister, Ann Keen told NHS staff today as she toured an exhibition showcasing that latest high tech products designed to beat infections such as MRSA and C.difficile.

In her keynote speech at an International Healthcare Associated Infections (HCAIs) Technology Summit, organised by the NHS Purchasing & Supply Agency, Ann Keen praised the hard work of NHS staff in more then halving MRSA infections, and reducing C.difficile rates by over 30%. But she told delegates that the battle against HAI's goes on.
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Recognition for new technologies put to work in the fight against healthcare infections

HCAI technology award winners OspreyDeepcleanNew technologies for use by the NHS to help combat healthcare associated infections (HCAIs) such as MRSA and C. difficile won praise and recognition last week at the first HCAI Technology Innovation Programme Awards.

The awards have been created to highlight and celebrate innovation and success within the field of HCAI related technology and technological developments. They recognise that new and innovative technologies are helping to save lives and making it easier for doctors and nurses to fight infection.
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Study shows effectiveness of new hand hygiene compliance system

Epidemiologists and computer scientists at the University of Iowa have collaborated to create a new low-cost, green technology for automatically tracking the use of hand hygiene dispensers before healthcare workers enter and after they exit patient rooms. This novel method of monitoring hand hygiene compliance, which is essential for infection control in hospitals, was released this week at the annual meeting of the Society for Healthcare Epidemiology of America.

"We know that a range of pathogens are spread from healthcare workers to patients by direct touch and that the current rates of hand hygiene compliance are suboptimal," said Philip Polgreen, MD, University of Iowa Health Care, as the report was released. "Our new low-cost method of monitoring could potentially reduce cost while increasing compliance rates."
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Poor hospital hygiene blamed for Danish deaths

Danish authorities are claiming that poor hygiene in some of Copenhagen's hospitals is partly to blame for the current spread of the potentially fatal intestinal bacteria, which so far has claimed 12 lives and caused 75 people to become ill.

According to the Copenhagen Post, outbreaks of the bacteria have so far been reported at Hillerød, Helsingør, Esbønderup, Hørsholm and Frederikssund hospitals.

Steam decontamination for Scotland's NHS

bed frame cleaningProventec plc, the provider of specialist cleaning and coatings technologies, reports that it has received a substantial order from the Scottish NHS for its specialist OspreyDeepclean Dry Steam Vapour decontamination machines.

Commenting on the importance of addressing infections in Scottish hospitals, the Scottish Health Secretary, Nicola Sturgeon, said: "Tackling healthcare-associated infections is my top priority because it is vital that the public have confidence in the care they will receive if they need hospital treatment. Steam cleaning is a particularly effective way of cleaning areas affected by Clostridium difficile and substantially increasing the number of steam cleaners available to the NHS will ensure they are available locally when needed."
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High-tech way to track hand hygiene

The University of Iowa has created a low-cost, green technology to track the use of hand hygiene dispensers used by healthcare workers.

Epidemiologists and computer scientists collaborated to develop a novel method of monitoring hand hygiene compliance, which is essential for infection control in hospitals.

"We know that a range of pathogens are spread from healthcare workers to patients by direct touch and that the current rates of hand hygiene compliance are suboptimal," Dr. Philip Polgreen of University of Iowa Health Care said in a statement. "Our new low-cost method of monitoring could potentially reduce cost while increasing compliance rates."
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Infection Control specialists team up for hospital infections TV documentary

"Tackling MRSA and other hospital related infections" is one of a series of documentaries to be aired via Sky TV and simultaneously broadcast on the NHS TV web site.

Steam decontamination equipment manufacturer OspreyDeepclean teamed with healthcare cleaning specialist CK Group for a long day's filming and interviews for the documentary that airs Thursday 23rd July on Sky channel 166 7:30pm, with a simultaneous broadcast on NHS247 where it will play for 12 months. The documentary seeks to educate and inform both NHS staff as well as members of the public as to what measures are being put in place to help combat Healthcare Associated Infections (HCAIs).
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New public sector NVQ for hospital staff

Cleaners, caterers, porters and housekeepers at a Hampshire hospital have been the first to gain from a new training programme aimed at raising skills in public services, which we announced in Cleanzine in June.

