Scottish NHS - MRSA Cases Down By 81.5%

Today's Anti-SNP article in the Herald is laughable.

Alex Neil, the Scottish Health Secretary, was visiting the new Royal Victoria Building in Edinburgh when photographers asked him to sit on a bed for a photocell.  According to Mr Neil, who is aware of visitor protocols, he was told to go ahead because the bedding was due to be changed immediately after his visit.

However, Jackson Carlaw, the Tory deputy leader, at yesterday's FMQs, said the following:


"The First Minister, I wonder, would he respond to the following that I received this morning: 'As a nurse, I was rather disgusted to see the Scottish health minister park his backside on a patient's bed while opening a new hospital and wittering on about infection control.'

If (yes I said if) that nurse was present then she wasn't paying attention because I doubt if anyone of Alex Neil's age - or mine - would sit on a patient's bed without being given the go-ahead.  We are of the generation which knows that adhering to visiting times is important for patient recovery, that washing hands is essential, that two visitors at a time is enough - sometimes too much - for patients and that sitting on beds is taboo. When I was visiting a neighbour in hospital just before Christmas, one patient had six visitors (two of them children) and most sat on the bed as there was only one chair available. The nursing staff said nothing.

The NHS offers guidance to people visiting someone in hospital:

Under the heading "What not to do when visiting someone in hospital", the first piece of guidance states: "It's best not to sit on the patient's bed as this can spread germs. Use the chairs provided."

Why are we now so stuck in this 'guidance' culture?  The NHS should be instructing hospital visitors and if they did so then they may just find that infections fall even further.  

The reason for Alex Neil's visit was to publicise the new building's design of single rooms throughout, which it is hoped will reduce the risk of healthcare associated infections (HAIs).  When were HAIs changed from Hospital Acquired Infections?

The poor journalism proffers a measly two lines to the massive reduction of 81.5% of cases of MRSA in the last seven years since the SNP took office.  The Herald should be publicising that fact and not worrying about Alex Neil having his photograph taken sitting on an unclean bed.

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This Should Be In All UK Hospitals

This video should be played on large screens at all hospital entrances.

Staff of the University Hospital of South Manchester filmed it in their spare time.

I would have liked to have seen a little more emphasis on soap and water being the only effective barrier to c.difficile, but perhaps another hospital could take that on board in a similar manner.  Well done all concerned.

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Hygiene. What's That?

The public inquiry into Scotland's worst outbreak of clostridium difficile has been of interest to me.  A total of 55 patients developed C.diff and 18 died after admission to the Vale of Leven Hospital in West Dunbartonshire.  C.diff was blamed for nine deaths and was a contributory factor in nine more.

On Wednesday the Herald reported the evidence of two daughters of an 84-year- old woman who was put in a room with patients who had already had the deadly infection.  Their mother survived, but they noted that on three separate occasions hand-gel dispensers in the ward were empty.  It was three days before they were replenished. Mrs Jones' daughters also told the inquiry that they weren't informed that other patients in the room had C.diff and they only found out through conversation with other relatives.

Although I appreciate that Mrs Jones should not have been put in a ward with C.diff patients, it would certainly not have been appropriate for staff to discuss other patients with her family.

Mrs Malcolm told the inquiry there was no literature about C Diff at the hospital and that visitors were not told to wash their hands or given any advice on how to prevent spreading the infection. (my emphasis)

Yesterday the inquiry heard from relatives of Walter Scullion, 69, who was admitted with a urinary tract infection.  By the time he was discharged he had contracted herpes from an oxygen mask, tested positive for C.diff and lost 22lbs in weight.  Mr Scullion said his family were not told by hospital staff he had C.diff and they only found out after he told them himself.  Mr Scullion reported other serious breaches of hygiene in the hospital for which there is no excuse.

Walter Scullion’s relatives were also allowed to visit him in his single room without being told to wear any protective clothing or being given any advice on hand hygiene or on how to safely wash his soiled clothing, which they took away in supermarket carrier bags. (my emphasis)

Both families complained to the inquiry about not being told to wash their hands.  I shook my head in despair when I read this. Have we become such a nanny state that hospital visitors need to be told to wash their hands to prevent infection?  It seems so.

Of course this attitude has been encouraged by the laxity of hospitals allowing visitors at any time of day and having no firm rules about their behaviour.  Visitors should not be allowed into wards unless they do wash their hands and if that rule was firmly applied throughout Scotland's hospitals, the general public would quickly realise that thorough hand washing is the best way to prevent infection.  It does sadden me that so many people rely upon modern gels which are only basic chemical disinfectants.

Mr Scullion has since returned to the Vale of Leven as a visitor and commended the upgrading.  It's all very well having new beds and painted walls, but if patients, staff and visitors don't treat the basic hygiene rule of hand washing, such expenditure is a waste of money.

