Real Nurse
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 0 Comments
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 0 Comments
Friday, 3 August 2007
Storing Up Problems
I never fail to be amazed by bureaucracy's constant attempts to take over the world.
Recently, the ward got a big, bright, clean storeroom, replacing several smaller storage areas. Very nice, and very confusing, as everything had moved and autopilot no longer found what you needed.
But we were getting used to it, when our Stores Top Up Man went on holiday.
The stand-in guy couldn't find where to put some things, and, er, didn't bother. So we ran out of stuff. Unsurprisingly, Stand-In Guy didn't want to be blamed, and voiced his anger and frustration that items weren't stored in the order dictated by his catalog. His boss, of course, agreed.
We suggested (equally unsurprisingly), that we didn't think the catalog order was necessarily right for us, the users. One nice example is IV device dressings; the catalog, like the Drug Tariff, wanted to place these dressings with all the other dressings; we, inexplicably (duh!), wanted to place them adjacent to the IV devices.
Following the shouting matches, we've now moved on, like mature professionals, to a three hour meeting, with at least four people. So twelve hours of expensive professional time ... this one will run and run ... ¶ 10:30 0 Comments
Recently, the ward got a big, bright, clean storeroom, replacing several smaller storage areas. Very nice, and very confusing, as everything had moved and autopilot no longer found what you needed.
But we were getting used to it, when our Stores Top Up Man went on holiday.
The stand-in guy couldn't find where to put some things, and, er, didn't bother. So we ran out of stuff. Unsurprisingly, Stand-In Guy didn't want to be blamed, and voiced his anger and frustration that items weren't stored in the order dictated by his catalog. His boss, of course, agreed.
We suggested (equally unsurprisingly), that we didn't think the catalog order was necessarily right for us, the users. One nice example is IV device dressings; the catalog, like the Drug Tariff, wanted to place these dressings with all the other dressings; we, inexplicably (duh!), wanted to place them adjacent to the IV devices.
Following the shouting matches, we've now moved on, like mature professionals, to a three hour meeting, with at least four people. So twelve hours of expensive professional time ... this one will run and run ... ¶ 10:30 0 Comments
MRSA - Stating The Obvious - 1
MRSA - methicillin resistant staphylococcus aureus - is a fact of health service life in the UK, as, indeed in most of the world.
The newspapers are full of it - well, half truths about it - to the point when recently, a patient stopped at the ward door and refused point-blank to come in.
I don't blame him, really. It's no mystery that NHS wards are dirty places, and little mystery that patients often enter hospital without infection, and go home with it.
So why are MRSA policies so utterly lacking in common sense?
Isolating Patients
This is the first of several factors I'll be looking at over the next few weeks.
It seems fairly obvious to me that isolating a patient in a crowded four-bed unit is pretty much a non-starter. The other three patients have to be at increased risk, surely? Do we need to wait for someone to do some research, someone to die, or someone to sue, before that obvious fact finally gets accepted?
Sure MRSA is rarely airborne, and so there is a theoretical possibility of not transmitting the infection from one patient to the other three. But in the real world, with shared curtains, visitors moving chairs, domestic staff moving plates, nursing staff moving all manner of things, not to mention cancelling callbells and filling in charts ... does anyone on the planet believe that gloves are going to get donned and removed correctly 24/7?
One group of people ... hospital managers. No one else.
And even if normal human beings believed in that particular Santa, would they believe it right to take that gamble with three other sick people? With poor or non-existant warning signs? And you can bet that whatever notices do exist will not mention MRSA (not even in tiny print).
And even if they sold their souls and accepted that risk ... could it ever be right to do it without even telling those three patients? (not that they won't guess, and lose all respect for the staff ...). ¶ 10:28 0 Comments
The newspapers are full of it - well, half truths about it - to the point when recently, a patient stopped at the ward door and refused point-blank to come in.
I don't blame him, really. It's no mystery that NHS wards are dirty places, and little mystery that patients often enter hospital without infection, and go home with it.
So why are MRSA policies so utterly lacking in common sense?
Isolating Patients
This is the first of several factors I'll be looking at over the next few weeks.
It seems fairly obvious to me that isolating a patient in a crowded four-bed unit is pretty much a non-starter. The other three patients have to be at increased risk, surely? Do we need to wait for someone to do some research, someone to die, or someone to sue, before that obvious fact finally gets accepted?
Sure MRSA is rarely airborne, and so there is a theoretical possibility of not transmitting the infection from one patient to the other three. But in the real world, with shared curtains, visitors moving chairs, domestic staff moving plates, nursing staff moving all manner of things, not to mention cancelling callbells and filling in charts ... does anyone on the planet believe that gloves are going to get donned and removed correctly 24/7?
One group of people ... hospital managers. No one else.
And even if normal human beings believed in that particular Santa, would they believe it right to take that gamble with three other sick people? With poor or non-existant warning signs? And you can bet that whatever notices do exist will not mention MRSA (not even in tiny print).
And even if they sold their souls and accepted that risk ... could it ever be right to do it without even telling those three patients? (not that they won't guess, and lose all respect for the staff ...). ¶ 10:28 0 Comments
