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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 October 27; 335(7625): 846–847.
PMCID: PMC2043410

Government toughens its stance on NHS hygiene standards

Medical staff who ignore guidelines on hand hygiene are “not welcome” in hospitals, said England's chief medical officer, Liam Donaldson, last week, signalling a more aggressive phase in the government's campaign to improve hygiene standards in the NHS.

“Failure to comply is now unacceptable practice,” said Professor Donaldson. “Those who do not comply are not welcome in these august institutions.”

Speaking at Bart's Hospital, London, at the launch of the third year of the National Patient Safety Agency's “Clean your hands” campaign, he said the time had come for “tougher talking, firm professional leadership, and clarity on standards.”

He had recommended in his annual report that alcohol hand rub be given to hospital patients “so that they can ensure that healthcare professionals clean their hands before touching them.”

His comments coincided with the release of the Healthcare Commission's second annual “health check” of NHS trusts (see News doi: 10.1136/bmj.39374.482662.DB). Inspectors found that 25% of hospital trusts and 28% of all NHS trusts had failed to implement at least one of the three infection control standards laid down by the Hygiene Code, which became law in October 2006.

Of the total of 394 trusts, 111 had not complied with at least one of the code's provisions. In June trusts were asked to sign a declaration stating whether they had failed to meet any of the targets, and 99 admitted missing at least one. Healthcare Commission inspections flagged up a further 12 non-compliant trusts that had claimed to have met the new standards.

The commission's inspectors have carried out 87 spot checks this year, and they plan to inspect every trust at least once next year. After the publication of the figures the health secretary, Alan Johnson, said that inspectors from the new regulatory body that is due to replace the Healthcare Commission will be given wider powers to close wards deemed unhygienic “and, in exceptional circumstances, place the trust under special measures so that changes can be made.”

The “Clean your hands” poster and education campaign, which is at the midpoint of its planned four years, will this year be extended to 19 “pioneer” organisations, including mental health, primary care, and ambulance trusts, care homes, and hospices.

An independent audit of the campaign's progress measured a 10-fold increase in the use of alcohol hand rub in acute settings but little change in the use of soap.

The audit has yet to publish data showing an effect on rates of infection, but the Health Protection Agency found in July that the number of infections of methicillin resistant Staphylococcus aureus had fallen nationally by about 10% over the previous year, with a particularly sharp decline in London. Rates of Clostridium difficile infection were up 2% over the same period last year.


For details of the “Clean your hands” campaign see

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