A large part of the trouble is that "not my job" and "we just don't have the resource" and "we're just too busy" are institutionalised to the point of reflex response. Cleaning should be done by people on the spot as they can immediately see what needs doing. By people who have a vested interest to see that things are clean and kept clean - that vested interest being to ensure the welfare of the patient. Cleaning should not be contracted out.

GC, Harrogate,

It is interesting to note that in France there is no equivelant of the HSE, workers relying on the law, police and trade unions, and there is no more health and safety problems than in the UK and people feel far freer as any visitor to a French public swimming pool would notice. Their hospital acquired infection rate is 1/80th the rate of the UK. Although France has far more state run enterprises, etc. there is also far more delegation with services being run far closer to and more responsive to the user. We could learn a lot from them.

R Mason, London, UK

Clearly what is required are more speed cameras.

David Masu, Zürich,

Whats is difficult to understand is why French doctors and nurses seem more dedicated then ours in the UK. French saleries are 40% lower than in the UK. UK doctors and nurses are the second highest paid in the World after the USA.

Bill Rees, Pieusse, France

Ok, I study hospital infections for a living. The overarching theme is cost: spare beds cost, matrons cost, in-house responsible cleaning costs, infection control costs, proper nursing levels cost more than the untrained health care assistants. It is down to the money: started by the Tories, perfectioned by NL, the NHS has been squeezed like a lemon. It is really quite simple: we all need to pay a lot more for our hospitals. And rather appoint second class managers, we should put the money back to the consultants and nurses and ask them to organise their hospitals properly, just like in the good old days. The decline in hygiene standards over the last 20 years is no secret. It is time to draw the lesson: The managerial classes have failed us miserably and need to be cut and let go.

Fred Freeloader, Manchester,

Having spent 28 nights in hospital last year I observed some bad hygiene practise.

Nurses and doctors would go to wash the hand at the ward bay tap, turn the taps on with dirty hands, wash then
turn off the taps that would have just been dirtied.

Also when people in the wards go to the toilet/washroom
people wash hands etc then have to pull open a door with a handle that had just been opened by someone with dirty hands.

I used to wash then use tissue to grip the handle to exit bathroom.

Kev Somers, Hertford, Herts

My 86 year old mother is in hospital, and we're not yet sure if she will pull through. My mother is receiving the best possible care available, dedication the like of which is very moving to see. I want to commend all the staff of Chelsea and Westminister Hospital for their tireless good work, their care, concern, good humour under difficult circumstances, first rate extensive clinical expertise and genuine respect for their patients and families. The NHS is a magnificent and much needed institution and those who work in it are some of the leading lights in our medical system. Let's do everything we can to give these courageous and unswerving people dedicated to curing and saving lives, the best possible support we can.

T. Bishop, London, UK

Has there ever been good idea that couldn't be ruined by the attention of a few civil servants? NHS staff are hired, managed and renumerated in the same way as civil servants. Why do we expect them to behave any differently? Are they sacked for breaking the rules? Can they be found guilty of malpractice for not washing? When was the last NHS employee or contractor suspended with no pay for endangering a patient's life?

If this litany of laziness and error belonged to a private company the employee responsible would have been sacked for gross misconduct long before a patient came close to dying. But it's OK - NHS damages are paid by the taxpayer, so even if we could win a case for malpractice we end up paying for it ourselves!

A quango is not responsible to anyone except the treasury and they aren't responsible to anyone except a bunch of MPs who live out of the same purse.

KR, Stockport,

Oh joy, another round of NHS bashing! The only thing that seems to divert peoples attention from our national obsession with doing down the insitutions which keep us safe and secure is the occational terror attack. Clearly in a health service that is haemorrhaging staff to the rest of the English speaking world due to dwindling moral, endless critism, and coordinated government attack, the introduction of yet another group of bullying, self important, single issue practitioners would be less than a good idea. Maybe what the world needs is more ill informed journalists, short sighted politicians, and whinning, curtain twitching, middle class twits. Here's my idea, how about we pay the money required to have enough beds and nurses and cleaners for the NHS to actually work properly (ie. with your taxes!) or how's about you all getting up of your enraged, disgusted, and shocked backsides and cleaning up your local hospital (or just raise the funds to do it!).

ned thomson, Manchester,

It seems to me that there is an ever-growing number of people whose self-audit at work is guided by the thought:- "If I'm not sacked from my job, and I don't get too many bollockings, I must be doing it as well as anyone has a right to expect". And that, with exceptions, this outlook pervades our entire society, from top to bottom.

Am I being incredibly naive in thinking that we really can't get anywhere while this attitude prevails, and that most of what's going on in society is strengthening, rather than eradicating it? Is a re-focus on developing genuine pride of performance, self-assessed, something that just can't happen in the 21st Century?

