Briitish and Irish race to kill off hospital bugs

Here’s a heartening story from the Independent which reports that the powers that be in British and Irish hospitals are in a race to cut down on preventable deaths. As part of a world wide experiment, St Mary’s Paddington and other hospitals are instituting new checks on surgical instruments before each operation. It’s reckoned the checks will save over 1,000 lives a year. The measures resemble the simple checks pilots make before take-off. While I know at first hand of sterling efforts to beat MRSA, C-Difficile and the like, I’m still amazed the hospital system hasn’t been convulsed in crisis over the death toll. Good to see the Republic’s Health Minister Mary Harney competing with GB to start the checks. Is NI in on the act, I wonder? Does anybody know?

  • Different Drummer

    Good Report on the South

    One problem with it – it doesn’t ring true.

    Why?

    Because Harney and the free marketers in the South as in the north have been centralising services for the past two decades. A school student could tell you that that would have increased the likelyhood of cross infections.

    sorry mate no Blue Peter badge for that introduction.

    This is were you should have started:

    http://video.google.com/videoplay?docid=7451469006023401823

  • It was Sammy Mc Nally what done it

    After a recent visit to hospitals in the Republic and in Wales it was noticeable that in ROI there are large signs on entering requesting visitors to wash their hands and facilities in the wards to do so and pedal bins for disposal of rubbish. No such obvious and simple stuff in Wales – with only small signs in the wards. Obviously infections move in mysterious ways but surely it must make sense to limit what is actually brought in by the public. Signs reminding visitors of their responsibilities and accompanying stats on infections could be implemented immediately at little cost.

  • George

    Different Drummer,
    a school student would also tell you that in many instances, centralising medical expertise saves lives and helps reduce the risk of misdiagnosis significantly.

    Cross-infection kills but so does misdiagnosis.

  • Different Drummer

    errr George

    Asserting an opposite possibilty is not a point of view.

    I think you should expand your answer and we will take it form there.

  • Turgon

    The problem of hospital infections is undoubtedly serious but there are things that people forget. These infections and certainly the life threatening manifestations of them occur almost exclusively in people who are already extremely sick and hence are already severely compromised. As such they more easily succumb to infections others would easily recover from. Frequently the infections they succumb to are actually common in the environment.

    I see that in Wales there is talk about a new uniform for nurses. One problem is suggested to be that nurses wear their uniforms home which they did not do in the past. However, there is no evidence that this causes a problem and more importantly in the past nurses had adequate changing facilities and their uniforms were laundered in the hospital laundries. Hospital laundries for staff have disappeared.

    Antibiotic policies and hand washing do help but there are other issues which the government choose to ignore:

    There are relatively few single rooms in NHS hospitals. Single rooms greatly reduce infection rates. there are even circumstances where infected people are not moved to single rooms.

    Due to the reduction in the number of beds, beds are often used for 2 patients during a single day. As such sometimes there cannot be enough time to clean the beds etc. properly clean. The reduction in beds has been driven by the mistaken analysis that day surgery etc. would reduce the number of beds needed. That analysis forgot that most patients admitted to hospital are admitted with medical conditions (needing tablets, injections etc.) and not needing surgery. The increase in the elderly population and rising expectations of cure also increase the number of admissions.

    Different Drummer is sort of correct. Increased centralisation is good and necessary but has usually resulted in a reduction in number of beds in the centralised hospitals. That is a major error.

    The solution to these problems are complex and require more money. Implying that the staff are partly to blame is much cheaper and easier.

  • George

    Different Drummer,
    Asserting an opposite possibilty is not a point of view.

    You merely posted a link to a 20-minute speech by an issue group and blithly stated:

    A school student could tell you that that would have increased the likelyhood of cross infections.

    I simply responded in like fashion:

    a school student would also tell you that in many instances, centralising medical expertise saves lives and helps reduce the risk of misdiagnosis significantly.

    Naturally, if you bothered to explain what you actually think and why….

  • Different Drummer

    Errr George

    The link Inposted is to an excellent in depth case against centralisation by some one at the coal face as it were.

    In most cases it is better to defer to someone like that I had assumed that you were also a heath care professional or someone involved in the field.

    That’s why I hoped for a better reply.

  • Turgon

    Different Drummer,

    Centralisation is necessary because with advances in medicine doctors, nurses and other healthcare professionals cannot be experts in all fields.

    Clearly one wants an expert looking after one’s heart attack, stroke, hernia, gall bladder etc. These experts, to maintain their skills, need to predominantly concentrate on their specialist field and also need an adequate throughout put of patients to keep up their skills. Hence. one needs a relatively large hospital to have all the necessary specialists and also one needs a fairly large catchment area to provide enough patients to keep those experts expert.

    Where you are correct is that when hospitals have been amalgamated the new hospital has always had fewer beds which is a major problem, leads to inadequate time between patients to clean etc. and so can lead to increases in infections.

    Going back to the small hospital with a given physician treating all medical problems and a give surgeon performing all manner of operations is, however, a very bad idea.

