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The cost of poor hand hygiene in the NHS

3 min read

Nigel Mills MP blasts the "woefully inadequate" hand hygiene checks in the NHS and calls for action to improve level of compliance.

I tabled this debate to request that the Government ensure that proper checks are introduced so that patients can have confidence that everything possible is being done to enforce proper hand hygiene best practice. At a time when we are experiencing rising levels of antimicrobial resistance, we need to concentrate on how we can prevent infections in the first place.

Healthcare Associated Infections (HAIs) represent a worrying trend across the healthcare profession. According to 2011 data, patients in England have a 6.4% chance of contracting an HAI - if people visiting a restaurant had a 6.4% chance of contracting an infection, that restaurant would not be able to continue to operate, so why are we tolerating such levels of HAIs in our hospitals?

Here in the UK, HAIs affect more than 300,000 patients every year, resulting in 5,000 deaths and costing UK hospitals up to £1billion every year. It’s thought that more than 30% of HAIs could be avoided simply through better application of existing knowledge and realistic infection control practices – which would save lives and prevent unnecessary and prolonged hospital stays.

Currently, in the NHS, under NICE guidelines, best practice is measured using ‘direct observation’ with nurses manually counting the number of handwashes vs opportunity. The problem is that people tend to change their behaviour when they are aware that they are being observed – known as the “Hawthorne Effect” - which is thought to artificially increase compliance rates by over 50%. Moreover, under the current guidelines, trusts are simply required to audit hand hygiene practices and capture the data locally; no onward reporting, review or validation of this vital data is required or in place.

UK trials using 24/7 electronic monitoring demonstrate that hand hygiene compliance rates are actually in the region of 18-40%, as opposed to the 90-100% reported by hospital wards. The current methods of reporting are not only inaccurate, they’re also taking up valuable nursing time which could be applied elsewhere if more accurate reporting methods were employed.

I would like to see every NHS trust introduce a hygiene improvement programme, as current methods for auditing hand hygiene compliance are outdated and data is hugely overstated. Sir Mike Richards, Chief Inspector of Hospitals for the CQC has highlighted the inaccuracy of local hand hygiene audits.

I am therefore asking the Government and the Department for Health to make sure Care Quality Commission and hospital trusts introduce proper checks on hand washing. The incidence of HAIs highlight that current checks are woefully inadequate – as, whilst hospitals are reporting higher levels of compliance, this isn’t supported by the rates of HAIs. I would like to see the Government introduce measures to reduce the rate of HAIs and look closely at how data is collected to ensure data on hand hygiene is captured accurately to ensure quality improvements.

This is a priority patient safety issue and I am working closely alongside Andrea Jenkyns MP, who recently launched the Handz campaign (, to raise awareness on the importance of hand hygiene. 

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