Killing killer bugs

The current concerns about hospital acquired infections seem at first glance extremely frightening and indeed there have been deaths associated with Clostridium Difficile. The Department of Health has launched an investigation.Any solution to these problems will be complex and multi faceted. Firstly one must note that frequently people become infected with this bacterium due to the use of potent antibiotics which have had to be given to them due to their severe illnesses. Infected patients can then indeed transfer their infections to others themselves or via staff or inanimate objects. Staff hand washing is indeed important as is cleaning in hospitals. One problem which must be remembered about cleaning is, however, that with very high rates of bed occupancy there is less time to clean before the next patient arrives. As such increased cleaning not only costs more money but also reduces apparent efficiency. That it increases overall efficiency is of course without doubt but such things are more difficult to measure especially in the target obsessed NHS.

The minister’s announcement also proposes a review of hospital visiting which is I am sure useful but one must remember that people in hospital want and need visitors so there is actually a balance to be struck. The proposals on staff dress code also sound sensible but the BMA has pointed out that some of the proposals about staff dress code have little evidence of benefit to support them. One major benefit would also be having more patients in single rooms as noted in this press release. That is of course a problem in older hospitals and the capital costs of creating all single room hospitals would be vast.

This is, however, a problem which is unlikely to go away and will require multiple solutions, as such it is not an easy subject for the media to cover and there is a danger of journalists shrilly calling for instant solutions and politicians being forced to adopt measures which are not necessarily useful. For once I almost feel some sympathy for Mr. McGimpsey, which is a change for me; maybe I should see a doctor?

  • joeCanuck

    the capital costs of creating all single room hospitals would be vast.

    There are ways to cover this. Large firms in Canada, such as mine, pay the hospital charges for a semi-private (2 person) room for all staff and the cost of a private room for Managerial staff.
    The premium that the firm pays to its insurance company to cover this expense is treated by the taxman as a taxable benefit so individuals pay tax on it.

  • joeCanuck

    Other such bugs are likely to appear in the future.
    People can help to prevent or delay this by not using antiseptic products in the home. It helps a lot too to let your children play in the muck and get dirty (before washing them with non-antiseptic soap).

  • Eireannach Saolta

    Theirs sweet FA anyone can do about erradicating C. difiicile anyway as a large portion of the population are carriers anyway

  • Turgon

    Eireannach Saolta
    “a large portion of the population are carriers anyway”

    Quite correct. The problem is when broad spectrum antibiotics are used and kill other bacteria allowing overgrowth of the C Diff which then becomes pathogenic rather than commensal.

    The solution is of course to not use antibiotics too much and only to use narrow spectrum ones. That is fine until a person is really, really sick and one cannot wait to grow the bugs and establish exactly which antibiotic to use lest the person die in the interim.

    It is a very difficult problem though one which can be reduced a bit with all the measures detailed. I hope it will soon fade from the headlines as it means that people will not panic and those professionals who understand the problem can try to help at least reduce the problem.

  • BfB

    Unfortunately JC, you would most likely be dead before you got to your spiffy room.

  • joeCanuck

    Well, believe it or not, BfB, I have had very poor health for a number of years and I have been in those rooms on many occasions.
    The staff have saved my life on three separate occasions. I am eternally grateful.

  • BfB

    Miracles do happen JC…..goes back to that whole faith thing I guess.

  • joeCanuck

    Well, I’m not in the least religious. By all accounts I should have been dead these many years past. I’ve seen many doctors and they all call me Mr. Atypical.
    Guess I’m just lucky and I’m sure not complaining.

  • Briso

    “due to the use of potent antibiotics which have had to be given to them due to their severe illnesses”

    This problem has come about largely because doctors have routinely proscribed prophylactic antibiotics to large numbers of people who don’t need them, both inside and outside hospitals, creating resistant strains of otherwise unremarkable bugs which become dangerous in the resulting monoculture. It’s much easier to blame nurses and cleaners though.

  • lab rat

    At last the real reason for the likes of C diff and MRSA is being addressed – misuse of antibiotics.

    All the cleaning and handwashing won’t kill the likes of C. diff especially as it is a spore forming bacteria. It is present in the gut of many healthy adult and even more healthy kids so eradication is nonsense.

    For years mircobiologists and pharmacists have been aware that the run on antibiotics – a pill for every ill – would come back and bite us.

    Equally overly hygienic homes, excess use of bacterial reducing cleaners and in adequate cleaning in hospital environments have all contributed and will contribute to these problems and we haven’t even mentioned vetinary use of antibiotics.

    So what should be done.

    Firstly blind treatment particularly in hospitals should stop, we have rapid identification methods for bacterial infections these should be used.Antibiotics should only be used where ther is a clear tratable bacterial infection. Secondly control of infections is the role of mircobiologists not nurses. Nurses have a role in nursing practice but bacteria and spread is a microbiological/epidemiological matter not nursing. Thirdly pharmacists must be used to control the use of antibiotics, clinically they are the experts and finally,even though cleaning of itself won’t cure the problem, cleaning should be carried out by trained staff, using appropriate chemicals, in correctly made up solutions, with proper contact times and regularly audited.

    This may seem a rant on behalf of allied health workers but these experts have been ignored you only need to see the responses by the health trusts – I believe 5 new infection control nurses per trust. What is the extent of their microbiological training? Horses for courses, correct treatment of patients and proper cleaning regimes.

  • Briso

    lab rat, more power to your elbow. There was a bbc news report a year or two ago about what the NHS could learn from the Dutch system which basically did not have these problems at all, neither C-Diff nor MRSA. All about washing hands, changing sheets etc etc. No mention of the fact that it is almost impossible to be prescribed antibiotics in Holland and it is certainly never done as a precaution to prevent infection. Dot Kirby is the first reporter I’ve ever heard actually mentioning the most important cause, so well done her.