Wednesday, 22 August 2007
MRSA - Stating The Obvious - 2
One of the most obvious features of ill people is the sweat. Sorry, but it's true. Anyone with a high temperaute will be sweaty as part of the body's temperature control; many ill people live with with cold sweats, night sweats and warm ward sweats. Warm ward sweats?
The average NHS ward is, to put it mildly, warm. In summer, this is largely due to the effects of the summer, combined with poor ventilation, no ventilation or inadequate air conditioning or broken controls. In winter, just plain stupidity.
Sure you could spend a few years and doubtless make a few reputations researching this - or you could apply common sense and first principles: Bugs love warmth and damp. Skin-dwelling bugs love warm, damp skin. Staph. aureus is a skin-dwelling bug. Logic suggests we may have ideal conditions for MRSA to thrive.
But why stop there? Take logic and common sense a little further; up the arms of nurses, for example. Nurses are getting good at using gloves*, and at hand cleansing. But it all stops at the wrist. Just watch nurses with patients who need physical care; the contact almost invariably reaches well above the wrist, indeed, it often goes to the shoulder, with all that sweat rubbing onto the uniform ... and off again at the next patient.
But all this is theoretical, surely? Isn't it?
1. Patients nursed in four-bed rooms are often discovered to be carrying MRSA by chance. Statistics at one hospital show that the other three patients carry a much higher risk of picking up hospital acquired MRSA than the average patient. No, it hasn't been published; it never will - it undermines their policy of not even isolating those patients.
2. That hospital had a pilot study which included screening every patient on the ward, once a week. Guess what? they found too many. So the weekly screening was stopped. Now they screen on discharge, so the damage is dicovered waaay too late. Government targets do not encourage looking for MRSA - you might find it! Go figure.
3. A few years ago, I had a job which entailed visiting a central London ICU several times each week. Patients there were nursed in pairs; so much equipment was shared (often sweaty) and nurses 'covered' for each other for breaks, etc. Over a period of several months, quite a few patients were found to have MRSA after admission; they were usually isolated on discovery - but in almost every case, the patient who had been 'paired' was later found to be positive.
I have no doubt, from my own observations, that warm wards increase the risks of MRSA transfer. As well as being a pretty unpleasant environment for both patients and staff. And all too common.
*wearing gloves can include wearing the same pair from patient to patient. Using gloves correctly isn't just about hand cleansing and putting them on properly - it's about changing them between patients.
¶ 10:18
The average NHS ward is, to put it mildly, warm. In summer, this is largely due to the effects of the summer, combined with poor ventilation, no ventilation or inadequate air conditioning or broken controls. In winter, just plain stupidity.
Sure you could spend a few years and doubtless make a few reputations researching this - or you could apply common sense and first principles: Bugs love warmth and damp. Skin-dwelling bugs love warm, damp skin. Staph. aureus is a skin-dwelling bug. Logic suggests we may have ideal conditions for MRSA to thrive.
But why stop there? Take logic and common sense a little further; up the arms of nurses, for example. Nurses are getting good at using gloves*, and at hand cleansing. But it all stops at the wrist. Just watch nurses with patients who need physical care; the contact almost invariably reaches well above the wrist, indeed, it often goes to the shoulder, with all that sweat rubbing onto the uniform ... and off again at the next patient.
But all this is theoretical, surely? Isn't it?
1. Patients nursed in four-bed rooms are often discovered to be carrying MRSA by chance. Statistics at one hospital show that the other three patients carry a much higher risk of picking up hospital acquired MRSA than the average patient. No, it hasn't been published; it never will - it undermines their policy of not even isolating those patients.
2. That hospital had a pilot study which included screening every patient on the ward, once a week. Guess what? they found too many. So the weekly screening was stopped. Now they screen on discharge, so the damage is dicovered waaay too late. Government targets do not encourage looking for MRSA - you might find it! Go figure.
3. A few years ago, I had a job which entailed visiting a central London ICU several times each week. Patients there were nursed in pairs; so much equipment was shared (often sweaty) and nurses 'covered' for each other for breaks, etc. Over a period of several months, quite a few patients were found to have MRSA after admission; they were usually isolated on discovery - but in almost every case, the patient who had been 'paired' was later found to be positive.
I have no doubt, from my own observations, that warm wards increase the risks of MRSA transfer. As well as being a pretty unpleasant environment for both patients and staff. And all too common.
*wearing gloves can include wearing the same pair from patient to patient. Using gloves correctly isn't just about hand cleansing and putting them on properly - it's about changing them between patients.
¶ 10:18
