I’m healthy, but hospitals are sick
I recently spent some time as a patient on a ward in an NHS hospital where I had been admitted for some tests. Thankfully, all the results were negative and I was diagnosed as being quite healthy for a person of my advanced age :-)
As anyone who has ever spent any time as an NHS patient knows only too well, one of the defining features of the experience is an awful lot of waiting around. I spent just under a day on a Clinical Decisions Unit ward where patients are admitted for testing and then either discharged or moved on to longer stay wards for treatment. There were a lot of very sick people on the ward, but I was feeling fine, so there wasn’t much I could do other than sit and observe the goings on, which is how I discovered that
Infection control in hospitals is broken
“Hospital superbugs” such as Staphylococcus aureus MRSA, Clostridium difficile and Noroviruses feature prominently in the news media and consequently on MicrobiologyBytes, with claim and counterclaim about increasing, static or declining infection rates constantly being batted backwards and forwards, and the Department of Health publishes endless guidance on infection control procedures. Apart from quack claims of miracle cures, the formal response to hospital-acquired infections are procedures for infection control such as cleaning, disinfection and sterilization, protective equipment and surveillance of infection rates. As an observer on a busy ward I was able to watch what happened as patients and staff came and went.
The care I received was exemplary, and for the most part, the ancillary, nursing and medical staff worked hard and clearly cared about the welfare of the patients. But that’s not enough. The reality is that the complexity of the system pushed all the staff beyond their limits, and damaged morale. As a simple example, I watched a domestic ancillary employed as bed maker drifting around looking for beds to make. She was once about to make one when she was called away, and when she came back, the nurses had made the bed. I listened to the nurses grumble about how the ancillaries didn’t do their jobs properly, and the ancillaries grumble about the nurses. And of course, everyone grumbled about the medical staff. Morale was at a low ebb. But it gets worse. Time and time again I watched ward staff strip the linen from beds which had been vacated by patients and painstakingly disinfect the mattress and the bed before remaking the bed with fresh linen. What’s wrong with that? No-one cleaned the bedside chairs. When the next patient arrived, they kicked their bags around on the floor for a while before putting them on the chair, which the nurses dumped the fresh linen on before making the beds.
In less than 24 hours, I was treated by dozens of medical staff and wheeled all over the hospital for various tests. The ward was like a motorway, with staff, patients and visitors constantly moving from ward to ward, street to common areas, canteens and homes. Flawed understanding of basic microbiology is not compensated for by mandated infection control procedures rigidly-applied without any thought or appreciation. Errors are compounded by a totemic belief in the miracle properties of alcohol hand rubs which adorn every bed but which distract from more effective handwashing procedures. Did I need to be visited by the person flitting from ward to ward to fiddle with the TV/radio/phone console above every bed? Even if they did spend several seconds squirting alcohol gel on their hands before moving on to the next patient? I don’t think so.
Infection control in hospitals is broken by the complexity of the system
So how can you fix it? Apart from better microbiology training, the system needs to be radically simplified so that staff and patients are not constantly moving around. Wards should be much more autonomous with a limited number of staff responsible for them, and allowed to do their jobs properly. This would allow much better standards of care arising from the evident motivation they have. There’s no need for people to flit constantly from ward to ward, delivering meals, borrowing equipment, chasing test results and spreading contamination. Simplify. Let people do the jobs they have been trained for and to feel pride in themselves. Back to basics.
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Tags: Health, Medicine, Microbiology, Podcast
