Jawaban Atas Surat Terbuka Untuk Menteri Keuangan

https://www.facebook.com/nufransa.sakti/posts/10156633370576446

Nufransa Wira Sakti

Akhir-akhir ini banyak suara-suara yang begitu mudah menghakimi rencana Pemerintah menaikkan iuran program Jaminan Kesehatan Nasional (JKN) dan usulan untuk mendisiplinkan peserta yang menunggak iurannya, khususnya peserta mandiri. Sasaran utamanya: Menteri Keuangan.

Salah satunya adalah Edi Mulyadi, yang "mengaku" sebagai wartawan senior. Dia menyinggung kebijakan rencana kenaikan iuran BPJS Kesehatan dengan menyatakan bahwa Menteri Keuangan seolah-olah mengingkari sumpah jabatan yang mengatasnamakan Tuhan, menafikkan kesetiaan terhadap republik, bahkan menyinggung kapasitas keilmuan Sri Mulyani Indrawati.

Hal ini tentu saja harus diluruskan karena Edi Mulyadi tidak mengerti tentang apa yang terjadi sehingga menghakimi tanpa bukti.

Perlu diketahui, bahwa kenaikan iuran ini tidak akan mempengaruhi penduduk miskin dan tidak mampu. Saat ini, sebanyak 96,6 juta penduduk miskin dan tidak mampu, iurannya dibayar oleh Pemerintah Pusat (APBN) yang disebut Penerima Bantuan Iuran (PBI). Sementara 37,3 juta jiwa lainnya iurannya dibayarkan oleh Pemda (APBD) melalui kepesertaan penduduk yang didaftarkan oleh Pemda (yang terkadang disebut juga PBI Daerah). Dengan demikian, ada sekitar 134 juta jiwa yang iurannya dibayarkan oleh APBN dan APBD.

Sementara untuk pekerja penerima upah, baik ASN Pusat/Daerah, TNI, POLRI maupun pekerja swasta, penyesuaian iuran akan ditanggung bersama oleh pekerja dan pemberi kerja.

Khusus untuk peserta mandiri Kelas 3 hanya akan naik menjadi sebesar Rp42 ribu, sama dengan iuran bagi orang miskin dan tidak mampu yang iurannya dibayar oleh Pemerintah. Bahkan bagi peserta mandiri Kelas 3 yang merasa tidak mampu dengan besaran iuran ini, dan nyata-nyata tidak mampu, dapat dimasukkan ke dalam Basis Data Terpadu Kemensos, sehingga berhak untuk masuk PBI yang iurannya dibayarkan oleh Pemerintah.

Kenaikan Kelas 2 dan Kelas 1 juga dipertimbangkan dalam batas kemampuan bayar masyarakat (ability to pay). Dalam hal ada peserta yang merasa benar-benar berat membayar, bisa saja peserta yang bersangkutan melakukan penurunan kelas, misalnya dari semula Kelas 1 menjadi Kelas 2 atau Kelas 3; atau dari Kelas 2 turun ke Kelas 3.

Ditegaskan sekali lagi bahwa ada sekitar 134 juta jiwa yang iuran BPJSnya dibayarkan oleh pemerintah melalui APBN dan APBD. Oleh karena itu, pendapat Edi Mulyadi yang menyatakan Pemerintah abai terhadap rakyat yang tidak mampu dalam BPJS kesehatan ini, tolong berikan data lain yang valid kalau ada. Sesuai dengan janji para pendiri bangsa, Pemerintah akan selalu memikirkan kesehatan masyarakat, khususnya yang tidak mampu.

Silakan mendatangi rumah sakit dan bertanya kepada mereka yang telah bertahun-tahun mendapatkan layanan pengobatan secara gratis dengan berbagai sakitnya. Silakan Edi Mulyadi mencari tahu ke Puskesmas di tempat terpencil dan ikut merasakan bagaimana masyarakat pinggiran terbantu dengan program ini.

