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There’s a lot to be said for a uniform approach

By Mónica Lalanda - 18th April 2010 6:15 pm

During my last few weeks working as a British doctor, I made myself look like a warehouse man. This had more to do with personal principle than fashion.

I admit to having been one of the last dinosaurs, so keen to wear a white coat that when my hospital instructed us to ditch them, I refused to take orders. I cut the sleeves of the item and dyed it in denim blue. It looked terrible and I looked awful but I made my point, my white coat was not white any more so it wasn’t really a forbidden garment. A few daring nurses approached me: “What on earth are you wearing?” The answer: a white coat in disguise.

The idea that doctors’ coats were making hospitals soar with infection is ludicrous particularly because doctors stopped wearing white coats in Britain ages ago. Funny enough, back in 1991, 72% of hospital docs wore white coats but, by 2004, only 11% did, just the inverse evolution of the MRSA infections. I guess high bed occupancy, dirty hospitals and excessive use of antibiotics are the biggest culprits.

Most doctors stopped wearing white coats long before they were officially banned. No matter the symbolism that they carry hope, tradition, scientific approach, cleanliness but also practicalities such as easy recognition, protection of own clothes and the almighty pockets; white coat detractors say that they are uncomfortable and that uniforms bring down the prestige of the profession.

My first day as a Spanish doctor was fantastic; during my personal induction I was taken to the sewing room, measured and then provided with a huge pile of white pyjamas, white coats and white trainers, everything marked with my name, the hospital logo and a big ‘DOCTOR’. I must admit I spent a while in front of the mirror, admiring my newly recovered ‘doctor look’ and remembered my pathetic last days as a warehouse man in England.

It certainly feels good. The Spanish hospitals provide the uniforms and of course take charge of cleaning them all too; there are no excuses abour wearing dirty white coats.

I mentioned it several times during my first days here, with some long sighs; it feels so good to have a white coat again. Why? What do British doctors wear? My colleagues thought I was kidding when I explained to them that doctors in Britain don’t wear any form of protective clothes and mostly just wear their own clothes. Their faces tend to go from incredulity to disgust. For Spanish doctors the concept of white-coatless doctors is almost as surreal as that of an astronaut in a bull-fighter’s suit.

So, for me, wearing a white coat again is the end of a personal battle against the system; it is just a shame that I had to move countries to win.

Tags: HAI
Posted in Mónica Lalanda | 5 Comments »

Hopping mad over infection control suspension

By Jerry Nelson - 30th March 2010 10:24 am

Oh, Arse. Well at least I’m back at work, dignity nearly intact. After a bit of a talking to from the chief exec and a bunch of flowers to the old witch from infection control they decided I could come back.

Huh! Bloody police state these days.

They reckoned I bullied her, but you know what? I reckon she bullied me! Bullying, n: “to use superior strength or influence to intimidate someone to force him or her to do what one wants”. So who’s the one with the influence, huh? Not me. She can run to the chief exec every five minutes if I don’t immediately kowtow to all the bloody policies that say you have to wash your hair in Betadine and not tread on the cracks in the pavement because of ‘infection control’.

What I don’t understand is, where do all these policies come from? Who’s writing them?

Infection control woman doesn’t write them herself, as she’s quick to point out if you dare challenge them. Plus, as we know, she can’t string a coherent sentence together. The trust board doesn’t write them, they just wave them into law, usually without reading them. You can spend all day on the phone without finding anyone who’s prepared to admit to writing any policy. So how do they come about? Do they just appear?

Do you know what? I’ve just had an idea.

Right, just set up a fake email account, so off we go:

From Mrs Maureen Spudge, Deputy Liaison Support Coordinator, Trust Coordination and Liaison Support Liaison Dept.

Dear all,

Please find attached the latest draft of the Hopping On One Leg policy, as agreed by the trust board. As you know, Hopping On One Leg has been shown to significantly reduce the incidence of hospital-acquired infection. Please cascade to all relevant clinical teams and departments.

