Infections like MRSA kill up to 5,000 people a year

The government should stop contracting out cleaning services and bring them all under direct NHS control, it says.

The National Audit Office estimates so-called superbugs like MRSA kill as many as 5,000 people each year.

Unison says the sharp rise in infections caught in hospitals can be directly attributed to the number of cleaners halving in the last 20 years.

The union, the UK's biggest, says contracting out cleaning jobs has led to poor training, low retention levels and dirty hospitals - and it wants private contracts scrapped.

Dave Prentis, Unison general secretary, told BBC News: "Two things have happened over the past 15 years.

"Cleaners have been contracted out to private companies, the criteria has been to reduce the cost of cleaning, rather than improve the quality, so now they're no longer part of the ward team.

"We've also had a massive reduction in the number of cleaners... 15 years ago we had over 90,000 cleaners, we now have something like 55,000."

The government recently issued new guidelines to improve cleanliness and allow poor contractors to be punished.

Spot checks

But the chief nursing officer for England, Chris Beasley, said it was too simplistic to say NHS cleaners were good and private cleaners bad.

"There's no doubt about it, in the 1980s and 1990s, the process both for contracted-out cleaners and indeed for in-house cleaners, there was a real push on just the cost and not the quality.

"Now, there's really good examples of cleaning from contracted-out firms as well as in-house... there are good in both cases."

She said the government had improved cleaners' pay levels and she expected the numbers of cleaners in the NHS to rise in the coming years.

Recent spot checks showed 90 out of 1,184 hospitals had poor or unacceptable cleanliness.

Following the introduction of compulsory competitive tendering, there had been concerns from some quarters that hospitals were taking up the cheapest cleaning contracts instead of basing their decision on which company would do the best job.

Health Secretary John Reid told the BBC: "I have made it plain to chief executives that cleanliness cannot be regarded as an optional extra - it has to be be put right back at the centre of what hospitals are about."

Mr Reid said he had made sure that frontline nursing staff had been given control of ward hygiene.

"That was one of the great mistakes that happened when we got contracting out - we broke that link between the ward sister and the nurses, and the actual cleaning on the wards."

Shadow Health Secretary Andrew Lansley said MRSA infections had doubled under Labour - but Mr Reid seemed to place most of the blame on the policies of the previous Tory administration.

"Labour have said time and again they will introduce measures to improve ward cleanliness yet hospital hygiene has become a issue of great public concern.

"The government must be brought to account for their incompetence."