Bring Back Matron

Those were the days when matron ‘ruled the roost’ – woe betide anyone who stepped out of line! The old matrons ruled with an iron fist and commanded huge respect in the hospitals. They held both power and authority and as a result our hospitals were spotlessly clean.

Nowadays, by comparison our hospitals are filthy and it seems that nobody wants to take responsibility. Better hygiene is the only way to ward off superbugs. MRSA has been shown to survive in dust and dead skin cells. It doesn’t matter how much hand washing is done – to please our Minister for Health – if the hospital environment is dirty, the spread of infection will never be stopped . De-contamination of the hospital wards and equipment is essential if we are to curb the rise of the MRSA superbug.

We need to put Matron back where she belongs – in charge!

Control of MRSA

It is a well-known fact that MRSA in now endemic in Ireland. Today’s infection levels suggest that the guidelines for the Control of MRSA in Ireland, produced by SARI (an offspring of the HSE) were never implemented. Comprehensive updated guidelines, published by the Health Protection Surveillance Centre (HPSC) in September 2005, stated “Responsibility for the implementation of these guidelines rests with individuals, hospital executives and, ultimately, the Health Service Executive. The Infection Control Subcommittee, when reviewing the literature and the evidence, undertook to provide guidelines according to what is currently consistent with best practice. However, it is acknowledged that in many healthcare settings in Ireland, it will not be possible to implement much of what follows despite the best efforts of all healthcare professionals, because of inadequate resources, sub-optimal infrastructure and a lack of access to relevant expertise locally. Nonetheless, these are guidelines that all healthcare facilities should aspire to implement. Where it is not possible to implement some or part of the recommendations, the reasons for this should be highlighted to senior management. In this way, it is hoped that these guidelines, in tandem with other measures, will heighten the profile of infection control and prevention, and also facilitate the provision of the appropriate resources.”

What has the Minister for Health done in response to all of the above? Overall, have sufficient resources been allocated to the problem? No. Have we seen any evidence that appropriate resources have been allocated to improve the Dickensian infrastructure of our public hospitals? No. Has the problem of insufficient personnel in infection control been corrected? No. Have any senior management in the Health Service or HSE, been held accountable for their failure to implement the guidelines? No. Our Minister for Health has instead zoned in on the failure of hospital staff to wash their hands. “Hand washing is essential”, she says. She’s right, but hand washing alone won’t solve the problem!

On 22 August 2006, five years after SARI launched it’s first report, the HSE finally came out with hands up, saying it needed €20 million a year to combat MRSA. They stated that this money was needed to employ more consultant microbiologists, more infection control nurses, more antibiotic pharmacists and more surveillance staff. Recently we were told that the HSE failed to spend almost one fifth (€97.7 million) of it’s allocated budget last year. Now that sort of money would go a long way to help control the spread of MRSA in Ireland! Dealing with hospital infections costs serious money. While the MRSA problem is only one of many areas in our health service which requires an urgent allocation of resources, not dealing with this problem will cost more in the long run. Infection control is cost-effective as well as being life-saving. Prevention is always better than cure.

However, it now looks as though MRSA has reached a stage where it cannot be eradicated in Ireland. Infection control experts must have little to be optimistic about. We are well-justified to be fearful of MRSA. Superbugs rule, ok?

Junior Doctors

Another excellent four-part series by Mint Productions is being repeated on RTE 1 television (Mondays 11.45pm). Part 1 was screened last night and this ‘real-life’ medical drama should not to be missed by anyone thinking of studying medicine. Mint Productions also produced Surgeons, another brilliant series featuring the lives and daily work of Irish surgeons.

‘Junior Doctors’ is a fly-on-the-wall documentary series which follows the plight of four interns – Paddy Barrett, Catherine de Blacam, Sinead Beirne and Paul Carroll – over the course of their first year as junior doctors at St. Vincent’s University Hospital, Dublin. As ‘interns’ they are on the lowest rung of the medical ladder. It is an incredibly hectic and demanding job where these junior doctors are expected to work 80+ hour weeks at the coalface, in life and death situations.

This is definitely not a job for the faint-hearted. The programme gives a very good insight into the life of interns as they come to terms with the incredible hardships, compromises and rewards of their chosen profession. It was interesting to witness last night how a simple, mundane task such as remembering the code to unlock a door, could become a real issue for over-worked and exhausted junior doctors.

Co-located Patients

When is all this co-located hospitals nonsense going to stop? Ireland is about to replicate a discredited system by promoting a 2-tier health system. It seems that our Minister for Health is determined to pursue her goal despite widespread opposition. She still maintains that the co-located scheme to free up 1,ooo public beds in public hospitals by providing 1,ooo private beds in co-located hospitals, will cost less than providing new public beds directly. It’s time for Mary Harney to come clean on this because from what we hear and read (Highly recommended: ‘Emergency- Irish Hospitals in Chaos’ by Marie O’Connor 2007), the figures simply don’t add up.

These co-located hospitals are to be built by ‘for-profit’ companies on public hospital grounds subsidised by the Irish tax payer. As Maurice Neligan points out in his column Heart Beat in the Health Supplement of today’s Irish Times “Co-location has nothing to do with patient welfare but is merely another prop from an overdeveloped and soon-to-be-troubled construction industry”.