Simon Stephenson, Windermere, UK

There are ways of totally removing all traces of superbugs from buildings. And provided that the Dutch approach is adopted to prevent reinfection then hospitals could literally start with a clean sheet. The food industry has really set the precedent for the solution. In the bread-baking industry certain hygienic standards need to be maintained in order to prevent infection within the building that can result in certain heat-resistant spores from contaminating bread to gives rise to the condition known as "rope" (B. Mesentericus) and a similar one producing a melon odour in bread (B.Subtilis). Both infections destroy the crumb of bread by reducing it to a sticky mass. In rare instances where the factory becomes infected the most effective way of "sterilising" the building is to use a suitable disinfectant gas thereby enabling all parts of the building to be accessed. Whether the PC brigade will allow the old-fashioned hygienic practices to be applied thereafter is the real question

Dr Edward Willhoft, Epsom, UK

I think more needs to be done, however it is a difficult task in getting compliance by staff, patients and visitors. In April my father had to go to hospital to have an operation, my mothers a carer and I am a biology student so we both understand infection control. Whilst walking into the ward approximatly 7 people entered with us, 5 were nurses, 2 were other visitors and only my mother and I cleansed out hands. I was furious at the time and just sitting in the hospital watching normal activities you see how dirty things really are. I would just like to comment on the previous comment, and its understandable that nurses and staff are busy but their main role and motivation in that job is patient care. A lot of infections could be prevented just by a little more thought that makes 10 second difference by changing gloves, washing hands.
There is a long way to go, but people need to be shown the importance, and educated.

Tracey, Birmingham,

Jon suggests that "...to expect Nurses to act as they did 20 or 30 years ago in insane." Nonsense - not if things were better then. Life might be better for nurses today than it was, but this has been at patients' expense. I can only assume Jon is a "odern nurse, too "educated" and "highly trained" (ie, self important) to bother with such mundane matters as basic hygeine.

Nick, Rotherham, UK

I was a patient in a North London hospital A&E cubicle a week ago. There was a prominent notice instructing all medical staff, visitors and patients to wash their hands in the sink using the antibacterial dispenser pumps every time they entered or left the cubicle.

Two different doctors and five nurses entered and left my cubicle on about fifteen occasions in the hour and a half I was there.

Not one of them washed their hands unpon entering or leaving my cubicle at any time.

When I myself came to leave the cubicle I washed my own hands using the antibacterial dispenser. It took less than twenty seconds.

Andy Fellows, Canterbury, England

The UK has a Union organised, Government funded jobs scam. The fact that it is a " Hospital ", is irelevant. Actually superfluous. The Union is all.

Desmond Taylor, Houston, USA Tx

Why will they do anything except ACTUALLY CLEAN THE HOSPITALS PROPERLY AND SEVERAL TIMES A DAY?

Thalia, London,

The cleanliness of our hospitals is quite honestly alarming, surely the use of private cleaning companies must have a detromental effect, because no matter who or what they profess to it must be profit not cleanliness that keeps them operating. The cheaper the labour the bigger the profit! hospitals should be run by Medical staff and employ only those that have to answer to the hospital admin. staff (who, incidently should answer to medical staff. the present arrangement where surgeon/doctors and nursing staff answer to a small army of useless hangers on. Admin personell should be kept to a minimum and have no offical control over the running of out hospitals.

Alan, London, england

Five years on after an operation, at the Royal Cornwall Hospital Truro, which become infected, I still have problems. Last year I spent around three weeks on the heart ward at the same hospital and was disgusted to find things were even worst than before. Fortunately I managed to get the surgery I needed carried out at Hare field Hospital Middlesex. After spending nearly three weeks at the Royal Cornwall I have vowed never to let myself be admitted there again. The standard of care at the Hare field showed me just how good things can be and just how low the standard of care is at the Royal Cornwall hospital.

D Case, Newquay,

6 to a ward is 6 or 12 to one lavatory in the night. Cough and sneezes circulate un checked, added to by swarms of visitors in the day. Drifts of staff wandering the corridors.Face masks? nary a one.
Giant jugs of tepid water hanging about for patients to drink while staff graze off refrigerated water machines.
By comparison dust on the floor is as irrelevant as cakes on the moon.
My wife's triage nurse had blood on her hand during examination.
Third World? Only Hampshire and Worcestershire.

Chris, Malvern, England

I fully agree with Jon, Woking. Cleaner hospitals are easily achievable by reducing bed occupancy rates and improving the training and leadership of cleaning staff. It all comes down to target driven management and lack of effective resources, forcing the front-line staff to sacrifice optimal patient care for a "best we can for the most we can" approach. NHS morale is at its lowest ebb for many years, and it is not the fault of Nurses or even NHS middle management but a series of misguided and unresourced central government directives.

Euan, Aldershot,

Why aren't people more angry at this betrayal of what the NHS is supposed to stand for? Why aren't opposition parties pressing vociferously for the Health Protection agency to publish figures for individual hospitals? How many more patients have to die before rigorous standards of cleanliness are ENFORCED in all hospitals? What about patients' 'human rights'?

