title: Outsourcing cleaning services increases MRSA incidence: Evidence from 126 english acute trusts.
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).
authors.affiliation: Department of Sociology, University of Oxford, Oxford, UK. Electronic address: veronica.toffolutti@sociology.ox.ac.uk.
authors.forename: Veronica
authors.initials: V
authors.lastname: Toffolutti
authors.affiliation: International Inequalities Institute, London School of Economics and Political Science, Houghton Street, London, UK.
authors.forename: Aaron
authors.initials: A
authors.lastname: Reeves
authors.affiliation: Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.affiliation: Department of Sociology, University of Oxford, Oxford, UK; Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Stuckler
mesh_terms: D004469:Economics, Hospital / Q000639:trends; D004739:England / Q000453:epidemiology; D006305:Health Status Indicators; D006761:Hospitals / Q000592:standards / Q000639:trends; D006797:Housekeeping, Hospital / Q000379:methods*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology / Q000517:prevention & control; D015994:Incidence; D017053:Infection Control / Q000191:economics* / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity; D020416:Outsourced Services / Q000191:economics* / Q000592:standards*; D013203:Staphylococcal Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D013222:State Medicine / Q000191:economics / Q000639:trends; D000078329:Workforce
keywords: Contracting-out; Hospital acquired infections; Hospital cleaning; Outsourcing