NHS hospitals that outsource cleaning ‘linked with higher rates of MRSA’

The superbug is becoming increasingly difficult to treat. As from 2005, trusts have been required to regularly report incidents of MRSA, which has enabled researchers to produce empirical evidence for the first time that compares the rates of infection in hospitals that outsource cleaning with those using in-house cleaners. They calculate that, on average, the incidence of MRSA infection between 2005 and 2009 was 2.28 in every 100,000 bed days in trusts that outsourced their cleaning, compared with 1.46 bed days in trusts that used in-house cleaners –.a difference of almost 50 per cent. However, the research also highlights that trusts which used outsourced cleaners did save money. Their cleaning costs were lower by around by around £236 per bed per year compared with hospitals that used in-house staff, according to the paper published in the journal, Social Science and Medicine.

The research was conducted by the University of Oxford, with the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Researchers calculate significantly fewer patients in trusts with outsourced services described the cleanliness of hospital bedrooms as ‘excellent’, compared with patients in hospitals that had their own cleaners, with a similar result in patient surveys for bathroom cleanliness. The research also shows that only 63% of NHS staff in hospitals with outsourced cleaning services reported having available hand-washing facilities, compared with 68% in hospitals using in-house cleaners.

There has been plenty of anecdotal evidence but for the first time we have empirical data revealing a clear link between outsourced cleaning services and increased spread of MRSA

Dr Veronica Toffolutti, Department of Sociology

Researchers sampled 126 NHS trusts for the study. Only those with sufficiently high quality, consistent data in relation to MRSA incidence and perceptions of cleanliness were included. Trusts that had changed the type of cleaning service they adopted during the study period or used a mixture of both in-house and outsourced services were left out of the sample.

Our study finds that contracting out NHS services may save money, but this at the price of increasing risks to patients' health. When these full costs are taken into account, contracting may prove to be a false economy

Professor David Stuckler, Department of Sociology

Lead author Dr Veronica Toffolutti, from the Department of Sociology in the University of Oxford, said: 'There has been plenty of anecdotal evidence but for the first time we have empirical data revealing a clear link between outsourced cleaning services and increased spread of MRSA. These findings are significant as efforts to reduce the infection of superbugs in hospitals become increasingly urgent.'

Co-author Professor David Stuckler, also from the University of Oxford, said: 'Our study finds that contracting out NHS services may save money, but this at the price of increasing risks to patients' health. When these full costs are taken into account, contracting may prove to be a false economy.'

Another co-author, Professor Martin McKee at the London School of Hygiene & Tropical Medicine, said: 'The UK has been a world leader in the battle against antimicrobial infection, recognised as one of the greatest threats facing humanity. These findings suggest that what many had suspected is actually true. Outsourced services pose a risk to staff, patients and the wider population.'

Researchers calculated the MRSA rate by using the number of MRSA reports recorded by each hospital trust for every 100,000 bed days. MRSA incidence, published every six or 12 months in the Public Health England’s annual reports, was matched with reports on patients’ perceptions of hospital cleanliness and health workers' feedback on the availability of handwashing facilities (2010-2014). Out of the total sampled, 51 of trusts outsourced their cleaning services, whereas 75 used staff cleaners.

The researchers did not examine why there might be slightly lower standards of cleanliness reported for outsourced cleaners as they did not have relevant data on staff turnover or recruitment levels, which the paper says could indicate a measure of job dissatisfaction. The researchers obtained reports into perceptions of cleanliness from surveys commissioned by NHS England from Picker Institute Europe. Data analysed on the economic costs of cleaning per bed are from Estates Return Information Collection for the period 2010-2014.