HAI

One of the bugbears that each party is addressing for the upcoming election is the concept of HAI's or Hospital Acquired Infections. So far the politicians have been mainly concentrating on MRSA, but this is not the only thing that you can catch in hospital.
I've just come from a job where a 95 year old female, who had spent a week in hospital for a blood clot on the leg, was suffering from some difficulty in breathing.

The patient had been discharged from the local hospital yesterday, and during the night had developed laboured breathing, a cough and a feeling of tightness in the chest.

Upon examination it seemed that they pain wasn't related to any form of cardiac cause, the tightness was worse when she breathed in, she had a slight temperature, and coupled with the cough and no history of heart problems it seemed like a simple chest infection.

The patient and her daughter were happy with this provisional diagnosis, but were glad that she would be going to hospital for some more tests.

But then the daughter asked me where her mother could have caught her chest infection.

And I really didn't want to say “from the hospital”.

I imagine that the ward from which the patient had been discharged had one or more people with a chest infection. Having worked in a hospital I know that a lot of patients, and their visitors don't cover their mouths when they cough, and it seems completely reasonable that this is where the patient caught this infection.

It is probably unrelated to nurse or doctor hygiene (as these sorts of infection are often airborne), but instead due to something as simple as someone not covering their mouth when coughing. It might not have been another patient – hospital wards see a lot of visitors, including small children who are constantly exposed to, and incubating infections.

It seems to me that a lot of hospital infections could be cut if patient visitors didn't treat the ward like some form of hotel, tracking their infections in and out of the community, and generally acting like the rules of hygiene don't apply to them. I'm a big fan of restricted visiting for the majority of cases – and is there really any reason for children to be dragged around a hospital at all hours of the day.

It used to drive me barmy when I was running a ward.

But medical staff do need to improve their hand washing.

29 thoughts on “HAI”

  1. Hospital workers can scrub as much as they want, but how can they cope with visitors who don't have even the most basic consideration for others? Imagine, for example, the woman on my bus yesterday, if she had visited a hospital. She was coughing away for several minutes with no thought to put a hand, tissue, sleeve or anything else in front of her face, so her fellow-passengers got the full benefit of her sprayed expectorant. Can't treat that with alcohol rubs.

  2. i am 25wks pg and have a nasty chest infection which is now being treated with antibiotics, something i wanted to avoid at all costs if possible. where did i get the chest infection? sitting in the doctor's waiting room last week waiting to talk to the doc about a life insurance(mortgage) doctor's report.. something i could have discussed on the phone but they insisted i had to make an appointment. i guess i got a bonus..

  3. There you go – the worst place to be ill is in an GP's office or hospital ward.'cause it's full of sick people.

  4. Well I have an NPSA “Now wash your hands” mug on my desk so I know the score.Samuel Goldwyn: “A hospital is no place to be sick”

    And since you mentioned the election I'm gonna get on the political bandwagon. Why on earth do the Conservatives think that giving Matron MORE powers will clean wards? Do they expect Matron to get on their knees and scrub the floors? Or maybe shout at the cleaning staff who are employed on minimum wage through an unpractical PPP that THEY introduced and forced most hospitals to take up?

    Also most Matrons at Anytown NHS Trust spend most of their time in meetings discussing strategies or defending little sub-contient nurses from verbal abuse from patients families – when are they going to have time to get the Mr Muscle out?

    You try writing that on one of the posters.

    However they have made it nice and easy to graffiti the “It isn't racist to oppose imigration”. If I had a pound for every one of those I had seen with “Yes it is!” scrawled on – I'd be a rich man.

    Anyway, sorry Tom for using your comments box as a political soap-box but without my blog I don't have anywhere to rant.

  5. Officially, HAI stands for healthcare associated infection these days. Healthcare because, as we've already seen, it doesn't have to be a hospital per se that is the root of the infection. Associated because there's never very much proof that such infections come from particular places. If it's MRSA, sure they'll genetically fingerprint the isolate so that they can type it and work our where you fit within the context of any outbreak, but a chest infection probably won't be followed up like that. Plus, as you say, it might be an infection caught in hospital…from your own husband, who happens to carry MRSA or Neiserria menigitidis (one of the bacteria which will cause menigitis, and which is carried in the noses of 10% of people).The trouble with people in hospital is that, generally speaking, they are ill. Which means that any bug, which when encountered by you or I would be taken care of in a flash by our immune system, can cause serious infection.

    Incidentally, hand washing isn't the way forward. Soap and water involves the mechanical removal of organisms. Most people aren't very good at it. Alcohol handrubs kill organisms on any surface of the hands they touch, can be used as you walk through a ward, and are less drying to the skin. Believe you me, it's no surprise that healthcare workers don't wash their hands as much as they should- you try washing your hands every ten minutes for a nine hour day. They'll be red and raw by the end of it. Hand Hygiene. Very Important.

    rant over.

