14th February 2005
"There is nothing as dirty as pure filth," said the man and it was impossible to disagree with him. Now I have no intention of defending the lack of hand washing between attending to patients by personnel in our hospitals but pure filth is a problem, too.
Years ago the late Peter Derham, some time obstetrician in the Rotunda and gynaecologist at Sir Patrick Dun's had a party piece on the subject of war amongst the bacteria. How I wish I could remember it all. But I do remember that Staphylococcus Aureus featured as one to be feared in battle and that was long before the little fellow got his new flak jackets. His first flak jacket was made of methicillin resistance but he rapidly upgraded this for one that was of multiple resistance and what notoriety it has got him! Internationally many people, if not killed by this organism, have had their demise brought forward. Others have spent months in misery during recuperation from an operation which had gone well but infection by MRSA had delayed their discharge. The cost of all these delays and increased need for other treatments must be staggering.
The acquisition of MRSA by a member of the Dail helped put the problem firmly on the political agenda. The Deputy said he had become infected after a relatively minor procedure and publicly told of the case and said he felt he had been lucky not to lose his arm. Even as it is, apparently he will always have reduced movement in the limb.
The Tanaiste and Minister for Health and Children was asked a question by Deputy John Gormley in the House about the extent of infection by MRSA in our hospitals and how it is spread. On the 2nd December 2004 she said, "Hand hygiene is a key component in the control of MRSA. The SARI infection sub-committee has just released national guidelines for hand hygiene in health care settings. Chief executive officers at hospital and health board level have corporate responsibility for infection control.
My Department will await the final version of the recently issued draft guidelines which will then be evaluated. Costs arising in this context will be discussed at that stage. I want MRSA to be a priority issue for the new health information and quality authority when it becomes operational. Cleanliness and hygiene in hospitals are a concern I intend to address through the accident and emergency package of measures we are going to put in place next year."
My constituents contact me about MRSA, too. Some have been infected or have had a member of their family infected but with others it's just what they observe in hospitals about both hand washing and general cleanliness.
One person, a health care professional told me she was working in a ward in one of our major teaching hospitals where all the patients were MRSA positive, all isolated in there. She was gowned, gloved and so forth. In comes the lady with the dinners, gives them out to the patients and proceeds to the next ward which was MRSA free.
A man wrote to me with a similar type of observation. He had nothing but praise for the hospital where his now teenage child is a patient but the child who has a chronic condition has been MRSA positive for some time. The child is always isolated when he is in hospital but the father said only about one in five of the doctors and nurses who come in to deal with the child wash their hands either before or after touching him. He said he frequently reminds them that the child is MRSA positive.
The lack of cleanliness in parts of some hospitals is a frequent cause of complaint and crops up in the letters page of the Irish Times every now and then. It would appear that many hospital cleaning services are now contracted out and have been for many years. There should be no problem with this except that with a rapid turnover in staff as appears to be the case, no-one has ownership over the area they clean.
In the Good Old Days, the Matron was the Monarch in the hospital and the Ward Sisters her Crown Princesses on earth. But there were another few powerful ladies too. They were the ward cleaners. They were part of the ward team and woe betide any junior who messed up "their" ward. "Was it you Dr. Henry, who spilled blood and didn't clear it up properly?" etc. would be the shout. They are excluded from the team in too many wards now. All we have are a succession of different people, changing far too frequently.
Even if there was some ownership by someone of cleaning a certain area anyone who has ever done any cleaning in their lives will realise how difficult the job is made by overcrowding. Here I disagree with the Tanaiste's reply on the 2nd of December. When Deputy Gormley asked her in a supplementary question if "the terrible conditions and overcrowding in our hospitals are fundamental causes of difficulties with MRSA?" she said "Basic hygiene is not related to numbers" even though Deputy Gormley had already pointed out that one of the recommendations of the SARI report was that there should be less overcrowding.
One is much less likely to wash one's hands when there is difficulty getting around beds to the washhand basin.
In A & E one sees eight, ten, twelve beds, trolleys - call them what you like - where there should be six. Patients are in chairs everywhere, sometimes with drips in their arm and oxygen masks. How could anyone clean in a situation like this which goes on all day? The IHCA has called for the Health and Safety authorities to visit A & E departments and it will be interesting to hear what they have to say about conditions.
How can one properly clean beds when they are refilled with patients while they are still warm? I'm sure this is great productivity and good for "case mix" but it must be good for Staphylococcus Aureus in his flak jacket and for all those roguish Steptococci who are developing their own defences, too. Getting rid of dirt requires time and space as well as workers and cleaning materials.
The Young Scientists exhibition in the R.D.S. always has one or two exhibits focusing on pure filth. It was due to the work of a group of young girls which was presented a few years ago that I moved the tooth brushes in our bathroom. They showed that the nearer the toothbrushes were to the lavatory the more likely they were to get a shower of E.coli every time the loo was flushed! Very appetising indeed. This year another group had swabbed the handles in lavatories in restaurants and pubs; there was faecal material on one third of the handles! Let us hope they don't repeat their experiment in our hospitals.
A bacteriologist friend of mine told me that when an infection problem would arise in a ward she would ask the Sister-in-charge what she would do to improve ward conditions if she had a magic wand and the most useful of suggestions would come forward. I do hope this happens on a wide scale because if there was ever an example that there is no pill to cure every ill, the MRSA crisis is surely it.
Senator Mary Henry, MD