Janganlah menuduh sebelum melihat bukti dan data. Tuduhan tanpa bukti dan data yang valid layaknya bumerang yang akan kembali mempermalukan saudara Edi. Sangat memperlihatkan kualitas tulisannya yang buruk dan tidak kompeten.

Sri Mulyani Indrawati kembali ke Indonesia dengan meninggalkan gajinya yang puluhan kali lipat dari gaji yang diterima sebagai menteri sekarang ini. Begitu juga fasilitasnya, sangat jauh dari apa yang diberikan di Indonesia. Pengorbanan yang sangat besar demi cintanya kepada republik tempat tanah kelahirannya.

Sumpah jabatan yang dibacanya ketika dilantik sebagai menteri juga dilaksanakan dengan sepenuh jiwa dan hatinya. Bahkan berulang kali beliau selalu mengingatkan kepada pegawai Kemenkeu yang dilantiknya agar senantiasa memperhatikan sumpah jabatan yang tanggungjawabnya langsung kepada Allah SWT.

Keinginannya untuk mencerdaskan bangsa juga sudah diwujudkan dengan membentuk Lembaga Pengelola Dana Pendidikan (LPDP) saat menjadi Menteri Keuangan yang pertama kali. Saat ini LPDP telah membiayai puluhan ribu anak bangsa untuk melanjutkan sekolah pascasarjana S2 dan S3. Apa yang sudah dibuat Edi Mulyadi? Apakah tulisan-tulisannya di Kompasiana sebagai yang mengaku wartawan senior sudah turut mencerdaskan kehidupan bangsa? Terlihat justru kebalikannya.

Kenaikan iuran BPJS ini diiringi dengan perbaikan sistem JKN secara keseluruhan sebagaimana rekomendasi BPKP, baik terkait kepesertaan dan manajemen iuran, sistem layanan dan manajemen klaim, serta strategic purchasing. Rencana kenaikan iuran ini juga adalah hasil pembahasan bersama oleh unit-unit terkait, seperti Kemenko PMK, Kemenkeu, Kemenkes, dan DJSN. Bukan hanya ketetapan dari menteri Keuangan. Dan nantinya akan ditetapkan dengan Peraturan Presiden (Perpres).

Tentang kenaikan iuran, perlu diperhatikan bahwa di antara penyebab utama terjadinya defisit program JKN yang sudah terjadi sejak awal pelaksanaannya adalah besaran iuran yang underpriced dan adverse selection pada peserta mandiri. Banyak peserta mandiri yang hanya mendaftar pada saat sakit dan memerlukan layanan kesehatan yang berbiaya mahal, dan setelah sembuh berhenti mengiur.

Mengapa iuran harus naik?

Sejak tahun 2014, setiap tahun program JKN selalu mengalami defisit. Sebelum memperhitungkan intervensi Pemerintah baik dalam bentuk PMN (Penanaman Modal Negara) maupun bantuan APBN, besaran defisit JKN masing-masing Rp1,9 triliun (2014), Rp9,4 triliun (2015), Rp6,7 triliun (2016), Rp13,8 triliun (2017), dan Rp19,4 triliun (2018).

Dalam rangka mengatasi defisit JKN itu, Pemerintah memberikan bantuan dalam bentuk PMN sebesar Rp5 triliun (2015) dan Rp6,8 triliun (2016) serta bantuan dalam bentuk bantuan belanja APBN sebesar Rp3,6 triliun (2017) dan Rp10,3 triliun (2018).

Tanpa dilakukan kenaikan iuran, defisit JKN akan terus meningkat, yang diperkirakan akan mencapai Rp32 triliun di tahun 2019, dan meningkat menjadi Rp44 triliun pada 2020 dan Rp56 triliun pada 2021.

Dalam rangka menjaga keberlangsungan program JKN, maka kenaikan iuran itu memang diperlukan. Jangan sampai program JKN yang manfaatnya telah dirasakan oleh sebagian besar penduduk Indonesia terganggu keberlangsungannya.