Yours sincerely, etc, etc.

UPDATE: well that didn’t take long. Just seen the Headmaster hopping up and down like Dudley Moore on the local news, saying how important it is to take infection control seriously for the good of our patients. What an arse!

I think ‘Maureen’ and I are about to take over the world…

Tags: HAI, Humour
Posted in Nelson's Column, Bolg, Blog, whatever... | No Comments »

Powerless to resist infection control witches

By Jerry Nelson - 22nd March 2010 11:52 am

Arsington arsey McArse. Just got a call from Dawn, the new bossy fat cow Infection Control Modern Matron Nurse Consultant Practitioner Lecturer In The Healthcare Setting. She wants to spend the day with me. Yeah, in your dreams bitch. “Get in the queue,” I told her. But then she came out with a load of drivel about how I needed to have “ownership of the infection control process” and how she felt she needed to help me understand the importance of the care pathway, and how she felt that in so doing was being a patient advocate.

PATIENT ADVOCATE!? How I fucking hate that phrase. Why do you think I haul my weary arse out of bed every day (except Friday, non clinical) and come to work in this godforsaken dump (except Tuesday afternoon, golf day)? For a laugh? How did we ever let halfwitted overpaid cretins like this think they have the monopoly on caring about patients?!? And why is it that once they’ve decided they care more than anyone else, they think that anything they do is AUTOMATICALLY good for them?

So I went off on a bit of a rant, which I’m afraid only emboldened her, to the extent that she turns up on my ward round this morning, flanked by two shorter, uglier, clipboard-wielding Deputy Infection Control Modern Matron Nurse Consultant Practitioner Lecturer In The Healthcare Settings. And before I’d even opened my mouth, she said, in that voice that could melt steel, “we have a problem”.

I pointed out that she probably didn’t mean to use the first person plural, but being a compassionate man I offered her my deepest sympathies for her problems, and took the trouble to list a few of them. Next thing I know, one of the shorter ones, who looks like R2-D2 but without the charming conversation, stuffs a sheet of paper under my nose. “Dress Code,” she blurted. “Bare Below The Elbows Policy!”

Of course, I am dressed correctly - according to the Jerry Nelson dress code - three-piece pinstripe, Oxfords, double-cuffed shirt (with humourous yet slightly racy cufflinks) and golf club tie, Windsor knot. This is what the patients expect. They need to feel inferior, or else they don’t get better so quickly.

Apparently, the Witches of Eastwick (but a lot less hot) think that just because a few hundred patients got MRSA, I should turn up wearing a string vest.

So, I told them that I knew nothing of their Bare Between The Ears policy, and I cared even less. There followed a stony silence, then all three of them marched in formation off the ward. Wehey! Victory.

UPDATE:

Arse!

Arsey Arse!

Double, triple, and several higher orders of arse!

SUSPENDED!!!!

Tags: HAI, Humour
Posted in Nelson's Column, Bolg, Blog, whatever... | 1 Comment »

Things to do with your Infection Control Policy

By Jerry Nelson - 2nd March 2010 10:12 am

Arsington arse, it never bloody stops. Major infection control crisis in the department. Just because a couple of patients got that C. Whiff virus or whatever it is, now there’s all hell to pay. Typical - anything goes wrong, blame the surgeon.

Turns out that on one of the forms that the managers have to fill in and send to the DoH, there’s a box to tick. And that box is labelled: “Didn’t kill all the patients with C. Niff”. And the managers want to tick the box, because that way they get money. Or something.

So, they’ve appointed some bossy over-promoted nurse as the new Infection Control Coordinator, who looks like that old bint with the ridiculous hair from How Clean Is Your House, only several orders of magnitude more stupid and bossy.

Why will they never learn? Making appointments like this is so counterproductive. If they had any sense they’d appoint some fit-looking piece of totty for once, and they’d find that compliance with the new regime would be much higher. Look at my new anaesthetist Gabrielle - I do everything she tells me to immediately, if not sooner.

