Decontamination

April 25, 2009

Infection control in Irish hospitals is a serious problem as the superbugs are constantly developing resistance to disinfectants. In spite of hospital cleaning regimens, the bacteria can form spores which survive for months or even years in the environment. When a serious outbreak occurs, preventing cross-infection and the further spread of endemic strains requires effective control measures.

disinfectant-cartoon

In years gone by, there was no range of sophisticated cleaning agents available to disinfect a room following a case of infectious disease. The room was sealed off and a combination of disinfectant and a formalin lamp was used to decontaminate the air.

Here’s another excerpt from Home Nursing in the early 1900’s…

Disinfecting the Sick-Room

Whenever possible the help of a Sanitary Inspector should be sought. If this is not available:-

1.  Open all cupboards and drawers, and hang up dressing-gown and blankets on a clotheshorse or on cords stretched across the room

2.  Paste paper over the fireplace, the framework of the windows, and all other crevices except those about the door.

3.  Paste ready for use the strips of paper required for the door and the keyhole.

4.  Place a formalin lamp on a metal tray (as a precaution against fire) raised from the floor; ignite it, and leave the room quickly. To disinfect a large room, several lamps placed about it will be required.

5.  Close the door; cover the crevices about the door and the keyhole with the prepared strips of paper.

6.  Keep the room closed for twelve hours.

7.  Re-enter the room, open the windows wide, uncover the fireplace, and allow the room to remain in this state for another twelve hours.

8.  Send the bedding and mattress to be dis-infected.

9.  Burn all books, letters, etc., which have been in the room.

After her duties are finished the home nurse must disinfect herself, taking precisely the precautions which has adopted for her patient.


Infection Control

April 23, 2009

In the first decades of the 20th century, wealthy households employed trained professional nurses to care for seriously ill family members. These nurses stayed in the patient’s home, carrying out the doctor’s instructions, monitoring the patient’s condition and providing general care – making beds, bathing the patient, giving medicines and keeping the sickroom in good order. The role of the private nurse was not an easy one: she had an ambiguous social position – above domestic servants but below family members. Private nursing slowly died out after 1918, at the same time as did the live-in domestic servant.

Here’s another gem I found in my little book of Home Nursing from the 1930’s, on the precautions taken against the spread of infection. The HSE would do well to take note!

medical-kit

The following rules should be observed whenever a case of infectious disease is being treated at home:-

1.  At the outset of the disease soak a sheet in disinfectant and hang it outside the sick-room door, allowing the lower end to remain in a bath containing disinfectant.

2.  Immediately pour a strong disinfectant over all excretions, cover the bed-pan with a cloth, remove and empty it at once unless the doctor desires it kept for his inspection. After emptying the bed-pan scald it out and cleanse with a disinfectant.

3.  Burn in the fireplace in the sick-room all rags, cotton-waste, tow or cotton-wool used for discharges, also all dust taken up in the sick-room.

4.  Place in a pail of disinfectant for one hour at least, all soiled bed linen, including handkerchiefs, before boiling them.

5.  Keep a basin of disinfectant in the room but out of the patient’s reach, in which to wash your hands every time you have done anything for him.

6.  When the patient is declared free from infection, give him a bath to which disinfectant of the appropriate amount has been added, not omitting to wash the head. Put him into a dressing-gown which has not been kept in the sick-room, move him into another room, and dress him.

Disinfecting the Sick-Room to follow.


At the Front Line

April 22, 2009

A draft document from the Department of Health has been circulated around HSE managers warning of further job losses in the nursing sector. Staff nurse levels will be cut by 700 this year as part of a move to optimise resources. The Irish Nurses Organisation (INO) has claimed that these further cutbacks will have an unsafe impact on frontline services and that patient care will be compromised. The HSE  is defending the proposal and continues to insist that frontline services will be maintained. I wonder what the VAD nurses would have made of today’s working conditions at the front line?

