Dust if you must by @EGRoss85

People assume that as an infection control specialist I must live in a sterile environment or at least tidy. How wrong they are!

I read this poem recently. I think it’s great and this blog is a chance to share it with you. This is how I think we should live life. However, it caused my mind to wander

Author: Rose Milligan

 

My first thought was that if you get to the point of ‘needing’ to dust then your system is failing! If you keep an area tidy and wipe occasionally then there will be no dust.

So then dust is a systems failure.

Dust is dead skin and provides a lovely environment for bugs to grow but is it a risk?

Well that very much depends on where you are and what you are doing. I’m not undertaking any surgery in my home or office so a few piles of papers or books aren’t a risk.

The bugs have to be given access to the body. A healthy intact skin is the first barrier against infection; clean hands mean that we don’t put bugs all over the food we eat. Attending to both these aspects are fundamental to preventing infection.

Moving on from dust to another area of risk, food safety, I considered some of the choices I make on a personal level.

My team will tell you I have scant regard for sell by and even use by dates which horrify some. My perspective is that, as a healthy, informed individual, I can judge the potential impact of my risk based decision backfiring.

Pregnant, I would risk nothing. I’ve a friend who has lost a child to listeriosis and another hospitalised. Some risks are just not worth taking.

Undercooked beef burgers are a no, no for me. Salmonella, Campylobacter, E Coli 0157? No thanks! Steak tartare (raw, minced, fillet steak) from a reputable source? Oh yes!

Why? Well the mince has come from any part of the cow, including intestine where all the bugs live, fillet on the other hand is pure muscle and not where the bugs live. It’s a risk I am willing to take.

So why am I choosing to ramble on in a NHS Blog. Well as an Infection Control Team we are sometime told that our advice is inconsistent and I’d like to try to explain why sometimes this might appear to be the case.

We all have many different risk based decisions to make on a daily basis and these will depend on the vulnerability of the patient group, the activity being performed and the virulence of the organism likely to present the risk. This is why I never find infection prevention dull. It requires the application of specialist knowledge, an understanding of the patient’s clinical picture and the care being provided .There are no black and white answers, it really is 50 shades of grey (!) but whatever decision is taken, it will be made on a balance of risk.

Cleaning is important in a healthcare setting. It’s not about appeasing inspectors, it’s about risk. Dust is full of bugs but if doesn’t reach a patient it’s probably not a risk. But it does reach patients, on hands and equipment so we do need systems in place to make sure that it doesn’t build up and become a home for bugs.

So, ‘dust if you must’. Yes, there’s more to life than cleaning but let’s make a sensible assessment of what is required and if we consider the risks and do the simple things like keeping tidy then cleaning doesn’t become a major event, just the application of a simple process.

So please excuse me now as I go to attend to a low risk systems failure of my own!

Elaine Ross is Infection Control Manager at NHS Dumfries and Galloway

Sepsis 6: Are you on Target? by Sian Finlay

One of the things I have always liked about Acute Medicine is that it gives me a chance to make a rapid and noticeable impact on a patient’s outcome. Nowhere is this more marked than in patients with severe sepsis. Every year about 100,000 people in the UK are admitted to hospital with sepsis. About 30,000 of these have severe sepsis or septic shock, which carries a mortality of nearly 40%. It is these people where the stakes are highest. If they are recognised early and get some very simple interventions within the first hour, their chances of getting out of hospital alive are hugely increased. One study found that survival falls by 7% for every hour’s delay in antibiotic treatment!   This is where the ‘Sepsis Six’ comes in. It is a set of 6 simple interventions which should be done within an hour of a patient presenting with severe sepsis:

1. Oxygen to a target of 94-98% saturation (88-92% if risk of CO2 retention)
2. Blood cultures (and culture any other likely infection source)
3. Measure lactate
4. Intravenous fluids (give a 500ml bolus and reassess)
5. Intravenous antibiotics
6. Measure urine output (catheter or accurate fluid chart)

All of these steps can easily be delivered by junior doctors and nurses, and yet can make a huge difference. So why don’t we do it all the time? One problem seems to be the difficulty in recognising severe sepsis. Patients often don’t arrive with that label, and indeed may have another tag-line attached to them, such as ‘off legs’ or ‘confusion’.   Sometimes the other label doesn’t sound very serious and no-one else seems overly concerned about the patient. Compared to other emergencies such as acute stroke or MI, sepsis can present with a much broader range of symptoms, so diagnosis can be challenging. The only solution is to be vigilant, and to consider sepsis as a possible cause in every patient with an elevated Early Warning Score (MEWS).  

For the last few years, I have been involved with the Scottish Patient Safety Programme (SPSP) work on improving delivery of the sepsis 6. This group consists of nursing and medical staff from key wards, pharmacy, infection control, and SPSP improvement advisors. Initially we focussed on the Emergency Department and Acute Medical Unit, since most patients come into hospital through these routes. We encouraged staff to use our gold ‘Sepsis ICP’ forms for every patient who might have sepsis. The form takes the user through a list of ‘red flag’ signs, which are designed to identify those with severe sepsis. These are the people who need the sepsis 6, and the time for delivering each component of it is recorded on the form and filed in the patient’s notes. Recently we have spread the message to the Galloway Community Hospital in Stranraer and to the medical HDU. Parallel work is ongoing in Obstetrics. Since the project began, the median time to first antibiotic dose in DGRI has fallen to less than one hour, so we know we are on the right track. However there is still much to be done – when I am collecting the data each month, I still see one or two patients who go unrecognised for several hours or only get part of the sepsis 6.

