August 18, 2012

• My very first EVAR blog, way back on Y360.

  And that’s the only reason I’m keeping it. I’m a sentimental old sod.

   

  30/08/06 – MRSA And Other Nasties.

   

  Right, I feel a blog coming on – a subject close to my heart. (And for those of you who know me well, not a drop of vino has passed my lips, this is serious for once). Simon, I have not forgotten your advice re: work-related blogs, but what the hell.

  I’ve just been watching the excellent Kim and Aggie (supercleaners extraordinaire) doing their thing around Ealing Hospital here in the UK, looking into standards of cleanliness and highlighting the appalling state of our NHS hospitals. (“When Kim and Aggie Went to Hospital” – Channel 4 television, 30/08/06). As we all know, MRSA and other hospital-aquired infections (HAIs) have been news periodically for some time, they cost the NHS thousands, if not millions of pounds each year for screening and treatment, and campaigns to stamp them out are always at the top of the agenda.

  I’m sorry to say, it is never going to happen, for umpteen reasons. Many healthy people carry the MRSA bug naturally, with no ill effects. For example, if they screened all potential nursing staff before hiring them, there would not be enough nurses left to carry out the job. It is only if a person becomes sick and therefore immunely compromised that it becomes a problem, especially for the elderly or very young. I don’t profess to know all the ins and outs of this bug, but I know from personal experience of nursing patients with the bug that if it finds its way into the bloodstream it can cause severe illness, and on a more superficial level can delay wound-healing by weeks.

  Right, to the gritty business of how to prevent it, and hold it in check. MRSA is passed from individual to individual by touch, so the most important preventionary measure is STRICT handwashing techniques. As students, we were all taught the “Ayliffe” technique of handwashing, ensuring that no area is missed, such as fingertips, in between the fingers, the balls of the thumbs etc. (Unfortunately I am on holiday at the moment so could not ‘aquire’ a pamphlet of the said technique to include. My computer skills are also limited, so I was unable to copy and paste anything. My apologies). A big problem here is that, while nursing staff may know this technique inside out, it is not taught to patients themselves, visitors, cleaning staff and so on.

  Every ward in my hospital has a container of antiseptic gel outside the door, for EVERYBODY to use before entering, and on leaving the ward. Kim and Aggie surveyed how many people actually used the gel, and the numbers were disappointing to say the least. These gel bottles are also available in every bay of the ward, and we nurses carry a small bottle attatched to our iniforms at all times. Having the gel available literally everywhere is not the answer – we have to eduacte people to actually USE the stuff. Apparently at Ealing, Doctors were the worst offenders, with a staggering 93% failing to use the gel on entering the ward they highlighted. (I will get to Doctors in more depth later).

  Our hospital cleaners bear the brunt of a lot of criticism – a lot of the public see them as the main cause of the spread of bugs such as MRSA because of the poor standards of hygiene in NHS hospitals throughout the country. I feel damn sorry for them, and would not trade places for a million pounds. They have a mammoth task, trying to keep every nook and cranny of the wards in a respectably clean condition, in the time they have to do it. It simply is not possible. On my ward in particular, we have a group of superb cleaners who work their arses off, and deserve recognition for this. But I know this is not the norm. Cleaning staff are the epitomy of the phrase “overworked and underpaid”, to such a degree that some of them have no heart whatsoever for the work they are doing, and just go through the motions. While this is obviously not ideal, it is nonetheless a fact. Cleaning staff should be recognised for what they are – an integral part of the MDT (multi-disciplinary team), a term that seems to be used for everybody else – nurses, doctors, physios, dieticians, clinicians etc, but seems to exclude them. Poor cleaners. What an unfair load they carry.

  The next step in containing MRSA is patient isolation. We have three side rooms which we reserve exclusively for the use of patients with infectious conditions such as MRSA. To what extent we can, we try and keep the bug isolated. But we are always pressed to remember, and assure the patients also, that it is the BUG we are isolating, and NOT the patient themselves. Many patients, once they discover they have MRSA, become totally distressed and feel like lepers – largely due to the hype in the general media. Many of them are scared out of their minds about what is going to happen to them, and take what precaution they can not to spread the bug to others.

  But isolation does NOT mean imprisonment. It is more than common for patients with MRSA being nursed in side rooms to visit the canteen, the hospital shop, etc etc. Not only are they free to visit these places, but obviously they have to have the means to get there in the first place – i.e. the hospital lifts to the ground floor, which are often crowded with other patients, staff, visitors and so on. Also for their own care, theymay need to visit the x-ray department, ultrasound etc. Which is obviously their right – please do not think I’m advocating sticking them in a side room, never to emerge, for their entire hospital stay. I’m just trying to highlight the fact that ‘isolation’ does not mean ‘isolation’.

  Even if it did, and patients with HAIs stayed in their little room and had anything they needed brought to them by nursing staff, relatives and so on, the problem would not end there. All isolated patients have, outside their rooms, disposabe plastic aprons and gloves, which are supposed to be put on before entering the room, and discarded in the bin inside the room before leaving. I don’t understand why I have such a hard time explaining this to relatives, who seem to ‘forget’ every time they visit (not all of them, I hasten to add – most are very scrupulous in adhering to this advice), and, even worse, Doctors. Many of whom seem to think that they are above such regulations. On one occasion I had to phone the on-call night doctor to review an isolated patient I was concerned about. I reminded them on the phone that the patient was infectious and required the donning of gloves and apron before entering the room. I reminded them AGAIN when they arrived on the ward. I may have well saved my breath as the next thing I saw was this doctor entering the room without any plastic coverings, just his scrubs. When I stuck my head around the door to remind him, he looked at me like I was something stuck to the bottomof his shoe. How DARE I? A mere nurse!! Unfortunately this is par for the course with a lot of medical staff, who seem to think themselves above it all. God alone knows how many other patients that particular arsehole infected with MRSA that night.

  And it’s not just lack of care that causes the spread of HAIs. The most common bug we come across after MRSA is “CDT” – Clostridium Difficile Toxin. This is a bug which causes severe gastro-intestinal problems, specifically profuse diarrhoea. Unfortunately it is a common side-effect of the use of antibiotics which the patient is prescribed for another infection. The bug is airborne-carried via its spores, which are released once the patient uses the toilet, or, more commonly, the commode as they are often too debilitated to reach their toilet. While we are provided with the usual gowns and gloves to put on before entering the isolation room, I have often commented to my colleagues that perhaps the use of facial paper masks may be appropriate? A lot of sickness amongst staff seems to be due to “D&V” – diarrhoea and vomiting. I wonder how much of this we actually catch from the airborne spores from the CDT bacteria? However, facial masks are not provided for our use when treating these patients.

  Some months ago, I phoned a radio talk show about this subject, when it was their topic for the night. (Talksport.net – available just about everywhere via the internet and highly recommended, especially after 10pm when the phone-ins are not just about sport. James Whale and Mike Dicken are a couple of hosts you should listen in on). Anyway, I got the feeling I ranted on for a tad too long, as I was was eventually gently eased out and cut off. I feel the same may be applicable here. For those of you who have managed to read all of this, a pat on the back for your efforts. As for me, I’m off for a cold shower before my blood boils RIGHT over. Many thanks.

  • 12:13 am
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