Selama tahun 2018, total pemanfaatan layanan kesehatan melalui JKN mencapai 233,9 juta layanan, yang terdiri dari 147,4 juta layanan pada Fasilitas Kesehatan Tahap Pertama (FKTP), 76,8 juta layanan rawat jalan RS, dan 9,7 juta layanan rawat inap RS. Secara rata-rata, jumlah layanan kesehatan melalui JKN mencapai 640.822 layanan setiap hari.

Suatu jumlah capaian layanan yang luar biasa dan sangat membantu masyarakat. Apakah Edi Mulyadi dapat membantah kenyataan ini??

Lalu mengapa iuran peserta mandiri harus naik 100%?

Pertama, itu hanya berlaku untuk Kelas 1 dan Kelas 2. Untuk kelas 3, tidak sebesar itu. Untuk Kelas 3, usulan kenaikannya adalah dari Rp25,5 ribu menjadi Rp42 ribu, atau naik 65%.

Kedua, perlu diketahui bahwa peserta mandiri adalah penyebab defisit JKN terbesar. Sepanjang 2018, total iuran dari peserta mandiri adalah Rp8,9 triliun, namun total klaimnya mencapai Rp27,9 triliun. Dengan kata lain, claim ratio dari peserta mandiri ini mencapai 313 persen.

Dengan demikian, seharusnya kenaikan iuran peserta mandiri lebih dari 300%. Kalau begitu, mengapa usulan kenaikan iurannya hanya 100% untuk Kelas 1 dan Kelas 2 serta 65% untuk Kelas 3?

Karena dalam menaikkan iuran ini, Pemerintah mempertimbangkan 3 hal utama: kemampuan peserta dalam membayar iuran (ability to pay), upaya memperbaiki keseluruhan sistem JKN sehingga terjadi efisiensi, serta gotong royong dengan peserta pada segmen lain.

Intinya adalah Pemerintah sangat memperhitungkan agar kenaikan iuran tidak sampai memberatkan masyarakat dengan berlebihan. Sangat berjauhan dengan tuduhan Edi Mulyadi yang mengatakan bahwa pejabat publik sangat zalim kepada rakyatnya sendiri. Tuduhan keji tanpa dasar.

Perlunya kepatuhan membayar iuran.

JKN merupakan sebuah asuransi sosial dengan prinsip gotong royong: yang kaya membantu yang miskin (dengan mengiur lebih besar), yang sehat membantu yang sakit (yang sehat mengiur tetapi tidak memanfaatkan layanan kesehatan atau membutuhkan layanan kesehatan yang lebih minimal). Agar prinsip gotong-royong ini terjadi, maka yang sehat pun harus rajin dan patuh membayar iuran.

Pada kenyataannya, banyak peserta mandiri yang tidak disiplin membayar iuran. Pada akhir tahun anggaran 2018, tingkat keaktifan peserta mandiri hanya 53,7 persen. Artinya, 46,3 persen dari peserta mandiri tidak disiplin membayar iuran alias menunggak. Sejak 2016 s.d 2018, besar tunggakan peserta mandiri ini mencapai sekitar Rp15 triliun.

Agar program JKN yang sangat bagus ini dapat berkelanjutan, maka kedisiplinan membayar iuran bagi peserta mandiri ini sangat penting. Jangan sampai setelah mendaftar dan mendapatkan layanan kesehatan yang mahal, kemudian peserta berhenti mengiur atau menunggak.

Kepesertaan dan kedisiplinan membayar iuran ini, telah diatur dalam PP Nomor 86 tahun 2013 tentang Tata Cara Pengenaan Sanksi Administratif Kepada Pemberi Kerja Selain Penyelenggaran Negara dan Setiap Orang, Selain Pemberi Kerja, Pekerja, dan Penerima Bantuan Iuran dalam Penyelenggaraan Jaminan Sosial.

Dalam Pasal 5 ayat (2) PP 86 tahun 2013 diatur bahwa pelanggaran kepesertaan BPJS dikenai sanksi administrasi berupa: (a) teguran tertulis, (b) denda, dan/atau (c) tidak mendapat pelayanan publik tertentu.

