Hospital InspectionThe control of airborne infections in hospitals is crucial for patient safety. The recent announcement that hospital inspections are to be given a total revamp, becoming both broader and more robust may place a new emphasis on air quality in the hospital environment, perhaps leading more hospitals to employ hospital air filtration in more areas to ensure they meet new tighter standards.

The change comes against the background of the now famous Keogh report into 14 hospital trusts which found that several had slipped through the safety net that was supposed to be provided by the inspections of the Care Quality Commission (CQC). The report combined analysis of data with thorough multidisciplinary inspections (these will be the backbone of the new system, as it's believed that drawing upon a wider range of opinion during inspections will drive standards up). The hospitals in question were marked out by their higher than expected mortality rates.

In a hospital, unacceptable standards of care can arise from many factors and infection control is just one element. Staffing levels, training and management can all impact on infection control. Where infection control is poor, patients may contract and even die from Clostridium difficile (C.diff) or Methicillin-resistant Staphylococcus aureus (MRSA).

The Keogh report notes unacceptable numbers of C.diff cases in three of the hospital trusts under inspection and problems with preventing MRSA infections in four others. Infection control was found to be inadequate in the following:

  • Basildon and Thurrock University Hospital NHS Foundation Trust
  • Blackpool Teaching Hospitals NHS Foundation Trust
  • North Cumbria University Hospitals NHS Trust
  • Tameside Hospital NHS Foundation Trust

It is at least encouraging to learn that staff under inspection were mainly positive and very co-operative with the process and that, also, there were 'pockets' of excellent and dedicated care even where there were co-existing problems. And there was plenty of follow-ups and remedial work carried out.

It's to be hoped that the Keogh report will give the CQC and the hospital inspection system the shake-up that was evidently needed. In terms of infection control and air quality, there are a number of changes that are significant.

  • Inspections will consist of two days and will cover the whole hospital and every aspect, rather than the 'themed' inspections which occurred previously.
  • Teams will be 20 strong and include doctors, nurses and patients, rather than consisting of just four or five people. This multidisciplinary approach should mean there is less chance of infection control problems going unchallenged.
  • There are currently as many as 1,200 indicators of a hospital's standards. These will be trimmed to around 150 under the new inspection system, so it will be easier to focus upon infection control issues.

Sir Mike Richards, who is the new Chief Inspector for hospitals, has been widely quoted as saying that the new inspections are a 'completely different way of inspecting hospitals.' If the new system can deliver better airborne infection control and higher air quality, then it will be an extremely worthwhile development in public health.