Anyway, she’s bringing in a whole load of stupid new rules - wash your hands blah blah, don’t pick your nose when scrubbed blah blah, usual rubbish. What they don’t take into account is the negative effect of all these things. They’re a single issue pressure group - they only care about infection rates, and so long as they fall, they couldn’t give a monkeys about whatever else happens.

Whereas doctors like me have to consider all the possible consequences for our patients. It’s like that stupid 20mph speed limit they’ve put on the main road by the hospital, near the school for the blind and the pensioner’s day centre. You know the one, opposite the Cute Kittens That Might Stray on to the Main Road Refuge. I mean, sure it’s going to save a few lives, but hundreds of us are going to be late!

So, the next thing I know, I get a call from her. She’s called Dawn, and she has a voice like fingernails on a blackboard, only not as pleasant. She has “things to discuss”. And do you know what it was? Smoking.

That’s right, she wants to talk to me about smoking. Since when did infection control have anything to do with arsing smoking, for arse’s sake (apart from the fact that they’re both subject to interfering fascist puritan fuckwits)? She says she’s “not comfortable” with my practice of nipping out for a fag during my operating list.

Well, as you can imagine, I lamented her lack of comfort, but asked her to consider what would happen if I shoved her infection control policy up her arse sideways, and how comfortable she would be then.

And anyway, if it wasn’t for the anti-smoking fascists, we could smoke on hospital property, and I wouldn’t have to nip out, go all the way to the edge of the hospital grounds, hop over the fence to the Manure Farm and Slurry Processing Plant next door, just so I can get a bit of nicotine, whilst in the midst of a list of life-saving surgical procedures.

Jeez! She’ll be making me de-scrub next.

Tags: HAI, Humour
Posted in Nelson's Column, Bolg, Blog, whatever... | 3 Comments »

MRSA and C diff not the only hospital infections

BBC Health - 10th November 2009 9:29 am

The government has taken its “eye off the ball” on hospital infections other than MRSA and Clostridium difficile, a cross-party group of MPs says.

The Public Accounts Committee said setting targets in England for the two infections had led to a fall in cases.

But they warned there were signs other bugs, such as E. coli, were becoming more common and they called for better surveillance to curb the problem.

The Department of Health said it was already looking into the issue.

In England, MRSA rates are now a quarter of what they were at their peak in 2004, while C. difficile rates have fallen by nearly a third in the past year, following the introduction of targets.

But the MPs said these only accounted for about a fifth of the total number of all infections seen in hospital.

While MRSA is the most high-profile bloodstream infection, E. coli is much more common and has actually increased by a third in the past four years, the report said.

It also highlighted surgical site infections, which were twice as common as bloodstream infections, and respiratory and urinary tract infections, which were three times as common.

Further drop in hospital acquired infections

BBC Health - 10th September 2009 3:44 pm

The number of MRSA infections in hospitals in England has fallen by 40% compared with the same period last year, figures show.

Between April to June this year 509 cases were reported compared with 839 in the same quarter in 2008, the Health Protection Agency said. The latest figure is a quarter of the peak of nearly 2,000 in 2004.

Rates of clostridium difficile infection are also continuing to fall with a 37% drop from last year.

The HPA welcomed the progress but warned against complacency.

Clarity needed on ’symptom free’ rule for ill staff

By Dr Rachel Hooke, medical management consultant, Leicester - 14th June 2009 6:44 pm

There’s a common rule that hospital staff who suffer from diarrhoea and vomiting are expected to stay off work for 48 hours symptom-free. It’s in case they’re still infectious when the D&V’s finished. Such a policy only exists in this sector, where potentially vulnerable patients are being cared for.

Staff can obviously be susceptible to hospital-acquired infection. Paradoxically, trusts are clamping down on sick leave. More than three episodes in a year, even of only one day each, can lead to further action being taken. Staff may be tempted to skimp on what they view as unnecessary absence and return to work prematurely, or not go off at all.