  • Different Drummer

    Turgon’s Health check

    “Centralisation is necessary because with advances in medicine doctors, nurses and other healthcare professionals cannot be experts in all fields.”

    Well I don’t know what system you have been using but it certianly is not the NHS I knew.

    Why? Because it had alreday addressed the issues of specialisms in the system .

    Each local hospital had such expertise and was able to take time investigating fully the exetent of the problem and had good ground in the illness prevelent in their locaity. That all worked fine untill Denis Healy butchered the system (48 local hospitals were closed in London in the late 1970s and many many more throught the country).

    Which side were you on in the great Omagh hospital closure debate…

  • Turgon

    “Well I don’t know what system you have been using but it certianly is not the NHS I knew.”

    It is the modern system: the modern NHS, the one that despite its many problems delivers better survival outcomes in the likes of cancer and heart disease than the one you claim to have known. It is far from perfect but if you want to survive a major illness be treated by people who treat that illness very frequently, not by people who dabble no matter how kind and well meaning they are.

    In terms of Omagh: I care little except that there should be one hospital on one site. If you want my views on such try here. Health policy is something I have a passing interest in.

  • Different Drummer

    Turgon’s Health Check 2

    “So the question is: Whatever the efficiency improvements and the medical arguments in favour of a rationalisation of the number of hospitals here; have hospital closures become politically impossible and to what extent do the medical and nursing professions support them?”

    That is very similar to Ted Heath’s 1974 election question “Who Rules Britian”.

    And just as effective…

  • Turgon

    Different Drummer,

    Hospital doctors and nurses are no longer happy to manage all aliments that come through the door. They want to specialise in their areas of expertise. This results in better outcomes.

    If (God forbid) you had a heart attack I presume you would want a heart doctor looking after you in a Coronary Care unit with nurses used to doing so. It would increase your chances of survival and your chances of a good recovery.

    In order to have adequate specialisation it is a simple fact that you need larger numbers of doctors who subspecialise and that means you need fewer larger hospitals with larger catchment areas.

    That is 21st century medicine. It is also why the average survival with heart conditions, cancer etc. etc. has improved.

    I accpet that patients like the idea of the local hospital but the reality is that if you want to do better you should go to a hospital which can specialise. In the case of Omagh / Enniskillen the population just about allows one hospital to be large enough to have sufficient expertise. I care little where it is: it is just that there needs to be one hospital.

  • Harry Flashman

    If Tesco were killing their customers through sheer bloody negligence in the thousands that the NHS does there’d be police investigations and criminal prosecutions but instead Tesco and other private businesses who actually do provide a safe service and healthy environment for their staff and customers are regularly criticised in the media while the stinking disease factories of the NHS are held up as great national institutions and the dirty staff are described as “angels”.

    Government cannot run car factories, steel plants, coal mines, airlines or telecommunications industries without screwing them up monumentally why does anyone believe that congenitally lazy and unaccountable civil servants can run hospitals?

  • Different Drummer

    Flasher’s Health Check 1

    “Government cannot run car factories, steel plants, coal mines, airlines or telecommunications industries without screwing them up monumentally why does anyone believe that congenitally lazy and unaccountable civil servants can run hospitals?”

    Privatised cleaning was no better an did a lot of damage. But I accept that it would have been well neigh impossible to stop an outbreak whatever the admin did as services are so concentrated now as opposed to thirty years ago they simply can’t isolate an infected unit like they were able to in the past.

    As you know Flash one local hospital 12 deaths from MRSA/C-diff that is an appalling record!

    I think the US private health is better at avoiding these outrages as you imply because they are commercial operations so they must be better or face closure. But they are simply beyond the means of the majority of sick and long term sick.

    BTW the current NHS admin disasters are ideologically driven by New Labour for sure.
    But I think you know were that ideology came from.

  • Different Drummer

    “In order to have adequate specialisation it is a simple fact that you need larger numbers of doctors who subspecialise and that means you need fewer larger hospitals with larger catchment areas.”

    This is not working.

    Least of all is it an argument for closing hospitals and A&E;departments.

    The Sign ‘There is No A & E Department at This Hospital’ is very common – and that is NOT progress – it is wrong and regressive.

    As Flasher implies centralisation is a product of old and new Labour failed economic policies (which were also carried on by the tories).

  • George

    Different Drummer,
    The link I posted is to an excellent in depth case against centralisation by some one at the coal face as it were.

    It’s one point of view and is only on a particular issue – centralisation of acute services.

    So we have some person from an action group talking about centralising medical services but who, mentions hospital bugs or cross-infections.

    Perhaps you could tell me what it has to do with this discussion on hospital bugs and cross-infection, considering he doesn’t discuss the issue at hand?

    In most cases it is better to defer to someone like that I had assumed that you were also a heath care professional or someone involved in the field.

    Really? I don’t know Peadar McMahon’s health qualifications. What are they?

    Anyway, I don’t know how you can defer to someone who actually doesn’t talk for a single second about the topic in hand – hospital bugs.

    That’s why I hoped for a better reply.