Hospitals need to provide hand washing facilities at either the entrance to the building or the entrances to wards.  That is where money should be spent long before they think about decor.

Until I see this happening I will continue with my own hygiene system.

I've lost any hope of the public understanding the importance of hand washing. Is it laziness or complacency or a mixture of both?  The answer lies with our hospitals. In European hospitals visitors adhere to a very strict code of behaviour which includes hand washing on arrival and departure. We spend millions on hospital infection control yet permit the public to use hospitals like general meeting rooms.

It's long past time we stopped the casual approach.

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Hospital Hygiene

I'm a hospital visitor this week. Not one of my favourite occupations these days I assure you and that's mainly because the hospital I'm visiting still looks dirty. Mind you, Leg Iron will possibly tell you looking dirty and being dirty aren't necessarily one and the same, but my brain interprets the image in that way.

At Dundee's Ninewells hospital entrance a voice which appears to come from the wilderness tells you to 'put our your cigarette as this is a no smoking area' and then 'wash your hands when entering and leaving the ward'.

Once I reached the ward I required I couldn't see any wash basins, none before then either, so asked a member of staff where I could wash my hands. They looked suitably stunned, as if I'd asked for my own death certificate then stuttered, " You'll have to use the basin in the bay you want." Superb hand-washing management, you must agree.

If you're attending a clinic then you have to use the basins in a public lavatory - if you can find one - because clinic areas don't have wash-hand basins for public use. They are all in the consulting rooms.

I can't deny there are plenty bottles of hand-gel dotted along walls but there is nothing to tell the public that hand-gel does not destroy the c.difficile spores. Hot water and soap is the only deterrent. In the ward I was visiting there is a notice on the wall stating the number and dates of the last outbreaks of MRSA and c.difficile. That would really encourage confidence in me had I had been rushed there semi-conscious as was my friend.

So this week I decided I would snap on a pair of disposable gloves when entering the building and put them in the waste bin upon departure. Along with other sensible measures, such as refusing the offer of any food or drink, I'm hoping I will avoid anything to do with the c.difficile bug. If I contracted it a second time I doubt I would survive.

If hospitals can't provide hand washing facilities then perhaps they can provide disposable gloves at the entrances? A couple of pairs could see most visitors through the ordeal of fighting unseen life-threatening infections. Ninewells could be one of the best places to start a serious hygiene programme given recent events.

It's time the NHS in Scotland paid as much attention to hygiene as it does to funding Health Scotland.com.

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Hospital Infection Control System Criticised

Susan Brimelow, Chief Inspector

Healthcare Environment Inspectorate

The Healthcare Environment Inspectorate, established in April, has made its first NHS board report. Results would probably be classed 'could do better' for Stirling Royal Infirmary, the hospital visited.

'Several areas of concern were noted in ward six, including dusty floors, the lack of a domestic waste bin in the patient toilets, cobwebs and a dirty toilet. The patient day room was being used to store equipment and the patient bathroom was being used as a staff toilet'.

I would be most concerned if I was responsible for ward six but it seeme there are no problems because the report states 'A panel of eight patients were happy with the hospital'.

The hospital was commended for using motion-activated recordings to prompt people entering wards to wash their hands.

I hope the facilities to wash hands are better than Ninewells Hospital in Dundee. They must be because, on my recent unexpected visits to Ninewells, at the main entrance a male voice roars 'please wash your hands before entering wards'. Great I thought, a massive improvement and much needed, as I walked what seemed a mile to find Ward 25. After long corridors, down stairs, more corridors I finally found the ward entrance door. Where was the basin to wash my hands? Inside I thought, so off I drifted through the door to report to the nurses station truly expecting a washbasin to be visible. Nothing. Oh, that's untrue - there were bottles of hand gel available on the ward corridors.

As some of my readers may know I contacted clostridium difficile a couple of years ago and I keep an eagle eye on the progress made in the prevention of this debilitating bug. Infections such as this are usually spread through poor hand washing, but I am now convinced the growth of this infection in recent times is due to people being falsely led to believe hand gels kill all infections. They do not. Only hot water and soap kills c.difficile and for surfaces bleach is recommended.

Ninewells will not be the only hospital to have hand-washing announcements but they have to provide washbasins, soap and paper towels for people both entering and leaving the hospital. The public ladies has been renovated recently and it's now half its size and reduced to three washbasins. There is usually quite a queue. Surely a washbasin or two situated inside each ward door wouldn't be too expensive to install - accompanied by the roar of the motion-activated male of course!

One good aspect of the new Healthcare Environment Inspectorate is that every acute hospital will receive at least one announced and one unannounced inspection within a three-year cycle. Why inspections have to be announced at all defeats me. Perhaps someone can explain the necessity.

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