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'Failed hygiene' Trusts named

New healthcare watchdog the Care Quality Commission has singled out 21 NHS Trusts for not meeting required standards for infection control.

All 388 NHS Trusts were assessed by the CQC and while all were registered, 21 trusts only made it the list subject to improving standards within agreed timescales.

Among the criteria examined was how trusts dealt with legionella and MRSA, which can grow in or spread through hvac systems.

This is the first step towards full registration on all basic standards for healthcare trusts, a regime that will come into force from April 2010.

Public health consultant David Harper welcomed the report but said the delay in implementing the new tougher regime was not ideal.

“April 2010 is too late, we want this introduced now. I don’t want to sound dramatic but lives are literally at stake.”

Mr Harper urged the hvac industry to play a key role in keeping hospitals free from infection, both in terms of developing products and providing expertise in their installation.

The full list of 21 NHS Trusts which must take remedial action is published on the H&V News website.

In 13 of the 21 cases, the trust declared non-compliance with registration criteria that CQC used for judgement. In eight cases, the CQC had evidence that the trust had failed to achieve required standards for infection control on repeated occasions, had a high infection rate and/or the Healthcare Commission identified substantial issues that represented a potential risk to patients' safety at an inspection last year.

Ten acute trusts, six primary care trusts, four mental health care trusts and one ambulance trust were registered with conditions. Four of these are foundation trusts. Some conditions are ongoing, such as keeping wards clean, while others have a deadline for taking action (ranging from one to eight months).

The CQC has said it will pay particular attention to monitoring and inspecting non-acute services. Until now, hygiene inspections have targeted predominantly the acute sector, where most infections tend to occur.

Barbara Young, chair of the CQC, said: “All trusts must remain vigilant and constantly review and strengthen their performance. This is a continued drive and we want to see standards raised further.

“In 21 trusts we need further assurance that they are meeting the regulations. We have placed rigorous conditions on these trusts' registration and will monitor them closely. While infection rates at these trusts are not necessarily higher, they can do more to strengthen their approaches to infection control.”

To carry out its assessment, the CQC asked that trusts declare whether they were compliant with the regulations and cross-checked this with other performance information, including patient and staff surveys, findings from the Healthcare Commission's hygiene inspections, trusts' declarations against core standards for infection control, and rates of MRSA and Clostridium difficile infection.

In terms of heating and ventilation the Healthcare Commission assessed:

- Visual inspection of grilles and vents during observational audits within Duty 4c, if these are found to be dusty, cleaning arrangements are queried.

- Confirmation that the local policies regarding air handling systems reflect best practice and national standards are reviewed and updated. Duty 4a.

- The provision of specialist ventilation to provide positive pressure isolation for those patients that are at risk of infection or negative pressure for those that pose a high risk of infection to others via the airborne route. 

The hygiene code used up to 1 April for inspections:

The code use from now on:

The 21 trusts which failed to meet hygiene standards out of 388 which registered with the CQC are:

Alder Hey Children's NHS Foundation Trust
Barking, Havering And Redbridge University Hospitals NHS Trust
Barnet, Enfield And Haringey Mental Health NHS Trust
Barts And The London NHS Trust
Coventry And Warwickshire Partnership NHS Trust
Herefordshire PCT
Isle of Wight NHS PCT
Kettering General Hospital NHS Foundation Trust
Leeds Partnerships NHS Foundation Trust
Leeds Teaching Hospitals NHS Trust
Lewisham PCT
Manchester PCT
Medway NHS Foundation Trust
North Bristol NHS Trust
Plymouth Hospitals NHS Trust
Royal Surrey County Hospital NHS Trust
Somerset PCT
South West London And St George's Mental Health NHS Trust
United Lincolnshire Hospitals NHS Trust
West Sussex PCT
Yorkshire Ambulance Service NHS Trust