Dalam konteks ini, ketika Menteri Keuangan serta pejabat lainnya, termasuk DJSN dan BPJS Kesehatan, menyebutkan tentang sanksi tidak mendapat pelayanan publik tertentu itu bukanlah berbicara mengenai suatu usulan baru, tetapi berbicara mengenai sesuatu yang sudah ada di peraturan perundangan. Memang hingga saat ini, sanksi berupa tidak mendapat pelayanan publik tertentu itu belum dilaksanakan dengan baik.

Bertahun-tahun yang lalu pun sebetulnya sudah disosialisasikan mengenai peraturan itu. Sebagai contoh misalnya, bisa kita lihat pernyataan Ketua DJSN, Tubagus Rachmat Sentika yang dikutip oleh CNN Indonesia tanggal 29 November 2015. Dia menyebutkan bahwa Pasal 9 ayat 2 dan 3 PP Nomor 86 Tahun 2013 mempertegas sanksi yaitu berupa penghentian pelayanan publik yang dilakukan oleh Unit Pelayanan Publik untuk mengurus beberapa hal, di antaranya: Izin Mendirikan Bangunan (IMB), Surat Izin Mengemudi (SIM), sertifikat tanah, paspor, serta Surat Tanda Nomor Kendaraan (STNK).

Jadi sangat salah dan tidak tepat sasaran bila Edi Mulyadi mengatakan bahwa sanksi ini adalah usulan dari Sri Mulyani. Sungguh mempermalukan dirinya sendiri ketika ketidaktahuannya digunakan untuk membuat tuduhan yang tak berdasar fakta.

Terlepas mengenai sanksi berupa tidak mendapat pelayanan publik tertentu tersebut, sudah selayaknya kita semua mendukung program Pemerintah menuju Universal Health Coverage (UHC). Khusus bagi peserta mandiri, hendaknya tidak hanya mendaftar dan membayar iuran saat merasa perlu mendapatkan layanan kesehatan yang mahal, dan setelah sehat kemudian berhenti membayar iuran atau menunggak. Disiplin dan aktif membayar iuran merupakan wujud kegotong-royongan dalam mendukung program JKN sebagai sebuah asuransi sosial.

Mari bersama kita memberitahukan informasi kepada saudara-saudara kita yang tidak mampu bahwa Pemerintah menjamin layanan kesehatan mereka. Masih banyak mereka yang belum menyadari ini. Mari kita juga mencarikan solusi agar masyarakat Indonesia sehat sejahtera menuju SDM unggul, Indonesia maju.

Pemerintah senantiasa menjamin kesehatan dan kecerdasan rakyat yang tidak mampu melalui berbagai program dan subsidi. Ini semua sebagai wujud dalam menepati janji para pendiri republik untuk mencapai masyarakat yang bermartabat, adil dan makmur.

Nufransa Wira Sakti
Kementerian Keuangan RI

Lambada from Karolina Protsenko(violin cover)

Despacito- Karolina Protsenko (Violin Cover)

Can't Help Falling In Love - Elvis Presley - Violin - Karolina Protsenko

A New Age of Gay Genomics Is Here. Are We Ready for the Consequences?

https://slate.com/technology/2019/08/gay-gene-study-ganna-biobank-23andme-risks.html?via=homepage_section_features

By JEREMY YODER

AUG 29, 20197:21 PM

Lisa Larson-Walker

The scientists are presenting their findings with an abundance of caution. But that won’t necessarily prevent anti-queer abuse.

The notion of a “gay gene”—a genetic basis for same-sex attraction—has preoccupied scientists, gay civilians, and folks who’d rather queers didn’t exist for decades. The discovery of such a mechanism would have profound implications, as I’ve explored previously for Slate: On the one hand, we’d know more about how human sexual diversity has evolved over our history as a species. On the other, the same knowledge could be weaponized in embryonic screening by bigots seeking to prevent future queers from being born. Until recently, all of this was largely theoretical. But today, we took an important step toward real-world gay genomics: The results of the largest-ever project designed to harness modern genome sequencing to understand the origins of human sexual orientation have been published, and it’s a remarkable document—illuminating, admirable, and troubling in turn.

