The impact of environmental cleanliness on infection rates.

Much has been said in recent years about the lack of environmental cleanliness in hospitals. The House of Lords Select Committee (1998) talked about falling standards in hospital cleaning and, more recently, the government acknowledged in The NHS Plan (Department of Health, 2000) that hospitals were unacceptably dirty. Such comments may affect people's perceptions of hospitals and, rather than regarding them as safe environments that promote healing, they may be viewed as dangerous places that might cause vulnerable patients greater harm. While it is known that about 10 per cent of hospital inpatients have a nosocomial infection at any one time (Emmerson et al, 1996), there is uncertainty about whether there is a sound evidence base to support the theory that dirty hospitals cause infection.