A total of 53 staff employed by facilities firm OCS at Lymington New Forest Hospital have been awarded their NVQ level 2 in customer service, including teamwork, health and safety and equality and diversity through The Public Sector Skills Framework (PSSF).
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UK's first permanent hospital decontamination cleaning unit up and running

A healthcare cleaning company has launched what it believes is the UK's first permanent decontamination cleaning unit, at the Queen Elizabeth Hospital in Woolwich, London.

ISS Mediclean, which has over 25 years' experience in providing clinical and specialist healthcare cleaning, will use the permanent unit at the Trust as an extension of a rolling programme with all the hospital's mobile equipment being taken to the unit and deep cleaned regularly. The Queen Elizabeth Hospital will be one of the first in the UK to have addressed the need to minimise the potential of cross infection through the introduction of a planned deep cleaning programme.
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Naming and shaming improves hospital hand hygiene 300%

In a presumably sterile environment such as a hospital, diligence of staff washing their hands when moving from patient to patient can easily be taken for granted. Yet, according to The Joint Commission, handwashing failures contribute to healthcare-associated infections that kill nearly 100,000 Americans each year and cost U.S. hospitals $4 billion to $29 billion annually to combat.
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Hospitals and care homes need to improve communication to prevent infections

The Care Quality Commission has set out its concerns around the lack of communication between care homes and hospitals in preventing infections passing between these two settings. The CQC found that there was a need for hospitals and care homes to provide information about infections to each other to make sure that people with, or recovering from, an infection are cared for properly and to reduce the chances of other people being infected.

But the report highlights that this information is not provided in a coordinated way with 17% of the care homes participating in the study saying that they received no information on infections at all when people were discharged from a hospital to their care. Even when information was received, this could be weeks late, incomplete or illegible.
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CSSA tells NHS "We can help", following Care Quality Commission's latest report

The Cleaning and Support Services Association today welcomed the publication of the Care Quality Commission’s report on NHS Performance ratings 2008/09.

Speaking following publication, the CSSA Chief Executive Andrew Large said:

“The CSSA welcomes the publication of this report. We are especially pleased that the hard work that the NHS and cleaning contractors have put in is reflected in a one third reduction in the rate of C. difficile and MRSA infections and a 5 percentage point rise in compliance with standard C04a, which refers to the reduction of the risk of healthcare associated infections.”
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Department of Health Conference

On Tuesday 20th October 2009, chief Nursing Officer Dame Christine Beasley showcased England’s mandatory disclosure of infections and mandatory surveillance, the most sophisticated system in the world for monitoring MRSA and C. difficile and one that has helped reduce MRSA bloodstream infections by over 70% and C. difficile infections by over 30%.

Speaking at a Department of Health Conference in London attended by international experts on hospital infections, Dame Christine said:

“Tackling healthcare associated infections is a challenge for health services all around the world. That is why we have invited the leading experts from across the European Union and the World Health Organisation to both learn from them and to showcase the success of our mandatory surveillance and disclosure of infections systems. Surveillance is vital to driving down infections.”

Health Minister Ann Keen responded, saying:

“The whole of the NHS should take enormous credit for rising to the challenge of infections. NHS staff responded to the brave step of being completely open on healthcare associated infections and their hard work has made hospitals cleaner and safer for patients.”

Hospital cleanliness and low infection rates are selected most often (by 74% of patients) as an important factor when choosing a hospital.

Irish hospital first to fight HAI's with copper

An Irish hospital is thought to be the the first in the world to specify hygienic copper door handles throughout in a bid to reduce healthcare associated infections such as MRSA.

St Francis Private Hospital, a 140-bed facility located in Mullingar, County Westmeath, and its associated nursing home, St Clair’s, made the decision after examining the compelling evidence from the clinical trial at Selly Oak Hospital, Birmingham, which showed that copper surfaces such as taps, toilet seats and door pushplates can reduce microbial contamination by 90-100%.
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Ecolab introduces new hospital programme to improve hygiene in patient rooms

Earlier this week, Ecolab announced the launch of its new EnCompass Environmental Hygiene programme - a comprehensive clinical programme that helps hospitals improve patient room hygiene and prevent the spread of infections.

