Comment from the Closet (at the hospital) – listen for someone knocking on the door
Last week I found myself as an unplanned guest of the NHS in Scotland. The quality of care was fantastic and the improvements in communicating and reinforcing good hand hygiene practice over the last few years have improved immeasurably.
However I was amazed to find that the NHS is still using cartridge liquid soap systems. Now I can see the positive arguments for using a cartridge system, which is more expensive than bulk fill but in a hospital environment where you need single use dispensers and ease of shifting stock between rooms, bays, wards and wings the cost is probably worth it.
The bit that surprises me is that the hospitals have not moved to a foaming soap delivery method. ‘Why should they?’ I can almost hear you ask. Well we recommend foaming soap over liquid soap for a variety of reasons so let’s look at them individually.
- Cost – foaming soap lasts about 10 times longer than liquid soap depending on the manufacturer’s dosage. The average liquid soap will dispense between 1-3ml of soap per ‘pump’, and even 2 or 3 pumps of liquid soap doses have less volume than one dose of foaming soap.
- Efficacy – when washing hands it is important to wet your hands first so that the (liquid) soap is spread easily across the skin. Foaming soap has a much higher liquid content and is much easier to spread over the skin.
- Dry Skin – liquid soap is much more concentrated and is more difficult to wash off the skin. By leaving traces of liquid soap on your skin the oils are removed and can cause dry or cracked skin. Foaming soap is less concentrated and easier to wash off the skin.
- Packaging – the current system uses a plastic bladder inside a cardboard box. The box could go or even a supplier being innovative and moving to an even more environmental option
- Fun – children love using foaming soap it encourages them to wash their hands!
So why would the NHS not make the change? Possibly the cost to replace the millions of soap dispensers in the system, although any supplier worth their salt would be happy to bear that cost.
Possibly risk of infection? I can see an argument (albeit a weak one) that the foaming soap is mixed with air to create a foam or mousse, and that there is a hypothetical risk of pathogens being exposed to the soap, but is this risk any higher than pathogens being exposed to liquid soap not being washed off of hands properly? I think not and both risks are reduced by the use of hand sanitisers in the wards these days.
So this begs the question why does the NHS not make a small change and save potentially millions of pounds instead of washing it down the drain every day in every hospital in the UK?