The paper, published in the journal Science by an international team led by the Broad Institute’s Andrea Ganna, reports analysis of genetic data and self-reported sexual behaviors from about a half-million participants in the U.K. Biobank and customers of the personal genetics company 23andMe. Purely in terms of a search for “gay genes,” it is kind of a flop, though it does shed new light on the biology and evolution of human sexual diversity (more on that shortly). Of equal, if not deeper, interest, however, is how Ganna and his co-authors handle and present scientific work that may have far-reaching impacts on a marginalized community. The authors consulted with queer advocacy groups in presenting their results, and it really shows. The paper has a prominent sidebar devoted to clarifying that its focus is same-sex sexual behavior  rather than queer identity, and explains other methodological and terminology choices. It also makes a point to say that the term “nonheterosexual” is not meant to be pejorative, which would honestly never have occurred to me. Yet for all this care, I’m not at all sure they’ve resolved the risks inherent in this line of research.

To their credit, the authors are open about the myriad challenges of the project. Same-sex sexual behavior is difficult to measure, because in a disapproving social context, people may never act on same-sex attraction, or may not disclose same-sex experiences to researchers. The first figure of the paper demonstrates this: Older participants were substantially less likely to report same-sex activity than younger ones. The authors address this issue, to some degree, by looking first for genes associated with whether participants reported any same-sex experience; then, using only data from those who reported at least one same-sex experience, looking for genes associated with having a greater or lesser proportion of same-sex partners. They also analyze men and women as separate cohorts—just including women in the study, much less treating their sexual orientation as a co-equal focus of the project, is an improvement over some prior studies.

The primary result of all this is perhaps underwhelming, at least if you were hoping for microscope images of a rainbow-colored segment of DNA. As big as it is, the data set isn’t enough to pinpoint individual bits of genetic code, or loci, that explain a substantial fraction of variation in the sexual histories of study participants. This is a long-established problem in genetics. Even if a trait has a genetic basis—as seen in earlier studies of sexual orientation across family trees or in pairs of twins—when that trait is affected by many loci, the contribution of any one locus can be too small to detect. In this case, only five loci had effects big enough to identify confidently: two associated with same-sex behavior in men; one in women; and two more showing associations in both men and women.

Even these loci have very, very small effects. At the locus with the strongest association to same-sex behavior, a man carrying what we might call the “gay variant” has a 10 percent greater chance of having had sex with other men. If the baseline probability of this is about 4 percent (the frequency of gay men in the U.S. population), that means that out of 1,000 random guys on the street who carry that variant, 44 have actually had sex with other men. For comparison, something like 154 out of 1,000 men living in San Francisco identify as gay or bisexual—which means simply knowing a guy who lives in that ZIP code is as much as three times more indicative that he might be gay than knowing he carries the right variant at this one locus.

This result is consistent with the history of failure to find genes that are robustly associated with sexual orientation; if orientation were determined by a few loci with strong effects, they’d probably have showed up in earlier, smaller studies. It’s also consistent with the most pedestrian hypothesis for the evolutionary persistence of people who are disinclined to have the kind of sex that makes babies: Although natural selection should act against genetic variants that contribute to same-sex attraction, the contributing variants have such small effects that selection against any one of them is correspondingly weak. Variants that could contribute to same-sex attraction stick around because they’re carried in smaller-than-critical numbers by many folks who are mostly or exclusively attracted to the opposite sex. Queerness happens by a kind of rare and fortuitous genetic convergence, when enough of the right variants come together in a single person.