voluntary-aid-detachment3The British Red Cross Society formed the Voluntary Aid Detachment (VAD) in 1909 to provide auxiliary medical service in the event of war. While it was mostly men who fought on the front lines during the First World War, some women also worked close to European battlefields as nurses. These graduate nurses and members of the Voluntary Aid Detachment – a corps of semi-trained nurses – worked in war hospitals, drove ambulances, and served as cooks, clerks, and maids. Most women who volunteered with this unit were not professional nurses. They attended classes in first aid, home nursing, and hygiene with the St. John Ambulance Association for between three and six months and also volunteered in hospitals, making beds, taking temperatures, and performing other duties. Open-air drills also taught VADs to build and cook on camp fires, pitch hospital tents, and care for wounded soldiers.

The work was physically and emotionally taxing. Nurses worked long hours in crowded and chaotic hospitals treating severely wounded soldiers from the front lines. They slept on bunks, ate rations, and went without the usual comforts from home. Although the work was stressful and sometimes traumatic, it also produced a sense of satisfaction in many nurses by allowing them to make significant and public contributions to the war effort.

Image courtesy of the British Red Cross Museum and Archives.


Home Nursing

April 11, 2009

23661eWhile sorting out some old family belongings recently, I came across a  little handbook of nursing, titled  “Home Nursing – The Authorized Textbook of the St. John Ambulance Association“. This book was first published in June 1932 and contains some wonderful gems on patient care. These were the  days when patients were literally ‘nursed’ back to health.

BEVERAGES AND INVALID COOKERY

“Beverages may be refreshing, nourishing or stimulating”.

a. Refreshing.

Beverages for this purpose should be taken in sips, and the patient urged to hold the fluid under the front of the tongue or at the back of the throat. The effect will be a refreshing sensation of coolness, whereas a large draught does not so well allay the thirst and may induce flatulence.  Rinsing the mouth with cold water will often effectually allay thirst.

Teas made from Jam – Blackcurrant tea is especially suitable. Add a tablespoonful of jam to a pint of boiling water and allow to stand; strain.

Toast Water – Soak a slice of well toasted bread in a pint of boiling water; stand till cold; strain.

Apple Water – Slice thinly an apple without peeling or coring; pour over it a pint of boiling water; stand till cold; strain.

nurseb.  Nourishing.

Barley Water (thin) – Add half a pint of boiling water to a teaspoonful of washed pearl barley, with a pinch of salt: stand by the fire for an hour, stirring occasionally: strain through fine muslin: allow to cool.

Albumen Water – Stir the whites of two fresh eggs in half a pint of cold boiled water, to which a pinch of salt has been added; leave for half an hour.

Gruel (Oatmeal) may be made with mild or with water. Mix into a paste with water two tablespoonfuls of fine oatmeal or groats in a saucepan; add a pint of milk or water, as ordered, and boil gently for half an hour, stirring frequently. Flavour with salt or sugar.

Egg Flip – Remove the speck; beat up a new-laid egg with a teaspoonful of sugar; add half a pint of milk and, if ordered, a tablespoonful of brandy; stir well.

c. Stimulating.

Tea/Coffee.

Beef Tea (quick) – Remove the fat and skin from half a pound of gravy beef, which should be cut in small pieces and placed in a saucepan; add sufficient water to cover the meat and a little salt; while warming over a moderate fire, press out the juice of the meat for ten minutes; removed the meat and boil the liquor for one minute.

Those were the days! Do you think the  HSE could learn any useful tips from this book? More to follow…


MRSA – A silent stigma

September 30, 2007

A diagnosis of MRSA (methicillin-resistant Staphylococcus aureus) infection is not something to be taken lightly. It has the potential to become a life-threatening condition and intensive treatment with antibiotics will be required. However, there is another side to the diagnosis which is rarely talked about. There is the stigma attached to having an infectious condition and it forms a significant part of the MRSA journey. Hospital staff are best trained to deal with medical emergencies but their management of patients with an infectious status sometimes leaves a lot to be desired.

