Chamber
Plenary, 26 Mar 2008
26 Mar 2008 · S3 · Plenary
Item of business
Health Care Associated Infection
I welcome the commitment that the cabinet secretary has made and the opportunity that the debate gives us to consider how we can reduce the risk of contracting hospital-acquired infection. It is clear that members across the parties are willing to debate the matter constructively.
I will talk about one of the most at-risk groups: the frail elderly. The key issue is that acquired infection is, in the main, preventable. Hand washing and good hygiene are obvious and cheap yet, for many years, we as a society did not do enough to promote them. Progress is now being made.
An important principle is the presumption against admission. For elderly people—and particularly those with dementia—hospital can be a risky place. I am sure that every member knows of an elderly person who was admitted to hospital for a minor ailment but who at best ended up as a delayed discharge or at worst acquired C diff or a fracture because their resistance was lower and their vulnerability to adverse incidents was higher.
To state the obvious, we need to ask whether the balance of risk for an elderly person is greater at home or in hospital. Ian McKee touched on that. Too many elderly people are admitted to hospital not for an operation or a blood transfusion—for something major or serious—but for diagnostic testing. Improving access to diagnostic testing could play a major role in decreasing the number of admissions and therefore the number of hospital-acquired infections. The Forth Valley project on care pathways for people with dementia has taken an innovative approach that ensures that accident and emergency staff are fully trained in dealing with dementia and encourages them to ask whether an admission is absolutely necessary and where the balance of risk lies.
In relation to admission to hospital, I will talk about closed wards. I found out only recently that patients are not allowed into or out of a closed ward but a visitor can visit freely without a gown, mask, gloves or even an information leaflet about why the ward is closed. Relatives need to be provided with information. If a ward is closed but visiting is allowed—that appears to be the case occasionally—relatives must be required to undertake basic barrier precautions. I emphasise that that is not a matter for clinical staff; a top-down management decision needs to be taken. I would welcome the minister clarifying in her summing-up whether some of the resources that have been announced could be allocated to addressing that issue.
That leads me to contaminated laundry. Mary Scanlon made the important point that viruses can be transmitted on clothing. I was surprised to learn that when a patient is in a closed ward—even when there is vomiting or diarrhoea—relatives are expected to take home contaminated personal laundry for washing. Given what Mary Scanlon said about bugs being transmitted on clothing, that issue is serious. I ask the minister to consider how we can ensure that, when wards are closed for good reason, in-house provision is made for laundering contaminated clothing.
I turn briefly to the care home sector. I was surprised to read in the Scottish Commission for the Regulation of Care's report on cleanliness, hygiene and infection control for older people that there have been a higher number of outbreaks of the norovirus—the winter vomiting bug—in care homes than in hospitals. The regulations relating to, and the monitoring of, acquired infection are much more rigorous in the acute sector than in care homes and there are more resources in that sector. I welcome the additional resources that the minister said will be available, but it is vital that those resources ensure that there is appropriate monitoring and surveillance—Mary Scanlon made that point—and that care home staff are adequately trained. Currently, too many staff in care homes go to work when they are unwell because they are low paid and do not receive sick pay. A culture change is needed, as there has been with hand washing. Staff who are ill must be encouraged not to go to work and so place frail elderly people at risk.
Having clearer procedures for closed wards where such procedures are necessary, dealing with contaminated laundry and—most important—raising standards in hospitals and care homes for the elderly could help to reduce acquired infections. It is no longer acceptable that some of the most frail and vulnerable people in our society, who have no voice, should be treated in such a way. Let us say that we are on their side, that we are their voice, and that we will work tirelessly in the Parliament to raise standards for them.
I support the amendment in Margaret Curran's name.
I will talk about one of the most at-risk groups: the frail elderly. The key issue is that acquired infection is, in the main, preventable. Hand washing and good hygiene are obvious and cheap yet, for many years, we as a society did not do enough to promote them. Progress is now being made.
An important principle is the presumption against admission. For elderly people—and particularly those with dementia—hospital can be a risky place. I am sure that every member knows of an elderly person who was admitted to hospital for a minor ailment but who at best ended up as a delayed discharge or at worst acquired C diff or a fracture because their resistance was lower and their vulnerability to adverse incidents was higher.
To state the obvious, we need to ask whether the balance of risk for an elderly person is greater at home or in hospital. Ian McKee touched on that. Too many elderly people are admitted to hospital not for an operation or a blood transfusion—for something major or serious—but for diagnostic testing. Improving access to diagnostic testing could play a major role in decreasing the number of admissions and therefore the number of hospital-acquired infections. The Forth Valley project on care pathways for people with dementia has taken an innovative approach that ensures that accident and emergency staff are fully trained in dealing with dementia and encourages them to ask whether an admission is absolutely necessary and where the balance of risk lies.
In relation to admission to hospital, I will talk about closed wards. I found out only recently that patients are not allowed into or out of a closed ward but a visitor can visit freely without a gown, mask, gloves or even an information leaflet about why the ward is closed. Relatives need to be provided with information. If a ward is closed but visiting is allowed—that appears to be the case occasionally—relatives must be required to undertake basic barrier precautions. I emphasise that that is not a matter for clinical staff; a top-down management decision needs to be taken. I would welcome the minister clarifying in her summing-up whether some of the resources that have been announced could be allocated to addressing that issue.
That leads me to contaminated laundry. Mary Scanlon made the important point that viruses can be transmitted on clothing. I was surprised to learn that when a patient is in a closed ward—even when there is vomiting or diarrhoea—relatives are expected to take home contaminated personal laundry for washing. Given what Mary Scanlon said about bugs being transmitted on clothing, that issue is serious. I ask the minister to consider how we can ensure that, when wards are closed for good reason, in-house provision is made for laundering contaminated clothing.