The failure to find strongly predictive loci also neatly evades the most worrying prospect of this research: that its results could be applied in a genetic test for sexual orientation. Such a test could, in principle, be used to screen embryos or as evidence against adults accused of homosexual activity in a country where it’s illegal. Ganna et al. address that concern head-on by piloting a genetic test right in the paper. Pairing their results with genetic data from several earlier, smaller studies that collected sexual behavior data, they calculated “polygenic scores” for the participants in those prior studies—essentially, composite genetic estimates of how likely those people were to have had same-sex sexual experiences. Those polygenic scores were found to be correlated with the sexual behavior reported by participants in the prior studies, but there’s so much statistical scatter around that correlation that the scores “do not allow meaningful prediction of an individual’s sexual behavior,” as the authors say in the paper’s abstract. It is, I think, the first time I’ve seen a genetic study highlight a lack of predictive power as a primary result.

Ultimately, this paper represents to my mind the best possible way that a modern study of the genetics underlying sexual orientation could have turned out. It was informed by the community most affected by its results, designed to account for at least some of the complexity of sexual orientation (that identity vs. behavior distinction), and proved unable to produce the basis for a reliable genetic test of sexual orientation. That said, the hazards of this line of research aren’t really mitigated by ethical research practices, in the conventional sense. Those hazards lie not just in how the work is conducted and presented, but in how society receives it.

There is, as of now, not much regulation of how genetic data is used once it’s published. Anyone who pays for a personal genomic read from 23andMe can look up whether it registers variants associated with same-sex behavior in the new analysis, regardless of the actual predictive value of those variants. Lack of demonstrated predictive power hasn’t prevented the emergence of startups offering to tailor diet advice to your genetic profile, and even proposing to screen embryos for future traits based on polygenic scoring methods.

And there’s an established cottage industry of quackery purporting to “cure” queer people—though campaigns to restrict and ban such conversion therapy are making progress, there are plenty of U.S. states and jurisdictions across the world where it’s not meaningfully regulated. Will we see conversion therapists drawing on results from this paper, maybe trying to preempt homosexuality in children too young to even articulate a sexual orientation? As much as Ganna and his coauthors have done to try to head off this kind of misuse, it’s now beyond their control.

There’s also very little to prevent follow-up research by less cautious geneticists. For the foreseeable future, it will only get easier to collect larger data sets than Ganna et al. were able to assemble—and bigger data sets will be able to resolve loci with smaller individual effects. That could get us closer to an effective genetic test for orientation, or reveal enough of the underlying biology to suggest pharmaceutical treatments to change same-sex attraction. Scientists, as a group, don’t like to leave research questions unanswered.

I’ve been gratified that my previous writing about the concerns raised by genetic studies of sexual orientation has seen a generally supportive reception from other biologists. (At least, the ones who’ve talked to me about it.) To the extent that anyone’s raised a counterpoint, it’s more or less this: How can we reasonably foreclose a line of research, even if its possible outcomes are dangerous? In response, I’d actually say that I don’t expect us to. My feeling, in that earlier essay, was not so much that this scientific work could be stopped, but that it’s coming to fruition whether we’re prepared for it or not, and before society is ready to receive it in a way that doesn’t put queer folks at risk. I wish I could read this new study purely as an answer to my own curiosity about the biology and evolution of my queer identity. I hope, in the end, that’s all it turns out to be. But, reading the new paper, I know I’m not the only one with these worries—it looks like, on some level, the people actually doing the research are worried, too.

How clean is your hospital room? To reduce the spread of infections, it could probably be cleaner

https://theconversation.com/how-clean-is-your-hospital-room-to-reduce-the-spread-of-infections-it-could-probably-be-cleaner-122185?utm_source=twitter&utm_medium=twitterbutton
Brett Mitchell Professor of Nursing, University of Newcastle

Adrian Barnett Professor of Statistics, Queensland University of Technology

Hospital cleaning is an important way to prevent the spread of infections. From shutterstock.com

Imagine you need to go into hospital. First, you are likely to be seen in the emergency department, and then moved to a ward room for further treatment and recovery.

Unknown to you, the last patient in your room had an infection caused by a multi-drug resistant pathogen (bug) – meaning the standard antibiotics can’t fight it.