Some doctors have chronic non-infective digestive or psychological conditions and routinely have gastrointestinal upsets. They may not be able to tell if their symptoms are normal for them or caused by infection. If they are known to be affected and the 48-hour rule rigidly followed, they could end up never being at work.

Hospital-acquired D&V can also be a problem for those who live in, particularly in close proximity to the wards. Some resident doctors rely on the hospital canteen for sustenance, which is out of bounds if they’re ill. They may even be restricted from emerging to buy food if they have to pass clinical areas to leave the site. If they share accommodation with staff who are well and going about their work as normal, they risk contaminating them.

In reality, the 48-hour rule is not imposed universally. This is often because doctors do not reveal the extent of their afflictions, or anyone that they tell is not aware of the guidelines. Many doctors soldier on despite being ill, perhaps more ill than their patients. There has traditionally been a culture in the medical profession of not going off sick and burdening colleagues with extra duties. Anxiety surrounding this may be exacerbated if sickness targets are robustly enforced.

However, blatant lying is not advisable and you could still fall foul of the procedures anyway. You should also make sure that all your leave is recorded officially, even if you feel it is not fair. So long as you play by the book, you can argue the merits afterwards.

Some trusts take a pragmatic view. They acknowledge that if a certain virus is known to be doing the rounds and several people are off sick, then it could be construed as an industrial illness i.e. acquired as a result of your work. This could mean it need not be counted as sick leave. However, that is a matter of discretion. It may be something that cannot be hidden from a future employer who asks. If a member of staff takes several episodes of sick leave, supposedly because of hospital-acquired D&V, then occupational heath may want a stool sample to be submitted.

If staff are honest and trusts flexible, then this can go some way towards circumventing these problems. Trusts need to be stricter on applying this rule when it matters, yet allowing for non-infective causes of D&V. A more comprehensive occupational health history on appointment could identify specific digestive conditions, however mild.

At the same time, trusts should not penalise employees who are forced off sick when they would have felt well enough to turn up to work in any other sector. Such leave should not automatically be revealed to future employers, and certainly not if a junior happens to be going for a job in a different sector. There should be no guilt trips about going off sick if necessary. Stool analysis should be more rigorously and frequently carried out, no matter how distasteful. This will determine true causes of symptoms, even in retrospect, so that a pragmatic view can be taken on the nature and amount of sick leave.

And, finally, guidance needs to be issued for resident staff.

Tags: HAI
Posted in Dr Blogs | No Comments »

Juniors “hinder” the fight against hospital superbugs

The Guardian - 12th June 2009 3:44 pm

Doctors are hindering the NHS’s increasingly successful fight against hospital superbugs by not washing their hands often enough, an official report warns today.

The National Audit Office says that while good progress is being made in tackling hospital-acquired infections, not all NHS staff practice basic hygiene measures. “Compliance with good infection control practice is improving, but doctors remain less likely to comply”, says the public spending watchdog in a report assessing the NHS’s struggle against bugs such as MRSA and Clostridium difficile.

“Overall, nurses have been quicker to improve their clinical practice in relation to healthcare-associated infection than doctors, for example with higher levels of compliance with basic hand hygiene. In our surveys, doctors and, in particular junior doctors were viewed by trust staff as less likely to comply with infection control policies, including policies on hand hygiene”, it added.

Targets damaging hospitals’ infection control

Telegraph - 10th June 2009 9:00 am

Measures designed to speed patients through casualty departments or off waiting lists were limiting the amount of time hospitals had to clean, claims a BMA report.

Much trumpeted short -term moves, such as the deep clean of every hospital and bare-below-the-elbow staff uniforms would work only as part of a long-term culture change within the NHS. The BMA’s science committee also called for alcohol hand rub gels to be placed everywhere “where it is sensible and feasible” in hospitals and for greater numbers of “hands free” taps to help limit the spread of infection.

Official figures show that one in 18 hospital trusts is still failing to meet infection control standards and have been threatened with fines and closures by the Care Quality Commission, if they do not improve.