Abstract
There has been extensive outsourcing of hospital cleaning services in the NHS in England, in part because of the potential to reduce costs. Yet some argue that this leads to lower hygiene standards and more infections, such as MRSA and, perhaps because of this, the Scottish, Welsh, and Northern Irish health services have rejected outsourcing. This study evaluates whether contracting out cleaning services in English acute hospital Trusts (legal authorities that run one or more hospitals) is associated with risks of hospital-borne MRSA infection and lower economic costs.By linking data on MRSA incidence per 100,000 hospital bed-days with surveys of cleanliness among patient and staff in 126 English acute hospital Trusts during 2010–2014, we find that outsourcing cleaning services was associated with greater incidence of MRSA, fewer cleaning staff per hospital bed, worse patient perceptions of cleanliness and staff perceptions of availability of handwashing facilities. However, outsourcing was also associated with lower economic costs (without accounting for additional costs associated with treatment of hospital acquired infections).
Highlights
There is a long-standing debate in the United Kingdom about the impact of outsourcing of hospital cleaning services to private sector contractors
In the 1990s critics linked outsourcing to growing concerns about hospital acquired infections, and in particular, methicillin-resistant Staphylococcus aureus (MRSA), which was felt to be especially frequent in the UK
Outsourcing cleaning services was associated with significantly greater MRSA incidence, more reports that handwashing materials are not always available, and patient perceptions of less clean bathrooms and rooms/wards
Summary
There is a long-standing debate in the United Kingdom about the impact of outsourcing of hospital cleaning services to private sector contractors. Beginning in 1983, cleaning services were one of the first parts of the NHS to be contracted to private providers under HC(8318) “Competitive tendering in the provision of domestic, catering and laundry services”. The Department of Health and Social Security wanted hospitals to save money and argued that they would “make the maximum possible savings by putting services like laundry, catering and hospital cleaning out to competitive tender. Outsourcing has ceased in Wales and Northern Ireland (European Federation of Public Service Unions, 2011). These fears were dismissed by others, with the Business Services Association, representing outsourcing companies, arguing that “There is no evidence to suggest that outsourcing cleaning services causes increased rates of infection” (BBC News, 2008)_ENREF_11
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