  6. I shall bow to your experience when you tell me that HASI has changed – I remember when the 'M' in MRSE stood for Methacillin…And I agree about the alcohol gel – it is better for your hands, I see lots of nurses carrying around little dispensers pinned to their uniform. No in my day *cough* it was hand cream, I'm hoping that today it's alcohol gel.

    I use alcohol gel after every job (but I dread to think what is growing on the steering wheel of my car) – I had no problem with the normal hand wash, it actually made my hands nice and soft.

    But I'm strange like that.

  7. You have reminded me to do a post on the idea that Matrons are the be-all and end-all of all the problems in hospitals.The only problem is that it'll probably piss off a load of nurses…

    And Dre – you have got to start blogging again…

  8. I went into hospital a couple of months ago for a liver biopsy and came out with a stomach bug that got me the week off work. I don't know what the fuss is about. People go on as though it should be impossible to catch anything in a hospital of all places. After all, people go there to be cured.What they seem to forget is that a hospital (or doctors waiting room) is full of SICK people. Unless you're in a hospital where everyone is in isolated oxygen tents you're bound to catch something.

  9. My mother, who used to be a nurse, and went through training in the 70s, regularly comments on the quality of nursing care at our local hospital. When my grandmother fell ill recently her stay in hospital was a litany of poor quality of care, needless to say we were not surprised by that C4 documentary about nursing care. She is broadly of the opinion that matrons would benefit standards.Various problems include:

    Failure to change bedding properly

    ignorance of proper mouthcare for a stroke patient

    just 'plonking' meals down in front of patients and taking them away when they didn't eat

    failure to check dressings following an operation

    failure to ensure adeqate hygeine.

    1) Nurses today seem to think that cleaning up after patients is somehow below them – instead delegating them to HCAs.

    2) They seem to spend most of their time being 'mini-doctors' rather than actual nurses

    3) Nurses today seem to spend far too much time sitting around, she recalls spending entire shifts standing because there was no 'spare time'. The channel 4 documentary showed nurses on duty but sitting around on the phone, or drinking tea, ignoring patients, while there were clearly things they could be getting on with.

    When she was a nurse she spent all day on her feet, there was always something to do, Matrons had a dedicated 'domestic' cleaner who could be called to clean immediately any spillage or problem. The 'foreman' role of the Matron seems to be missing, ensuring that the junior nurses are working

    Oh, and the abandonment of 'non touch technique' for handling patients, nowadays nurses seem to just rinse their hands and then grab the patient.

    Ironically, the outpatients care is excellent.

    End Rant

  10. i was chatting to my doc about this the other day and he was saying that you cannot keep a hospital clean when it has visitors in from morning till night bringing everything that ails them in with them

  11. Alcohols have no activity against bactericidal spores and have poor activity against some fungi and non-lipid-containing viruses (i.e. naked viruses such as Norovirus); alcohol handrubs don't kill all organisms.Our lecturers on virology and bacteriology say that thorough hand-washing / proper washing of fomites is the best way against Norovirus.

  12. This is why, when I had surgery a few months ago, I was so grateful it was outpatient. I never made it further into the hospital than the recovery room, and then went to recover at home on bedrest.

  13. It's true that alcohol hand rubs are by no means a panacea, but they are still far and away better than soap and water. This is mostly because as you say, the key to stopping norovirus is thorough or proper washing. Which a plethora of studies have shown just doesn't take place.Today's modern alcohol gels contain a mixture of alcohols therby enhancing their spectrum of activity.

    The primary routes of spread of viruses tend to be aerosol (so hand hygeine won't make any difference) and ingestion of contaminated water/foodstuffs. (Which is why you only drink bottled water abroad, and then when you get the shits anyway revert to a diet of cocacola (reputable brand, contains sugar and liquid) pringles or crisps (for salt replacement) and bananas (for potassium). That said if you've got the shits real bad then sometimes it's better just ot stick to the coke. I digress)

    Unfortunately, viruses are easily spread by even minor contamination or food stuffs. However, one would hope that in a healthcare setting any index case (symptomatic or asymptomatic) would not be in contact with the foodstuffs of others. No making jessie in the next bed a cup of tea! Further to that, any nurse cleaning up vom or faeces has to not get herself contaminated. Complete change of clothes afterwards, than kind of thing.

    The standard line in HAI is that alcohol is the way forward. Unfortunately, one of the reasons it isn't as well used as it might be is that the public lack confidence in it. However, it really is the best we've got at the moment. The swiss in particular use it to good effect. I can provide refs if you want!

  14. I've just finished a district general hospital placement and back in uni now. We were 'taught' handwashing before being allowed onto the wards, I am appauled that sitting in the facilitation group people are saying they were the only one's doing it properly, and I have to aggree many doctors/consultants I was with on ward rounds etc.. believe they are Above the hand washing. and get really quite up close and personal with patients, they make sure they wash hands and change before going home mind!and on another note, alcohol gel doesnt kill everything, take C-Diff for example – only way is to wash with soap and water.

    I am supprised its not worse TBH.