I turn briefly to the care home sector. I was surprised to read in the Scottish Commission for the Regulation of Care's report on cleanliness, hygiene and infection control for older people that there have been a higher number of outbreaks of the norovirus—the winter vomiting bug—in care homes than in hospitals. The regulations relating to, and the monitoring of, acquired infection are much more rigorous in the acute sector than in care homes and there are more resources in that sector. I welcome the additional resources that the minister said will be available, but it is vital that those resources ensure that there is appropriate monitoring and surveillance—Mary Scanlon made that point—and that care home staff are adequately trained. Currently, too many staff in care homes go to work when they are unwell because they are low paid and do not receive sick pay. A culture change is needed, as there has been with hand washing. Staff who are ill must be encouraged not to go to work and so place frail elderly people at risk.
Having clearer procedures for closed wards where such procedures are necessary, dealing with contaminated laundry and—most important—raising standards in hospitals and care homes for the elderly could help to reduce acquired infections. It is no longer acceptable that some of the most frail and vulnerable people in our society, who have no voice, should be treated in such a way. Let us say that we are on their side, that we are their voice, and that we will work tirelessly in the Parliament to raise standards for them.
I support the amendment in Margaret Curran's name.
In the same item of business
The Presiding Officer (Alex Fergusson):
NPA
The next item of business is a debate on motion S3M-1621, in the name of Nicola Sturgeon, on the health care associated infection task force.
The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
SNP
I am pleased to open the debate and to present our ambitious new plans for tackling health care associated infection in Scotland during the next three years ...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
I emphasise how much we in the Labour Party welcome the debate. We acknowledge that our amendment will be accepted. I associate myself with many of the point...
Nicola Sturgeon:
SNP
I hope that I can reassure Margaret Curran that the investment that we have set aside for the next three years is 260 per cent higher than the investment ove...
Margaret Curran:
Lab
I will take that—graciously, I hope—as an indication of the cabinet secretary's commitment. However, as I understand it, England has prioritised the issue, a...
Mary Scanlon (Highlands and Islands) (Con):
Con
It is always good to follow the gracious Margaret Curran. The Conservatives welcome the debate on health care associated infection. We also welcome the inves...
Ross Finnie (West of Scotland) (LD):
LD
I do not discern—and I suspect that, by the end of the debate, I will not discern—any disagreement with the proposition that, because health care associated ...
Nicola Sturgeon:
SNP
I am pleased to intervene on that very serious point. I hope that the member will take some reassurance from my pronunciation of "coherence" during my speech...
Ross Finnie:
LD
I am greatly comforted. We must maintain standards in the chamber.Health care associated infection is a serious issue, and I welcome the debate. Margaret Cur...
Ian McKee (Lothians) (SNP):
SNP
We have heard a lot—and I am confident that we will hear a lot more as the debate progresses—about the virtues of cleanliness in preventing health care assoc...
Helen Eadie (Dunfermline East) (Lab):
Lab
I agree with Ross Finnie's suggestion that there is likely to be near unanimity on this vital issue. I welcome the cabinet secretary's announcements about th...
Nicola Sturgeon:
SNP
I am always happy to consider lessons from elsewhere, and I appreciate Helen Eadie's point, but I remind her that I mentioned our policy, which I launched ea...
Helen Eadie:
Lab
I am sorry that the cabinet secretary feels aggrieved, but if she had been listening she would know that I congratulated the Government on its screening init...
Michael Matheson (Falkirk West) (SNP):
SNP
I welcome the Cabinet Secretary for Health and Wellbeing's statement. In the spirit of consensus, I acknowledge the work that the previous Labour and Liberal...
Irene Oldfather (Cunninghame South) (Lab):
Lab
I welcome the commitment that the cabinet secretary has made and the opportunity that the debate gives us to consider how we can reduce the risk of contracti...
Nanette Milne (North East Scotland) (Con):
Con
This debate on dealing with health care associated infections is extremely important. However, I cannot help feeling sad that the reputation of a health serv...
James Kelly (Glasgow Rutherglen) (Lab):
Lab
I welcome the opportunity to take part in this afternoon's debate on health care associated infections. I endorse the cabinet secretary's announcement and, o...
Sandra White (Glasgow) (SNP):
SNP
The cabinet secretary is to be congratulated on this initiative. As the Labour amendment states, the previous Government is to be commended for the establish...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
Many members have talked about consensus, but consensus does not make the debate any less important—we should debate such issues.The cabinet secretary mentio...
Nicola Sturgeon:
SNP
Rhoda Grant makes an important point. It may be of interest to her and other members to know that we are working with the trade unions on a national uniform ...
Rhoda Grant:
Lab
Yes. I am grateful to the cabinet secretary for that information. The BMA position shows that doctors have the will and wish to see the proposal progressed.W...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
LD
I agree with nearly everything that has been said in this worthwhile debate. The unanimity of the message will be encouraging to patients and health professi...
Jackson Carlaw (West of Scotland) (Con):
Con
We welcome all that Nicola Sturgeon has said today in her speech and her interventions, including the MRSA pilot that she announced, in what has been a usefu...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
As all other members who have spoken have said, the debate has been consensual, informed and of a high standard. As Jamie Stone said, that should give comfor...
Nanette Milne:
Con
My point was that it does not matter who actually does the cleaning. What is important is the supervision of a high standard of cleaning.
Dr Simpson:
Lab
I hate to say this, but I could tell Nanette Milne numerous stories of when contract cleaners have come in, done their bit and gone away, leaving the questio...
The Minister for Public Health (Shona Robison):
SNP
I have listened with interest to this constructive, stimulating and wide-ranging debate, which has served as a stark reminder that the Scottish Government an...