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Factors other than hand washing contribute to hospital acquired infections such as changes in hospital practice which were designed to improve bed occupancy and officially to save money.1
Ward cleaners also used to be part of the team in an individual ward under the immediate control of the ward sister, who ensured that they were taught simple facts of hygiene. The cleaners would chat to “their patients” and were often told things that patients would not mention to the doctors. Unfortunately, this function of the cleaners could not be factored in by accountants, and, to save money, ward cleaning was contracted out to private firms. The cleaners employed were often less well paid, had no personal feeling about any ward or its cleanliness, could not be told what to do by the ward sister, and had no training in hygiene, so the standard of ward cleanliness deteriorated.
Competing interests: None declared.