The programme includes cleaning tools, products, dispensing equipment, auditing processes and cleanliness monitoring to help hospitals clean patient rooms more quickly, consistently and effectively.

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Clostridium difficile
- a dangerous and formidable foe

By: Peter J Sheldon, Vice President of Operations for Coverall Cleaning Concepts

Clostridium difficile is a frequently nosocomially transmitted bacteria causing illness and even death in many residential health, long term care and hospital environments around the world today. The source of the bacterial illness is fecal spores from the waste of patients that are on antibiotic medication.

Common routes of transmission result from improper hand washing and glove changing procedures as well as poor cross contamination cleaning practices. The spores are shed from the fecal matter onto surfaces such as toilets and can provide a source which may be transmitted by a nurse touching the toilet and visiting the next patient without changing gloves or thoroughly washing their hands.

Cleaning technicians utilising cleaning cloths and tools in multiple areas can also lead to cross contamination transmission. The critical nature of this growing exposure problem creates the immediate need to implement an effective defence against this killer beginning with an active and enforced soap and water hand washing and glove changing protocol. Without these procedures in place and strictly enforced any other efforts will be futile.
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Sodexo's Hillingdon hospital staff set to sit Level 2 NVQ in Cleaning & Support Services



Forty Sodexo employees at The Hillingdon Hospital NHS Trust are to take a Cleaning & Support Services NVQ Level 2, as part of a major collaborative approach to improving the skill set of the Trust's domestic staff.

Sodexo, which provides food and cleaning management services to Hillingdon and Mount Vernon Hospitals, introduced the qualification to its staff after identifying areas of potential improvement on the back of the government's call for deep-cleaning across all NHS Trusts, which, it indicate, was only one element of a wider strategy.
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A right Royal success



A move to Vileda Professional's Swep microfibre flat mopping system is playing a part in a successful hospital acquired infection policy at the Royal Cornwall Hospital Trust. It's just one of a number of measures introduced last year to reduce HAI's.

According to figures released by the Health Protection Agency in January, in the six months to September 2007 there was a 24% fall in the number of cases of MRSA - from 29 to 22. There was an equally impressive performance on C. diff where reported cases fell by 37%.
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Beyond the 'Dirty Hospitals' headlines









Maidstone & Tunbridge Wells NHS Trust might not seem a promising reference point for hospital cleaning and hygiene standards. Following revelations by an undercover BBC reporter about cleaning at Tunbridge Wells in 2004, the Trust experienced the UK's worst outbreak of C-Difficile in 2005 and 2006. The resulting Healthcare Commission investigation, published October 2007, was highly critical and resulted in the resignation of the Chief Executive, Chairman and most board members.

But as is often the case, beyond the 'Dirty Hospitals' headlines, things are not as simple as they might at first seem.   Domestic Services are not centralised within the Trust. Cleaning at Maidstone Hospital is managed in-house by the Domestic Services department and was the only hospital in the Trust using Green Valet's 'Clematis' stock control system at the time of the outbreak. By far the strongest criticism about hygiene standards was directed towards two other hospitals in the Trust and Maidstone had escaped the worst of the C-Difficile outbreaks.

Some of this was undoubtedly due to the more modern design of the hospital, in particular the better spacing of beds. But Barry Parker who was Domestic Services Manager at Maidstone Hospital at the time of the outbreaks is in no doubt that Clematis played a key role in the higher standards of cleanliness Maidstone hospital achieved - and he can prove it.
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Jonmaster joins infection control team at Musgrove Park







Musgrove Park Hospital in Taunton has recently introduced the Jonmaster ultra microfibre trolley system from JohnsonDiversey as part of its ongoing programme to reduce and control healthcare acquired infections. After the current rollout is complete Jonmaster trolleys will be used on each of the hospital's 30 wards and four major departments for daily cleaning tasks - replacing a traditional mop and bucket approach.