When I was first diagnosed with MRSA I was treated with the utmost urgency and received excellent care. I was barrier nursed in isolation whilst undergoing intensive intravenous antibiotic therapy. This involuntary withdrawal from the world took some getting used to but I quickly developed my own coping mechanisms to get through that lonely time. However the ‘fun’ really starts when a patient has to come out of isolation for investigation or treatment. When an MRSA infection is confirmed by laboratory tests, a patient’s hospital chart is labelled with a luminous sticker proclaiming their infectious status. This is a method of alerting staff to take the necessary precautions to minimise the spread of infection. Hospital staff however should be aware of the sensitivities involved for MRSA infected patients.

I had to be taken to theatre for some minor surgery while still being treated in isolation. Patients with a positive MRSA status have to wait until last in the queue to go for surgery because of the very real potential of contaminating an operating theatre. So after a very long wait while fasting all day for the general anaesthetic, a porter finally arrived to transport me on a trolley to my destiny. We were escorted to theatre by a very junior nurse who was given the task of carrying my hospital chart. I was duly lined up in the pre-anaesthetic area alongside a row of other similarly nervous patients to await my turn in theatre. My surgeon and his surgical team appeared briefly in an open doorway and made encouraging faces at me. Suddenly, a loud shout came from another direction and to my horror, I heard the theatre sister roar from a distance “get that MRSA patient out of there, NOW!”. I saw the surgeon raise his eyebrows in disbelief at what had been heard and in an attempt to lighten the moment, we exchanged grins about ‘SHE who must be obeyed!’.  The theatre sister however continued to loudly remonstrate the junior nurse for accompanying me (the infectious patient) to the wrong location and any humour in the situation, rapidly dissipated. The junior nurse was mortified to receive such a public dressing-down and I felt very humiliated to be treated like a leper in front of all the other patients and staff. It was as if I didn’t exist as a person – I was purely seen as a health hazard which had to be quickly removed. A nice welcome back to the ‘real’ world after spending so much time alone.

I have since sat in crowded out-patient clinics and had the clinic nurse make insensitive enquiries in front of everyone else. You do get better at handling the ignorance surrounding MRSA but you never get used to it. MRSA patients have enough problems to contend with without having to tackle the issue of stigma as well. The sticker on a hospital chart may change colour once MRSA clearance has been obtained but it appears that you remain a ‘labelled’ patient for evermore. The legacy lives on.


Nursing Care in Hospital

September 19, 2007

I was referred to the UK earlier this year to undergo surgery in a specialist unit at an NHS hospital. This operation was unavailable in Ireland unfortunately so I had to pack my bags and head across the water to the unfamiliar territory of the NHS. Having ‘done time’ on numerous occasions in Irish hospitals, I was interested to see how the UK would compare. The conclusion I came to was that nursing care in the NHS has ‘gone bananas’.

My first impression of the hospital was a good one. On admission, my immediate surroundings appeared spotlessly clean and modern – a far cry from the appalling conditions found in many parts of the Irish health service. I was allocated a bed in a tiny room (no en suite facilities) beside the Nurses’ Station – this room had glass doors to it to facilitate observation of the patient. I thought that this easy visibility would limit any hope of privacy but in fact, it worked to my advantage. The glass doors provided a ‘bird’s eye’ view of the daily activities of the ward staff and this was a source of much entertainment throughout my stay. I did wonder however if the fact that I was a ‘Paddy’ with a history of previous MRSA infection (and recurrence) might not be the real reason why I’d been put in this room. Anyway, I was duly installed as a patient and was whisked off to theatre a few hours later, to go under the knife.