Jean, London, England, UK

If the NHS wants to see an example of how one US cities' hospitals dramaticly reduced infections, look at Cincinatti. Once it was determined that every infection case actually COST them $45000, systems were quick enacted that dropped the occurance rates by almost 90%.

Richard Pare, Indianapolis, Indiana

The total number of HAIs has risen, therefore, differentiating between Cdiff and MRSA is a red herring; the fact is that both are HAIs which are spread and flourish in hospitals as a result of ineffective infection control. MRSA infection rates are not particularly well recorded in that only bloodstream infection are counted in the figures.

It is unfortunate that infection control is treated as the poor relative in comparison to the more glamorous and obvious areas in which NHS money is spent, whereas in fact, impeccable infection control would release more money for the cutting-edge hi-tech innovative practices to be expanded.

My eldest son has been left disabled after contracting MRSA four years ago aged 19, at a time when superbugs were not in the public eye. Why, after so much publicity, are the same issues arising? Why does H&S not apply in NHS hospitals?

Ruth Wollacott, Hornchurch, Essex

Hospitals should be run like the military using orders not requests.

David Thijm, Stourbridge, UK

The rise of MRSA in this country has closely coincided with the use of low paid contract cleaners instead of in house NHS staff. The only reason that these contracts were cheaper for the government and profitable for the companies that offered them was because they paid staff next to nothing, treated them terribly and cut corners in their work. To make priofits something has to give, why the surprise that it happens to be people's lives?

Jasper, Edinburgh,

Nick, Rotherham, UK - your spot on. Money saving is the motivation here and not patient care.
On Monday, i observed a wall covered with damp in Selly Oak hospital, the same place where our serive men get the best care!

Rob, Brum, UK

It doesn't matter how clean your hands are if the wards are dirty. Staff simply cannot clean theri hands every time they touch something. Also to expect Nurses to act as they did 20 or 30 years ago in insane. Nurses are resposible for a thousand more things than in the past, some of which are new and some of which a doctor used to carry out. Cleaning is NOT the job of the nurses.

Jon, Woking, UK

Modern Matron will not have the background of old fashioned
Matron, and will be of the sloppy school brigade!
When you see staff wearing earings, wristwatches, and their rings, wearing their clothes beyond the ward , or theatre staff
in scrubs wandering all over the place , what can you expect.
Agency staff spreading bacteria from hospital to hospital,or ward to ward. What happened to Lysol and carbolic, and phenol? Hospitals even smelt clean when these were used years ago. Shoes that walk from home to high street to hospital are also probably bug ridden!! Cross infection seems not to be taken as seriously as it used to be. Ward keyboards even, many fingers fiddling there!!
Unless the private cleaning staff are accountable to the ward
sister and her authority, things will get a darn sight worse

Mrs Maggie Snook, wareham, Dorset UK

In most other countries doctors wear white coats and scrubs which are washed at high temperatures in the hospital laundry. I can't understand why the only people to wear white coats in British hospitals are the porters.

Maclachlan, David, Romanshorn, Switzerland

Hospital cleanliness failures and miserable performance in hand-washing are not the government's fault, or the consequence of the "privatization" of cleaning services. They are the direct responsibility of doctors and nurses. Here's a simple suggestion: put the hand-washing stuff next to the patient. Enlist patients in monitoring whether those who care for them are doing it properly. Reward those who do - name and shame those who do not.

Nick, Rotherham, UK

Thank you Camilla Cavendish, this article shouts volumes and gives a clear indication of the failings of the medical systems in Britain particularly NHS hospitals and proves, yet again, that a tight ship, with command, control and communications and with delegated responsibility and accountability is the ONLY way to run an organization that has become sloppy, inefficient and ineffective. The system needs to get a grip and remove some heads 'pour encourage les autres'. The fact that reported instances of MRSA may have fallen by 6% falls into insignificance when reported cases of C Difficile have increased by 22%.

Kenneth Armitage, Suffolk, England

I have just been in hospital in France as I was taken ill on holiday.The hospital was superb and very clean.As it used to be in the NHS, the cleaning was done by the domestic staff and by trainee nurses in each dept.The senior nurses kept a careful eyeand they all worked as a team.What is wrong with NHS,apart from a politically correct bureaucracy in denial,is the .Until the system is changed instructions such as washing hands are no better than aspirins to aids sufferers.
Hospitals need to re-empower matrons and consultants and re-orient the bureaucrats to realise patient care ,not cost is their primary mission.

R G James, Braaschaat, belgium

The rose-tinted view of the NHS hospitals has gone for ever. The majority of frontline nursing staff are idle parasites employed on an agency basis - trying to live off the past glories of their colleagues. It is time that these parasites were deported. I have very recent first-hand experience of the neglect that the NHS in Chesterfield imposes on its 'victims'.

David, Chesterfield, UK

and staff take their uniforms home, wash on a colour wash in a domestic machine at 40oC or with "Ariel 30". Is that hot enough to kill CD?

Phil, Jakarta, Indonesia