The Department of Health and Children is in Hawkins St. in Dublin 2. Hawkins St. is a short street.
At the end of the street there is a memorial in Victorian style to Constable Patrick Sheehan who died, in 1905, trying to rescue a workman from a gas filled sewer.
The gas must be still there, affecting the Minister for Health.
The Health Service Executive is, currently, dysfunctional and a failure. It has failed on a number of fronts but consistently it has failed on the issue of hospital hygiene. The extreme cases of Ennis General Hospital and now St. Columcille’s Hospital where multiple deaths through nosocomial infections have taken place are representative of the general situation.
The Minister’s response to the situation is bizarre, and reported HERE:
She pointed out that the health service has a national plan to tackle health acquired infections which would see them reduced by 20% in the coming years, and MRSA in particular by 30%.
This would involve a reduction in the use of antibiotics, she said, of 20%.
The reference to antibiotics is a reference to her theory that health care infections are caused by the evolution of microbes. She attributes the evolution to excessive use of antibiotics.
She is not deterred in her assertions by any contrary evidence. Like the fact that Irish hospitals have a low standard of hygiene and that poor hospital hygiene is the cause of the infections. Or the fact that Clostridium difficile has not perceptibly evolved. Clostridium difficile is the infection that caused the deaths in Ennis and St. Columcille’s.
One can only feel, if the gas is not the explanation for her views, that she is motivated by the fact that no person or institution is answerable for excessive use of antibiotics and no legal liability would attach to the HSE if her view prevails.
Whilst I will not argue that hygiene standards in hospitals seem to be generally poor. It is one of the many factors, and I think you should be more considerate before asserting other facts.
“the fact that Clostridium difficile has not perceptibly evolved”. How you can say this I do not know. The emergence of the 027 strain – the strain repsonsible for just over 50% of cases typed in Ennis – shows that evolution is very much clinically perceptible. This particular strain possesses a mutated regulatory gene; that is, the gene that negatively controls the toxin producing genes. As a result, 027 is known as a hyper-producer of the toxin responsible for disease pathogenesis, and this strain is associated with more severe disease and increased fatalities.
Furthermore, although C difficile is not generally considered “drug-resistant”, the use of antiobiotics is clearly associated with the disease. Antibiotic use in patients clears the normal bacterial fauna in the gut allowing C difficle to overgrow and cause disease. It can do this in two ways: the ingestion of extremely tough spores afetr antiobitic treatment or growth of bacteria already in the gut which are resistant to whatever antibiotic has been used to treat another condition. Therefore, the reduction of broad-spectrum antibiotic use is known as one of the factors for control of C difficile disease.
The overuse of antibiotics clearly drives the evolution of antimicrobial resistance – it’s not just her theory, but that of almost every doctor, scientisit and public health professional involved in the healthcare associated infections. Better presciption policies are certainly needed. One of which is the reduction of unneccesary use, as broad-spectrum antibiotics are often prescribed before the underlying infective cause is even known.
The control of hospital acquired infections is a complex process – antibotic reduction is just one of the methods and improved hygiene is certainly another.
You can reduce and maybe control antiobiotic resistance but it is becoming clearer that we are unlikely to ever get rid of it.
Being but a humble layman in terms of hospital infections and the law I may be totally wide of the mark with this comment but… standards of hospital hygiene prevent and control infection. Use (or abuse or misuse) of antibiotics treat and control infection.
My grandmother used to tell me that an ounce of prevention is worth a ton of cure, a fact I’ve seen repeated in information quality issues throughout my career and is consistent with best practice in quality management.
Are hospitals and nosocomial infections different in some way to other domains of human activity that prevention is not better than cure?
Did my granny lie to me, omitting an uncomfortable fact that didn’t suit her world view? Does that mean that Mary Harney is my granny, or is she just applying the same filter on her view of the world?
My head hurts now, I think I’ll lie down.
On a serious note… focussing with clear tunnel vision on one causal factor without addressing other ‘common causes’ (a term in Quality management meaning causes that are endemic in the system rather than being ‘special’ and occuring through accident or sudden change) simply will not succeed in reducing the level of defect (in this case dead patients as a result of nosocomial infections). Tackling the largest causal factors on the basis of a ‘pareto’ prioritisation (start with the one that contributes most, eliminate, reduce or control that cause and then move to the next, repeat ad nauseam – no pun intended) is a proven approach to sustainable improvement in quality.
Dlugacz Yosef’ excellent book “Measuring Health Care: Using Quality Data for Operational, Financial and Clinical Improvement” gives insights into how quality management practices can be applied in relation to healthcare information. A documentary produced in 2006 by NBC shows how the application of quality management principles helped improve things in an American hospital.(http://www.4ulr.com/products/productquality/hopitalheal.html)
However the cynic in my suspects that the Dept’s avoidance of the hygiene issue has more to do with liability than science, as Mr McGarr has suggested.
Let me first state that good hand-hygiene is considered the single most important method for prevention of hospital-acquired infections.
But done alone, it is useless. For one thing, sadly you will never get 100% compliance 100% of the time. Furthermore, the constant transfer of people in and out of hopsitals (including patients, their family and friends) continually brings in bacteria: on clothers, on the skin, in the nose, and in the air. Short of asking every single visitor and patient to be stripped and disinfected and have their clothes burnt you will find it very difficult to have a hospital environment free of pathogenic bacteria.
Keeping wards clean using disinfectants is also problematic as many bacteria are resistant to the chemicals used. Some form resistant spores – like C difficle – others can actively pump the chemicals out of the cell before they can do any harm.
Let’s be clear that the use of certain antibiotics are a factor in the cause of C difficle associated disease. The cure can also be a cause – as much as a paradox as that might sound.
Let’s also be clear that multi-resistant bacteria are present, in hospitals and the community. Resistance is selected for by the use of antibiotics – persistance by the overuse. Some organisms are almost resistant to every single antibiotic known, and the incidence is increasing – that is a very worrying trend.
Thus, reducing antibiotic use is a clear strategy in reducing nosocomial infections – and it works. But it won’t work alone and certainly not without improved hygiene.
With regards the article, I don’t see where t suggests the Minister avoided the hygiene issue. It just isn’t mentioned – whether the editor failed to include it, the question wasn’t asked or, even, they may have indeed avoided it. There’s simply nothing to indicate that the issue was deliberately avoided.
We would all rather have prevention rather than cure, but we are nowhere near that stage at the moment. Improving hygiene and reducing antibiotic use are but two of the means of trying to get there. Good hospital management is undoubtedly another. Either done in isolation is asking for trouble.
My post was intended to make two points. Firstly, that the Ministerâs comments on antibiotics and a reduction in their use, had a political motivation. Secondly, that lack of hygiene is the proximate cause of nosocomial infections.
My second point is not diminished by citations establishing âthe connectednessâ? of things. For instance, a patient in hospital, surviving a road traffic accident will not assign legal fault to the driver(s) in the road traffic accident if he/she trips on the hospital stairs, even though, without the accident he would not be a hospital patient
What political motivation would that be?
A policy of reducing antibiotics is not “bizarre”. It has been given top priority along with hygiene in reducing and controlling nosocomial infections.
If they ARE ignoring hygiene as an issue then they would be sacked on the spot, but where does it imply this in the article?
Perhaps you have more background knowledge, which would make the context of your argument stronger.