The role of cleaning as an effective tool in the control of hospital acquired infections has generated much interest. Moreover, the role of cleaning personnel has been identified as being a more important factor in ensuring cleanliness than cleaning product. Adenosine triphosphate (ATP) is present in all types of organic matter and its measurement provides an indication of microbial and non microbial soil. This audit was undertaken at a large NHS university teaching hospital using ATP measurements to assess the effectiveness of the post outbreak cleaning regime. Two wards were assessed following outbreaks of norovirus and 23% of swabs failed to reach a previously established benchmark of 100 RLU. Nurse call bells were one of the most common failures (40%). Observation of practices during the audit revealed poor compliance with the cleaning procedure and confusion over cleaning responsibilities. The cleaning procedure at the Trust has been simplified as a result. Further work is required to establish acceptable cleanliness benchmarks using this technology.

Meticillin resistant Staphylococcus aureus (MRSA) has attracted much sensationalist reporting from the media in recent years and has contributed to a high level of anxiety among the public in general. In response to this, and bearing in mind the Department of Health's encouragement to involve the patient in improving healthcare services, the Infection Prevention and Control Team (IPCT) at a large acute NHS trust undertook an evaluation of patient satisfaction with their MRSA related care. The aim was to improve the service currently offered by IPCT to inpatients who are either infected or colonised with MRSA. The survey demonstrated a general satisfaction with the current service. However, several recommendations are under review as a consequence of the study, including: ■ Content of information leaflets ■ Content of MRSA educational programmes ■ Ensuring attendance at mandatory infection control education sessions ■ The method of information provision for patients with MRSA ■ The amount of protected time for link practitioners. Other trusts may have similar issues, levels of patient satisfaction and patient concerns, and infection prevention and control teams may find it beneficial to review the issues identified through this survey.

In the United Kingdom (UK), the majority of hospitalised patients colonised with meticillin resistant Staphylococcus aureus (MRSA) prior to or on admission to hospital are prescribed decolonisation treatment and isolated with appropriate precautions to reduce the risk of cross-transmission. However, MRSA colonisation in patients who have not completed decolonisation therapy does not prevent discharge or transfer to community healthcare facilities and current guidelines do not recommend routine community treatment and follow-up of patients. This qualitative study examines the perceptions of six senior infection prevention and control nurses in relation to the management of MRSA colonisation in the community. Data were collected using semi-structured interviews, and findings suggest that gaps exist in current service provision for patients colonised with MRSA who are discharged to community healthcare settings. Respondents perceived that this was due to a number of factors including: practice being shaped by targets, compliance with guidelines, and the split in hospital and community providers. We suggest that current guidelines should be modified to provide follow-up for patients colonised with MRSA who are discharged to community healthcare settings.

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