"This is an exciting development for us and we are really impressed by Jonmaster," says Wendy Sims, Hotel Services Manager at Musgrove Park Hospital. "Cleaners no longer need to use chemicals or hot water when they clean as the cloths are designed to be used when just damp. They work by drawing germs directly into the cloth which are then trapped and killed when laundered."
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iDCS cleans up in a hurry



The iDCS specialised hospital and healthcare deep cleaning service from cleaning contractors City & Kent Cleaning was recently used to deep clean maternity clinics, wards and other clinical services throughout the Mid-Essex Primary Care Trust.

The aim, according to Jean Glasspool, Business Development Director at City & Kent, was "to take the hassle out of an extremely pressured group of medical areas", resulting in some odd hours, and on one occasion, in two maternity clinics, while the units were still up and running!
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Hospitals in Victoria, Australia, to start screening patients for MRSA

All 76 public hospitals in the State of Victoria, Australia, will need to provide public reporting of Healthcare Associated Infections by the end of 2009, if they are to comply with the rollout of the 5-year 'Start Clean' Infection Control Strategy introduced in 2007. To maintain compliance, Victoria has selected Cepheid's GeneXpert System and Xpert MRSA test for the screening of high risk patients in up to 11 hospitals.

On-demand Xpert MRSA results enable Australian healthcare professionals to rapidly identify MRSA-colonised patients entering the hospital population, thereby reducing the risk of potential transmission.
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Bedford Hospital abandons plastic in pursuing gold standard for infection control



Bedford Hospital NHS Trust has teamed up with private company Vernacare to reduce the risk of cross infection from the use of shared plastic washbowls.

After the success of trialling the Vernacare single-use washbowl on a selection of wards, the Trust has now introduced this innovative new pulp product throughout the hospital, allowing it to throw away its plastic washbowls.
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LCC pioneers new BICSc Healthcare certificate

LCC Support services tells us was the first organisation to accept the challenge to train its management for the new British Institute of Cleaning Science's Healthcare Professional Cleaning Certificate.

Following a Pilot programme, 8 LCC Area and Site Managers successfully completed the course at LCC's training centre and will receive this highly regarded BICSc Certificate.
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Leading healthcare system decreases MRSA infection rate by 53%


Novant Health, one of the top 10 integrated health systems in the US, dramatically increased hand-washing compliance from 49% to 99% and decreased MRSA infection rates by 53% from 2005 to mid-year 2008 by implementing a hard-hitting, system-wide campaign that changed the health system's culture and spared an estimated 249 patients from the medical complications of MRSA.

Executives at Novant Health feel so strongly about hand hygiene and improving the quality and safety of patient care, they are making the health system's educational materials and details of their preventive programme available and downloadable free of charge.
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Healthcare disinfectant protects against AIDS virus



Betco UK has launched what it believes is the first peroxide-based, all-in-one cleaner and disinfectant designed to clean and protect against the AIDS virus HIV-1 and Influenza A in a healthcare environment.

Now in the UK following a successful US launch, Betco Oxyfect H is a powerful and proven multi-purpose disinfectant that will clean glass, mirrors, walls, counters, showers, toilets, hard floors and even carpet, eliminating the need for specialist products for different materials.
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Ecolab's Healthguard microfibre system wins East Lancs Trust contract

Healthguard, Ecolab's microfibre system has recently been chosen for use by the East Lancashire Hospital Trust, which covers a population of 520,000 people across East Lancashire.

The Trust was "looking for a cleaning solution that would provide improved cleaning performance and make it easier to eliminate and prevent hospital associated infections." A trial of microfibre systems from a range of companies and manufacturers was undertaken by the Trust. Hospital staff were asked to evaluate the systems and the Ecolab Healthguard microfibre system was chosen on the basis of ease of use, cost effectiveness, aesthetics, reduction in the use of chemicals, infection control benefits and laundering of the system.
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Just what the doctor ordered!



Vax Commercial has signed a deal with private healthcare giant Bupa Care Services to supply its revolutionary portable spot cleaning carpet washers. Bupa, one of the largest care companies in the UK, will be using the Vax Commercial VCW-02 in all its 304 homes nationwide.

"Vax Commercial's spot washers are just what we have been looking for," comments Tim Brooke, Head of Hotel Services at Bupa Care Services.

