Liam Donaldson, the chief medical officer for England, has named, in his latest annual report, “unacceptably poor” hand hygiene in hospitals and the chronic lack of organs for transplantation as the two most pressing public health issues.
Despite improvements in some hand hygiene practices, he said, such as more widespread use of alcohol based handrubs, the percentage of healthcare staff complying with hand cleaning protocols seldom exceeded 60%—and was often even lower.
“Patients find it astonishing and alarming that often nurses and doctors do not routinely wash their hands,” said Professor Donaldson. “However, they often don't feel able to ask doctors or nurses if they've washed their hands.”
He said it might be possible to empower patients by providing them with their own alcohol based handrubs, which they would be able to offer to clinical staff. A pilot study to test this was already being organised in an NHS hospital, overseen by the hospital hygiene expert Didier Pittet of the World Health Organization.
Professor Donaldson also renewed calls for the introduction of an opt-out system for organ donation, in which it would be assumed that people were willing to donate their organs unless they specified otherwise. This was, he said, vital to save lives “among a group of people who are currently dying at a rate of one a day.”
He said: “There is a shortage of organs in this country, as there is in other countries, and the situation is getting worse.”
He acknowledged that parliament had already rejected such an opt-out system, but he added: “Confronted with the worsening situation, people who opposed it in the past may now wish to change their minds.”
Keith Rigg, vice president of the British Transplantation Society and a consultant surgeon at Nottingham University Hospitals NHS Trust, said, “There is a clear need for an increase in organs for transplantation. An opt-out system may be one way to help meet the demand, but if introduced [it] must ensure that those opting in or out did so with informed consent.”
Professor Donaldson named three other priority areas in his annual report for 2006: reducing the risk of radiation overdose during treatment for cancer by extending the use of monitoring devices to all radiotherapy machines in England; conducting more research to establish the reasons why 500 babies die each year during childbirth, despite being apparently healthy; and taking steps to increase the number of women in the most senior positions in medicine.
He blamed the absence of flexible training opportunities and “cultural attitudes” for the low numbers of women consultants and professors.
When asked whether he took responsibility for the debacle over training posts for junior doctors and whether he felt he should resign over the matter, Professor Donaldson replied that everyone felt regret over what had happened but added: “The responsibility for implementation was widely distributed, and it would be hard to find any single organisation or individual who could be said to be responsible.”
The chief medical officer's annual report for 2006, On the State of Public Health, is available at www.dh.gov.uk/cmo.