When I next ‘came to’ I was back in the same little room but this time I had to share it with all the paraphernalia associated with having had major surgery – the drips, drains, monitors etc. I lay there in a morphine-induced stupor in full view of the nurses and watched the world go by. I waited and waited for a nurse to appear at my bedside to offer some reassurance but as time went on, I realised that this was a false hope. The nurses only came into my room whenever they had to record my vital signs and even then, there was little or no personal interaction. It was like as if the patient was superfluous to the job in hand. When I was originally diagnosed with MRSA, I was barrier nursed but now this was different type of isolation. I could see endless activity at the nurses’ station with nurses filling out forms etc. but it appeared that very little time was actually spent with the patients. In Ireland, the nurses generally (though not always) interact well with their patients despite also being very busy. It soon became obvious that huge differences exist between our two healthcare systems in terms of nursing care. The NHS may be better in some respects than it’s counterparts here but it lacks the personal touch that thankfully still exists in Ireland. I cannot complain about the medical care I received from the NHS but the standard of nursing left me cold. Not once during my stay did any nurse ask the simple question of “how are you today?“. My medication was dispensed at regular intervals throughout the day without any explanations given. I simply wasn’t consulted at all. And there was definitely no humour to be had despite my best efforts to attract a smile. I have a lot of experience of spending time in hospital and so I’m not easily unnerved by hospital procedures but I can still imagine how frightening it must be for inexperienced patients to be left alone to cope in an unfamiliar environment. I appreciate that nursing these days is very hard work and sadly, it is also often a thankless task. However I’m in no doubt that patient care is compromised when nursing loses it’s personal touch.

After several days of observing the activities of the NHS, I devised a plan to put the ‘system’ to the test. Every morning a junior nurse would come into my room to offer a simple breakfast menu of “Weetabix/Cornflakes, Tea and Toast?“. The choice never varied. Each item of food dispensed had to be ticked off on a list by the nurse. I decided to ‘rock the boat’ one day and request a banana with my cereal. The nurse looked at me in despair having studied the menu, and replied “we don’t ‘do’ bananas at breakfast time“. It was hard not to laugh at this reply but I persisted in my request (out of sheer devilment) and the nurse got more and more flustered as she continued to scour her list for a ‘banana’ box to tick. Eventually I had to tell her that I knew that there were bananas in the ward kitchen and all she had to do was to walk a short distance to fetch one. After a long pause, she left the room and returned with the said banana. I felt like I’d scored a victory! Sad, isn’t it? But this is the sort of behaviour you’re reduced to when subjected to hospital care that is not patient-centred. This is a small, but clear example of how target driven the NHS has become. Nursing care it seems, is now all about ticking the boxes. I got such pleasure out of beating the system that day and by the way – the banana was delicious too!


Voluntary Health Service

September 11, 2007

Our Minister for Health, Mary Harney, is very anxious to make cutbacks in the health service. You see, she faces a bit of a problem. The huge expenditure required to maintain the high salaries of the bureaucrats within the HSE (Health Service Executive) is eating into the budget that was allocated to improve the Health Service. It’s definitely a case of ‘robbing Peter (the patients) to pay Paul (public servants)’. Patients are fed up waiting for the awful conditions in our hospitals to improve. Hospital buildings are crying out for investment, much of the equipment is outdated and staff morale is at an all time low. So rapid action is needed if Mary is to save face.

First we were told that our Minister is putting a freeze on the employment of new health service workers for the month of September. The fact that the health service is almost on it’s knees from poor staffing levels doesn’t enter the equation. The figures have to balance at the end of the month somehow/anyhow. Now there’s another bright idea brewing. The Minister now wants to introduce a voluntary health service. Harney wants members of the public to ‘volunteer’ their services to provide support for hospital patients. Six month’s training and you’re in! Soon the staffing bill will be minimal as the general public takes over the running of our hospitals. This should also do away with the problem of nurses wanting higher salaries to match their skills when others are seen to work for nothing. This latest idea of course, has nothing to do with the fact that our public hospitals will suffer from staff shortages once the 2-tier health system swings into place. The co-located private hospitals will undoubtedly ‘lure’ highly trained staff over to their better working conditions. This is not about improving the lives of patients, it’s purely a cost saving measure.

Well, I’ve got another idea. Mary Harney should address the real cause of the overspending in our health service. The HSE is bleeding the system dry – she needs to ‘nuke’ it completely and start again from scratch. HSE employees could choose to either vacate their positions voluntarily or to continue their service in a voluntary capacity. That should reduce the bills, no problem!