Unfortunately, research suggests if you are admitted to a room where the last patient had this kind of infection, you are significantly more likely to be infected by that same pathogen than if you were admitted to a room where the last patient wasn’t infected.

The consequences of a hospital infection can be serious, including a much longer stay in hospital and even death.

However, transferring the pathogen from patient to room to patient is less likely when the room is thoroughly cleaned.

All Australian hospitals employ cleaning staff who play an important role in patient safety. But some of this cleaning could be more effective.

Our research team developed a “bundle” of evidence-based hospital cleaning initiatives, and trialled this across 11 Australian hospitals.

We found it reduced the incidence of hospital-acquired infections. And in a paper recently published, we estimate implementing this bundle across the 11 hospitals saved more than A$1 million in health-care costs.

Reducing infection risk

Infections during a hospital stay affect one in ten patients. Hospital staff are aware of the dangers of infections, and reduce the risks by keeping their hands clean.

But staff and visitors can still transfer pathogens to patients, because these pathogens can remain dormant (but still alive) on surfaces for a long time. Some pathogens can survive in hospitals for days, or even months.

We can break the cycle of infection by creating cleaner hospitals with fewer dormant pathogens.

Hospital-grade cleaning products kill or remove common pathogens. But the product used is just one element of cleaning – the right technique is also important. Technique includes using the product according to the instructions, not contaminating already clean areas, using sufficient pressure to clean, and cleaning in the right spots.

Frequently touched surfaces such as light switches, emergency call-bells and bed rails are commonly contaminated with pathogens. These surfaces require extra cleaning.

How frequently cleaning needs to occur in hospitals and the best methods to use are disputed. Decisions are complicated because you can’t see the bugs with the naked eye.

In Australia, there is considerable variation in approaches to hospital cleaning including in the use of cleaning products, the type of auditing used to check cleaning, and the training cleaning staff receive.

A cleaning ‘bundle’

Our research team developed a “bundle” of hospital cleaning initiatives based on expert opinion and scientific evidence. This included the use of a fluorescent gel, training and feedback to cleaning staff.

The fluorescent gel is invisible to the naked eye, but visible under a UV light. The gel is applied to surfaces before cleaning, and auditors can use the UV light to determine whether a surface was thoroughly cleaned.

After cleaning, if it’s been done properly, the gel should no longer be visible. Research has shown this approach, when combined with constructive feedback to cleaning staff, can greatly improve cleaning.

Although a room may look clean, it doesn’t mean bugs aren’t lurking. From shutterstock.com

We applied our cleaning bundle in 11 Australian hospitals and examined cleaning performance and infection rates before and after the change to cleaning. Our approach reduced the risk of an important drug-resistant bacteria (vancomycin-resistant enterococci) by 37%.

We also saw an improvement in cleaning success, measured by how often the florescent gel was removed after cleaning. Effective cleaning of frequently touched surfaces in patients’ rooms improved from 64% at the start of the trial to 84% at the end.

Investing in cleaners and cleaning

Spending money on improvements to cleaning practice should be given the same consideration as expensive new machines or new drugs. Improving cleaning reduces the risk of infection, which in turn saves lives, means fewer longer stays in hospital and the intensive care unit, and saves money.

We estimate the infections prevented by the cleaning “bundle” saved more than A$1 million in health benefits across the 11 hospitals by reducing treatment costs and length of hospital stays.

Of course, cleaning is not the only answer to dealing with hospital-acquired infections. Hand hygiene, identifying and isolating patients with certain infections, and correct insertion and maintenance of devices such as urinary catheters and drips are all important ways to reduce the spread of infections.

While the risk of infection for patients will never be zero, cleaning staff play an important role in patient safety. Yet they often go unrecognised.

Next time you visit a hospital, why not thank a member of the cleaning team for their role in reducing your risk of infection.

And patients should remember it’s more difficult to clean when tables, chairs and rooms are full of items. So reducing clutter will make it easier for cleaning staff to do their job.