  15. Very interesting talkback!! From what I have told (from my mum who is a Sister), the Matron in her hospital spends most of the time in meetings or doing paper, so I don't see how bringing more of them could improve the cleaniless of hospitals (I'm sure that there would be an increase in red tape, though).
    Also, if any saline etc dripped on the floor, it would be there several days later on her next shift. Yes, the nurses can clean it up, but what are the cleaners there for? These areas are not hard to reach.

    Funnily enough, when one of the family going to be admitted to hospital, the first thing packed is disinfectant. When I was little, I thought that my mum was over reacting when I saw her cleaning the hospital lockers and bed trolleys. I know better now (I hope!)

    Nurses can only do so much (and now there's talk of them taking on some things that only doctors are allowed to do at present). And I'm sure that stopping visitors and sick people going to hospital will help keep hospitals clean – great idea 🙁

    mini rant over

    'If we can ever make red tape nutritional, we can feed the world.' — R. Schaeberle

  16. We've got alcohol gel dispensers on every bed, and on the wall outside every cubicle. What's not great is that the ones on the wall don't all have any gel in them.Brilliant.

  17. Sounds like nursing care in the U.S. where our govt likes to tell us we don't need universal health care because we already have the best care in the world and that would only bring healthcare standards down. I think the standards are already pretty low. The expectations are pretty low too.

  18. Last time I was in hospital a medical dropped in and cheerfully asked if I had stapph yet then went on to describe the various ways I could die horribly of hospital-spread infections. I signed myself out an hour later.

  19. Your rant is pretty much what I'd say about 'modern matrons' – they'll spend all their time in meetings and talk about “extending the nurses role”.There are quite a few nurses who are quitting their registrations to work as HCA's because the job that HCAs have taken on is that of 'proper' nursing.

    'Proper' nursing being the nursing of people, rather than the management/administrative role thet they seem to have taken on these days.

  20. Yes that reminds me of visiting my grandmother in hospital. She couldn't move due to having a fall and then a stroke. She had fared badly from an operation which had also made her deaf although no one seemed to notice and thought she was just untalkative! Not only could she not reach the food slapped down in front of her – she was completely unable to feed or do anything for herself. If we hadn't have been there to feed her no one else would. Even more tragically, a nurse asked me to feed the lady next to her as she didn't have time to do it and I was doing such a good job!! Several others on the ward were in an immobile state and called out when their food was taken away as they were hungry. It was so upsetting. We were then given 24 hours to find her a home. Blah blah blah – f*@cking shit.

  21. I say slag the nurses off! I'm sure they can be brought down a peg or two. Most of them are probably filming secret documentaries at the moment.And I would have had a thing or two to say about that channel 4 prog too. Like why the heck didn't any of these nurses file an incident report if they knew there was substandard care being given?

    As for blogging again. I would but I'm spending too much time trying to reach government targets! If only one of the political parties would try and cut down the paper work I have to do so I can go back to doing what I do best and that is doing exactly what I want, no matter what management say.

  22. C diff is generally a bastard though! for some reason it's relatively easy to get it in hospital and end up with horrific colitis or lose a leg. Yet, on the other hand, my mate Allison is doing her phd with C diff and has endless trouble getting the damned bugs to grow. There's no easy solution.

  23. Ah yes, but she could have developed a pulmonary embolus form the clot in her leg. ALso, you often find that most HAIs start from people bringing them in from the community! I work as a doctor in a busy Yorkshire hospital, and we have all been given a little pump full of alcohol gel that clips to our trousers, so after every patient we examine we can use it …of course the other alternative is not to lay a hand on the patients at all!!!!

  24. My dad was treated for cancer in what is supposed to be one of the best hospitals in the world (in Boston MA, USA). His first visit got him a staph infection which led to an extra 3 weeks in the hospital. I never saw a doctor wash his or her hands. Even when he was in a positive pressure room (because of pnuemonia and immune problems) the room was less than clean. I don't blame it on the nurses though, they were wonderful, but overworked.

  25. After having V.A.T.S. surgery last year to prevent a further spontaneous pneumothorax (i've had 2) I was encouraged to cough a lot to improve my lung function.I was actually told off for covering my mouth whilst doing so by the nursing staff.

  26. I started in radiography in the early 70s. I have just returned to NHS radiography 30 years on. The difference is HUGE – mainly due to the age of the patients. We no longer heal patiients to go out and lead a full life, we patch up decrepit old nursing home residents to return to their high-backed chairs until their next fall, infection etc etc. Comparisons to the quality of nursing in the past is wrong – the girls who went into nursing then mostly weren't that bright (nor was I). They now have a degree – wouldn't it be considered a waste of skills for a brain surgeon to spend his day washing incontinent patients? But it's ok for nurses?There is a chronic shortage of radiographers and nurses now, there wasn't then – surely that says it all.

  27. I have psoriasis, and constantly washing my hands leaves them red raw and weeping – alcohol rub has been my savior – I do still wash my hands every 3rd or 4th 'rub', but I'm not in constant agony anymore!

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