Aah yes, when nurses were mainly female, a male nurse was a novelty, we wore white dresses, American tan tights and hats that lived in our lockers on top of our lace up shoes. Hats which we only replaced following head butting a pillow whilst performing Australian lift!
Doctors were God and not to be challenged, the only walk round we did was when the Director of Nursing popped up and asked you to take her round the patients questioning you on each one and very occasionally we were visited by minor royalty.
Discharge planning was undertaken in the bathroom and we rolled ‘pinnies’ or did the flowers during visiting time. The green water was carefully poured down the sink in the patients’ bathroom where we encouraged them to wash themselves. Then we were surprised when they got Pseudomonas wound infections! C.difficle was unknown to us but we knew that our post op patients had diarrhoea and it had a farmyard smell. MRSA was something you got in city hospitals and if transferred from one you spent days in a side room until we knew you were “safe”. Our first infection control nurse was funded due to nationwide concern over HIV (remember those tombstone adverts everywhere?) yet HAIs kill more patients than HIV.
We were kind, compassionate and largely clueless about evidence based practice. Doctors and nurses were never questioned by patients because we knew best. I splinted and bandaged all cannula and I made countless Kaolin poultices and placed them on inflamed sites (I loved that smell). Oh yes and there were always lots of nurses and time to spend with the patients… Or was there?
So as young staff nurse at the dawn of the 90’s I was sent to take charge of a surgical ward. I was the only trained member of staff and was supported by 2 students and with another trained member coming on at 3pm. A student came running for me. A man in his late 60’s had recently had a hernia repair and now he was holding his open abdomen and the bed was covered in pink pus. A surgeon was called and examined him without gloves or hand hygiene. ‘This is already infected’. He removed a gangrenous testicle in the room. I was horrified. I stood with my arms across the door and insisted he wait until I had a sterile pack brought from theatre. Whilst this was happening I spent time trying to source a pressure relieving mattress as this chap was clearly now at high risk of developing a pressure sore and I needed to move him from the carnage that was his bed.
That man died, not of the hernia though I believe that was an entirely preventable infection, but from an infected pressure sore. He came in for a routine operation and died before his time. We had no targets and little inspection so this catastrophic event went unnoticed.That experience kindled an interest in pressure and wound care that led me to the role I have now.
These days we do have targets and inspections and I believe they have brought improvement. We count everything, we can have data overload at times but in the past we didn’t know, issues were invisible to us rising to epidemic proportions before they were addressed. Just look where we were with C.difficle a few years ago.
Now if I say we are going to miss a target or we are at risk of failing an inspection there is support and resource there that was not available to me before. But it is not simply about meeting the targets and not looking bad in the press. They have focused our attention on things that matter and that means on our patients and those who care for them.
We state as an infection control team that our vision is that no person will be harmed by a preventable infection. Despite, this we estimate in the past year around one third of all Staphylococcus Aureus Bacteraemia in NHS D&G may have been preventable. That’s amounts to 13 people and has an estimated cost of £26,000. In addition, national data indicates that in these people Staphylococcus Aureus Bacteraemia amounts to a 1 in 3 chance of dying as a result.
So next time we are checking cannula use please understand it’s not about targets it’s about people who we want to see leave hospital in a better state than when they came in and certainly not harmed by our care.
As for those Doctors and nurses that know everything, well let’s share that with our patients and encourage them to ask. Do I need this cannula? Have you washed your hands? Don’t take offence; take it as a compliment because you have the answers.
Elaine Ross is the Infection Control Manager at NHSDumfries and Galloway. Next weeks blog will be by Mr Mike Pratt Chief Pharmacist for NHS D&G.