    Fool I was I listened to the full 20 minutes.
    Did you even bother watching the very link you posted?

  • Turgon

    DD,

    No I am afraid you are completely wrong. Having a smaller number of hospitals and increased specialisation is the best option: the figures support it.

    Having tiny A+E departments with only one doctor on duty was dangerous and inappropriate. It may feel homely and maybe one is seen sooner but the reality is that care was poorer. Once the patient has gone to A+E they need to be referred onto the appropriate speciality within the same hospital. If a hospital cannot provide an adequate amount of specialist care (not necessarily all realy complex specilaities but enough to be adequate) then it should not have an A+E department, indeed it should be closed as it cannot offer safe and adequate care.

    Whatever you may think you know about the NHS; doctors and nurses now want to work in hospitals with adequate numbers of specialities where they can provide adequate care.

  • Turgon

    DD,

    I can accept that it seems distressing and odd that closing hospitals is progress but I am afraid it is. This is the nature of modern health care and with respect I suggest that you are unlikely to be in a position to have a professional expert opinion on this matter.

  • Different Drummer

    errrrm George & Turgoning

    Flasher is 90% correct

    These changes are not driven by what Drs of nurses want **organisationally** (like that was ever the case).

    The first mass closures steemed form what Denis Healy had to do to satisfy the IMF NOT NHS.

  • Turgon

    Different Drummer,
    My understanding is that a lot of doctors and nurses support these changes; they offer better care for patients, that being a priority for quite a few doctors and nurses. It also allows them to do their own speciality, something that they enjoy

    Or are you a currently practising doctor or nurse that you know better? Are you in Omagh or Enniskillen that you know better?

  • Different Drummer

    “are you a currently practising doctor or nurse that you know better? Are you in Omagh or Enniskillen that you know better?”

    Oh Jezze Turgon not that old chestnut…

    Oh OK here goes chestnut in reply….

    You don’t have to live in Zimbabwe to disaprove of Robert Magabe – (BTW gay rights activist were the first to try and stop him/publise his crimes).

    Similarly I could say that I don’t have to be a Dr or a nurse to know what an utter mess the NHS is here.

    To but it bluntly turgon

    12 deaths through MRSA & C-Diff – Christ-on-a-bike if that’s success I hate to see failure!!

    If you are curious about my ‘qualifications’ to comment I cared for a severly disabled friend for two years and watched him die in front of me due to the privatisation/decentalisation/ and *de-skilling* of the NHS.

    I also buried a brother because of as people have come to call it: ‘That Bloodly Royal’ who admitted liability to his wife who was chief heart sister at time. She couldn’t sue because she was implementing the very changes you support!!

    So she would have had to have sued herself!!

    I also have a sister who is a manager of the National Star Centre in Cheltenham for brain damaged teenagers. Think the NHS is going in the right direction do you – talk to her for five mins and she tell you it is not.

  • Turgon

    Different Drummer,

    The NHS may or may not be going in the right direction. However, centralisation of services is essential. Unlike you I am qualified to have an opinion on such an issue.

  • Different Drummer

    Turgon

    Your ideology tells you that you are right therefore thing it must be right.

    It ain’t necessarily so.

  • Turgon

    Different Drummer,

    I have been mildly entertained by your explanations of why centralisation is a bad idea especially that it was all Dennis Healy’s fault.

    Unfortunately you are trying to advance a position at variance from that of practically all the relevant health care professionals despite having absolutely no appropriate experience or qualifications to make such statements.

    The reality is that people are more likely to survive due to specialised care which has to be centralised. It is also that hospital doctors and nurses want to work within their speciality.

    I am afraid that unlike you I am rather better qualified to hold an opinion on this matter. It has absolutely nothing to do with my ideology and everything to do with my experience and qualifications on this specific topic.

    Now by all means continue with your ill informed opinions on the NHS in general and since you raised it Omagh / Enniskillen: I can categorically guarantee you that your opinions are not shared by and will not influence the professionals looking after the people in question.

  • Different Drummer

    Turgon

    My Apologies

    What I sould have said was:

    Your ideology tells you that you are right therefore you thing it **must** be right.

    It ain’t necessarily so.

    More later

    Meanwhile can you do your post over it doesn’t do you any justice.

    “I can categorically guarantee you that your opinions are not shared by and will not influence the professionals looking after the people in question.”

    Translation: I’m an X trust me!!

    In this life one thing I have learned:

    There are no guarantees.

  • Turgon

    Different Drummer,

    Yes no guarantees apart from the fact that I know a lot more about the issue than you do. That you are making a fool of yourself and that you have no say on how health care is delivered; which is rather fortunate since you manage to combine strongly held views with a complete absence of knowledge to back them up.

  • Different Drummer

    I don’t trust you Turgon and I never will as you think that Jim Alister is some you can pair up with.

    It’s the authoritanism that you exhibit:

    12 people are dead becuase of this issue.

    I lost a brother and a very close friend to the new ‘patient centred’ NHS.

    And all you do is make appeals on behalf of your authority.