Florence Nightingale caused a sensation when she revealed that more soldiers died of infections than wounds in the Crimea. Since then we have learned how infections spread and how deadly they can be. It is a scandal that, 150 years later, hospital acquired infections (HAIs) are taking a heavy and apparently increasing toll on frail, ill people who believe their trip to hospital will make them better. It is small comfort that the toll from infections such as MRSA and Clostridium Difficile (C Diff) is even worse in England than Scotland.
Following revelations about C Diff deaths at the Vale of Leven Hospital in Balloch, it has emerged that 24 people have died in one year from HAIs in one of Scotland's smallest health board areas. Ayrshire and Arran contains just two general hospitals - Ayr and Crosshouse, Kilmarnock - but shows an alarming rise in the number of patients infected, even though it is one of three boards piloting tough new screening measures.
It is clear that ill and elderly patients, often with wounds from operations, are particularly vulnerable to infections. Hospital superbugs spread with terrifying ease and are fiendishly hard to eradicate. However, the fact that infection rates appear to vary dramatically between different hospitals suggests that not enough is being done to share best practice. Though it is important to apply the microscope to the Vale of Leven outbreak to try to learn lessons from what went wrong there, the latest revelations suggest the inquiry should be widened. In the first instance, we need a detailed breakdown of HAIs from every Scottish health board area.
The Scottish Government's allocation of £54m to tackle HAIs over the next three years is a measure of how seriously it is taking the problem but we need to be confident that the money is being spent to best effect. We need to go to war on hospital superbugs on several fronts simultaneously. First, we must look at how to tighten the procedures of infection control teams and monitor their performance. There must be more emphasis on the sensible use of antibiotics, as unfinished courses of tablets allow new strains of infection to evolve. Also, as Britain's Chief Medical Officer, Sir Liam Donaldson, suggests, although there may soon be effective vaccines against MRSA and C Diff, it would be a mistake to regard them as a panacea. As he put it: "If you don't concentrate on hygiene measures, something else would come along to replace them."
What would Florence Nightingale say? She would urge us to pay attention to detail. For instance, it is all very well to supply dispensers of anti-bacterial gel to every ward but they will not protect patients unless doctors, hospital staff and visitors are constrained to use them.
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