"As they are so compact and portable they can be kept on hand to deal with spills and emergencies as they happen. We're very pleased to be introducing these in all our care homes for 2009."
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Recognising success in healthcare cleaning



The Health Business Awards, held last month at Arsenal's Emirates Stadium, recognised excellence in the NHS by presenting awards in 14 different categories to organisations that have made a significant contribution to its development.

Of course one of the most important awards was that for the best cleaning, and the organisers acknowledged that there is clear evidence of a tremendous improvement in cleanliness and infection control standards in the facilities that were entered for the award, which acknowledges the efforts made by NHS organisations in recent years to raise standards in cleanliness and reduce the risk of hospital acquired infections.
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New cleaning regimes improve prognosis for a Kent hospital Trust

A Kent hospital that was at the centre of an investigation in 2007, following the deaths of an estimated 120 patients from C.difficile, has made "substantial improvements", according to a report issued by the Healthcare Commission last Friday. The report says that the Maidstone and Tunbridge Wells NHS Trust must maintain momentum and make further improvements.

Better standards of cleaning and staff training - helped by an extra £1million allocated to the cleaning budget - have been identified as key improvements. Extra cleaning staff have been appointed, new audit systems implemented, and urgent cleaning needs are being more rapidly addressed.
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OCS sets higher standards with healthcare contract win



OCS Healthcare - part of the 'One Complete Solution' property support services group - has won the contract to provide professional domestic services across 16 Mental Health NHS Trust sites in South West London. The contract was awarded by South West London & St George's Mental Health NHS Trust which serves around one million people across five London boroughs. Typically, the Trust operates around 30 mental health teams and treats over 20,000 people at any one time.

The multi-million contract was won after five months of the most rigorous tendering processes and promises the introduction of the latest cleaning technologies and methodologies to ensure the sites meet the 49 elements of the National Specification for Cleanliness in the NHS.
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Outpatient infection rates cleverly controlled

Cancer treatment leaves patients with weakened immune systems... So it would seem obvious that an outpatient cancer clinic would be a prime breeding ground for infections because of the constantly revolving door of patients, visitors and staff, all of whom could be exposed to bacteria and viruses at home or in the community. After all, infections are among the most common causes of illness and death among cancer patients.

However, an aggressive infection control programme at the Seattle Cancer Care Alliance that mixes common sense measures with medical informatics has drastically reduced the number and rate of infection-caused illness since its inception three years ago.
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Nine million reasons why ‘green means clean’



The ‘green means clean’ method of visual management is helping to raise standards of infection prevention thanks to a popular innovation from medical products manufacturer Vernacare.

The Vernaclean Indicator Tape is a simple roll of green coloured adhesive tape that is signed, dated and attached to equipment after cleaning to reassure both patients and staff that satisfactory hygiene standards have been achieved. In this way it helps to reduce the risk of infection and improves cleaning compliance.
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Infection prevention success at Shrewsbury Renal Unit



Royal Shrewsbury Hospital’s Renal Unit has reported excellent results in infection prevention and the unit's manager Sister Nonny Stockdale believes that a novel air disinfection device has contributed to this success.

Over the last three years, the unit has experienced a three-fold reduction in bacteraemia episodes, despite a significant rise in the number of patient visits during this period. Sister Stockdale oversaw the study at the Renal Unit and is delighted with the steady decrease in the number of patients experiencing infections during line insertion for haemodialysis.2009.

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A test case: proving biocidal efficacy



In the face of competition from copycat products, DCCL - manufacturer of residual biocide-treated disposable cubicle curtains – decided to take proactive measures to prove its curtains’ efficacy. Research organisation Campden BRI was selected to provide independent verification, and the results were conclusive: DCCL’s impregnated curtain material inhibits the growth of MRSA, E. coli and VRE.
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Hired instrument helps hospitals check swine flu safety masks



As part of a strategy to manage the swine flu pandemic, hundreds of respiratory face masks worn by staff at hospitals and in primary care across Hertfordshire have been checked by advanced Fit Tester instrumentation hired from Ashtead Technology.
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