Our Minister for Health declared in early 2006 that the situation in A&E had to be treated as a ‘national emergency’. According to Eilish O’Regan in Independent.ie last week, emergency consultants were claiming that “some hospitals have seen record numbers of patients on trolleys in recent months”. The HSE hit back by challenging the doctors’ claims and by saying that we need “to take account of the time scales for key infrastructural developments aimed at enabling improvements in emergency departments including the construction and commissioning of 700 additional public long stay beds and the establishment of additional acute medical admissions units“. Could our Minister for Health please elaborate further on this point? We’ve heard lots about where the private co-located beds will be but we’ve heard precious little about the construction and commissioning of these much-needed public long stay beds. As for the medical admissions units – these just are another form of co-located beds where patients wait for an in-patient bed having been seen in A&E. This is co-location with a difference. No posh conditions will be found here! Patients will simply be re-located to these temporary holding bays in an effort to ease the overcrowding, and the trolley count, in A&E on any given day.

The failure to provide adequate funding for our public health system is costing lives. But it’s not about saving patients’ lives, is it? It’s all about co-locating them.

Coping with the Diagnosis

So where were you in August 2005? I know where I was – I was on a lonely journey in hospital, locked away in a tiny little isolation room having just received a diagnosis of MRSA infection.

The surgeon who had operated on my head, arrived in my room some hours after I’d been told of the MRSA diagnosis. I couldn’t help but laugh as this was the first time I’d seen him wearing the now mandatory gear of barrier nursing (a plastic apron and rubber gloves) but this light-heartedness was short lived. He was clearly shocked by this new development in my infection status. This took me by surprise as I was used to him always being a step ahead and ready for any challenge. I knew then that my instincts had proved correct and that I now had a serious battle on my hands. I had a rampaging wound infection on my forehead following intricate surgery close to my brain and it didn’t take a rocket scientist to work out that the implications of this could be very serious indeed. My surgeon was very reassuring but his disbelief at my diagnosis unsettled me. In fact everyone who came into my room that evening looked at me anxiously and I found myself trying to reassure them to ease the tension.

I didn’t get much sleep that night. I had been commenced on a new regime of IV antibiotics, the main one being Teicoplanin which I was told was the ‘gold star’ of medication to overcome methicillin-resistant Staphylococcus aureus. I tossed and turned throughout the night due to a combination of physical and psychological discomfort. I knew I was in good hands – especially so following a visit from a very kindly consultant microbiologist who’d been called in late at night to supervise my treatment – but I could still sense the aura of concern that hung over my head.

In the early hours of the morning I found myself humming the Monty Python tune “Always look on the bright side of life!” and soon my spirits lifted. I knew I’d found the key to getting through the coming days. I set about making a large sign for the door to my room bearing the above words and accompanied by a 😀 I felt defiant. No super bug was going to get the better of me! Over the following 24 hours, my infection began to respond to the new antibiotics and everyone who entered my room that day did so with a large smile/humming that tune. Even the paper lady used to sing the tune as she made her way down the corridor each morning. That sign achieved more than I could ever have imagined and to this day I still get comments about it.

Welcome! to ‘The MRSA Club’

I mentioned in a previous posting that I was admitted to an MRSA isolation unit a couple of years ago. I needed intensive intravenous treatment to stamp out an MRSA infection that had spread into the bone of my forehead following surgery for chronic frontal sinus infection. This isolation unit was open-plan with 5 or 6 bays, each containing about 5 beds – each of which was occupied by an MRSA ‘labelled’ patient. In this hospital when someone receives a diagnosis of MRSA, the front of their hospital chart is labelled with an illuminous sticker proclaiming their status – just great for patient morale. This is definitely not a sticker to be proud of! But of course once you make it into an MRSA isolation unit – you’ve truly joined the Club.

I really dreaded being admitted to this unit because I had a fear of what I’d find there. Those fears were not unfounded. I soon realised that most of the other patients were very elderly and some of them had been resident there for a very long time. I began to wonder if I’d ever escape out of the place. The unit was a pre-fabricated structure, which was over-heated and poorly ventilated. It had three toilets but at least one was usually out-of-use because of soiling, or plumbing problems. My abiding memory of the time spent in that unit, is of the smell – think ‘dirty nappies’ and you’ll get my gist – many of the patients were bed-ridden with infected leg ulcers and bed sores. I used to stand at the door to the unit whenever I could to get some fresh air but it would often turn my stomach to have to return to my bed. The blaring televisions left on all day didn’t help either. I longed for escape. The place was mainly staffed by overseas nurses who appeared demoralised by their work conditions. I witnessed some of the nurses treating the older patients with impatience and disrespect. It broke my heart to see the terror and confusion on the faces of the elderly as they struggled to understand instructions given in poor English. We quickly learnt to rely on the few nurses who were ‘gems’ and who lovingly cared for us, often above and beyond the call of duty. Meals were unappetising, non-nutritious and invariably cold, or at least cold by the time they got to us. Evening tea was served at 5pm and then nothing else until breakfast, over 15 hours later, at 8.30 am. We were lucky if we got offered a hot drink during the evening. Whenever I enquired about this I was told that there was a problem of staff shortage in the ward kitchen. Many of the patients in the unit were unable to fend for themselves but we soon learnt to look out for each other’s needs. Why does it have to be like this in this day and age? Why do patients have to endure these sorts of conditions when we have a booming economy in Ireland?

Of course all this talk of improving the Health Service by building co-located private hospitals on public hospital grounds does nothing to reassure me that conditions will improve in the general hospitals.  Comprehensive infection control requires funding. Noel Browne succeeded in eradicating TB from Ireland in the 1950’s by isolating the TB patients. The best our Minister for Health can offer is to underline the importance of hand-washing. But, if our Minister for Health was to take the MRSA situation in this country seriously – she could decide to re-locate all MRSA patients into new, purpose built ‘co-located’ hospital units. Now that really would be something worth talking about!