Time for hospitals to clean up their act

Tony Are patients at risk of contracting vCJD from contaminated instruments in operating theatres? SOPHIE PETIT-ZEMAN talks to a surgeon crusading for better hygiene practices

DONAL Shanahan, head of surgery at Homerton Hospital, could hardly have chosen a more dramatic way of getting across to MPs his point about the woeful inadequacies of hospital hygiene. In the House of Commons, where he was launching a Patients Association report on hygiene control before a gathering of MPs and leading lights of the medical profession, he put on a video which showed him cutting open a supposedly ultra-clean surgical instrument. It had gone through the hospital's usual sterilisation procedure, been placed in a sealed bag, stamped "sterile", and was ready for reuse.

As Mr Shanahan explains: "I cut open the tube, and out fell human debris - bits of people's bodies."

Almost one in 10 patients gets an infection while in hospital, and the report from the Patients Association revealed woeful inadequacies in many aspects of hygiene control.

A survey of 310 NHS hospitals found that only one-third keep records about infection rates following surgery - essential if patient-to-patient contamination is to be monitored and reduced. Almost one hospital in 10 admitted to recycling disposable equipment strictly designed for single use and almost a quarter said that even re-sterilising equipment designed for reuse posed moderate to very- high risks.

Mr Shanahan is determined to raise public awareness of this can of worms, as he believes that, through this, pressure will be brought to bear on the NHS and procedures improved. "Our research suggests that what I found in that tube is 'sterile dirt'. You're unlikely to get an infection from it.

However, sterilisation doesn't kill the prion protein which causes vCJD.

This can hide in human debris in surgical equipment and may get passed from patient to patient."

Mr Shanahan has been asked to advise a committee investigating this possible mechanism of vCJD transmission. He says: "If you get vCJD 15 years down the line, you're much more likely to think 'maybe it was the burgers I ate', not 'maybe it was the operation I had', although current hygiene procedures may make the latter a far more likely cause. If we prove that vCJD is transmitted this way, there will be a sudden massive switch to single-use disposable equipment for all surgery.

It's crazy to wait until then."

Some current approaches to hospital hygiene, says Mr Shanahan, are akin to reusing condoms. "If I suggested recycling one, you'd be horrified, yet that's exactly what's going on with supposedly disposable single-use equipment in a number of NHS hospitals."

When the sterilised human debris was discovered, Mr Shanahan immediately banned all surgery at Homerton.

"I had totally lost faith in our sterilisation procedures. I told my chief executive that I wouldn't allow surgery to start again until we were provided with disposable surgical equipment for all operations."

Within 48 hours the money was found and since this episode, four years ago, almost all surgery at Homerton has used disposable equipment. This is standard practice in the majority of US and many private UK hospitals.

On the question of cost, Mr Shanahan says: "The cost differential between employing people to clean instruments and buying disposable ones is not significant. If hospitals switch to single use equipment routinely, you or I would instantly be much better off if we needed an operation."

Mike Stone, director of the Patients Association, agrees that too little money is being put into hospital hygiene and safety. He says the Association's report raises many concerns and that radical and rapid changes are needed to protect patients against infection.

He fears that money is being inappropriately allocated to new high- tech treatments such as laser-surgery techniques at the expense of basic common-sense facilities.

"As well as the horrors highlighted in our report, we have evidence that doctors and nurses aren't washing their hands between seeing patients because the soap they're provided with is so cheap and nasty that it chaps their hands. The Government has to address basics like this, and take whatever steps are needed to ensure that being in hospital is safe," says Mr Stone.

THE Association is also urging the Government to ensure that patients are provided with clearer information about the reuse of surgical equipment, empowering them to make informed decisions before consenting to operations.

On a more positive note, it has also suggested that hospitals with particularly good surgical hygiene procedures should in some way be rewarded.

As Mr Stone says: "We're all in favour of seeking out and commending good practice. We suggest that this is done in parallel with an independent inquiry into the number of NHS bed days blocked by patients suffering from hospital-acquired infection."

The promise of prizes coupled with the threat of revealing yet more grim statistics may be the right prescription to help the NHS clean up its act.

lPatients Association: www.

patients-association.com; 0845 6084455.

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