So what are the next steps?

Firstly we need to raise awareness amongst medical and nursing staff that severe sepsis is a medical emergency. In a world where new doctors can rotate through a department every week, it is often experienced nursing staff who are best placed to take the lead in this, and to flag up the possibility of sepsis to the rest of the team. Next, we need to spread the sepsis work more widely, so we can be confident that a patient will get the same quality of care no matter where or when they become unwell. With this in mind, I would invite anyone who is interested in joining our team or contributing in any way (nursing, medical, or AHP) to get in touch and join our exciting project. And if you don’t have time to do this, but still want to help, just remember that if you encounter a patient with severe sepsis and deliver the sepsis 6 within an hour, you can go home that night knowing you have made a difference. It’s that simple.

If you would like to contribute and join our group please contact the Patient Safety & Improvement Team on dumf-uhb.PatientSafety@nhs.net

Dr Sian Finlay is an Acute Physician and Clinical Director for Medicine at NHS Dumfries and Galloway

 

 

Recreation and Wellbeing by Catherine Mackereth and Michele McCoy

September is well past the holiday season for most people, but we are both just about to go on ours (separately – we see plenty of each other at work!). We both enjoy holidays as it is a chance to relax, a change of scenery, explore new places, try out new things. It’s about recreation. But what do we mean by recreation?

Recreation is about re-creating, about being creative, in whatever way suits us. It is the key to getting refreshed, revitalised and energised. Creativity is a fundamental part of being human and we should take every opportunity to engage in activities that will promote that side of our lives. It is about looking at the world with fresh eyes, whether looking at a piece of art in a gallery, reading a good book, listening to the birds sing, spending time with friends and family, smelling the new mown grass…or making your surroundings look lovely!

 

Public Health as a function recognises the importance of creativity and its contribution to wellbeing.

Not only do we seek to promote it in other people, we are looking at how we can promote creativity in all our work. One example is around how we engage with communities and the general public. There is lots of talk about community engagement at the moment, but are we any good at it? Of course we are interested in engaging about the health and wellbeing of the population whether that is in regard to; promoting healthy behavior, working with colleagues to develop new services, establish positive environments for people. However, what we need to know is whether or not we are really doing that in an effective way?

The questions we need to ask are:

Will a questionnaire, received by email really prompt the kind of engagement that we are looking for? Will a notice in the local paper help us access the people that we really need to talk to? We all lead busy lives , yet we know that talking and exploring ideas will lead to creativity and finding solutions that we may not have found through simply asking a set of questions via the more obvious channels. This is not to say that these approaches are not applicable, but they must not be the only approach. If this is all we do, people may simply disengage. We need to capture the imagination and passion to achieve the sort of engagement which will help to inform our decisions.

We have been talking about what it would feel like if someone was trying to engage with us. We wondered about venue…maybe a comfortable coffee shop, or a trendy wine bar? What about being offered interesting food to make it worth our while? Or a voucher as a token of thanks for our time? None of these are likely in these times of austerity, but maybe we need to start using our creativity to make the whole process more enjoyable.

We have been developing skills across the region in Participatory Appraisal. This is a way of engaging local people using lots of different techniques, such as focus groups, or fun activities which allow conversations to take place as you do something (one of the most enjoyable was going on a boat trip – a captive audience!). Most people enjoy being asked their views, probably because they feel valued, and most people are clear about what would be best for their health, wellbeing and happiness. Given the time, space and the right environment we all have the ability to be creative about solutions for ourselves and others.

Sharing views, then finding solutions and ways of changing how we work to provide the best results are what true engagement is about. Not just being asked what we want, and information being taken away to have something ‘done’ with it. Real engagement might be a longer route, but it is the way of truly empowering people to be part of the decision making process and ultimately supporting communities to take on responsibilities, using the strengths within those individuals and communities, to improve health and wellbeing.

All too often we are working in situations when we feel the need to be logical, be analytical, instead of being creative. We have both experienced the reaction from colleagues when telling them that we have been engaging with communities and spent time drawing images to symbolise a certain situation, but then when they saw how it added value to the words, or the description they began to understand what we were doing and why. So, we would encourage you to welcome creative ideas, whenever they are expressed. It is amazing to see what solutions can be found when you explore that seemingly wacky idea, and at the very least they will keep us entertained. After all, even if there is no obvious solution, a laugh on the way will help make us all feel better. Those of you reading this short piece who are lucky enough to find they can express their creativity in work should count themselves blessed. For those who aren’t, well, maybe it is about finding those little moments that provide an opportunity to inject a new insight or idea into the workplace when possible. And going out at lunchtime to smell the new mown grass and watch the clouds go by may help.

This is a developing area and we have included the couple of links below which may be of interest

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804629/

https://www.liv.ac.uk/media/livacuk/instituteofpsychology/research-groups/The_Arts_and_Public_Health_Research_Proposal_Final_shortened.pdf

Health and Social Care Integration and the development of the new hospital offer opportunities for being creative in finding solutions to new challenges and ways of working.

We began this blog by stating we were each going off on our respective holidays and whilst these will be different, we will both be making sure that we find every opportunity to be creative and come back to work refreshed.

Catherine Mackereth and Michele McCoy are Consultants in Public Health at NHS Dumfries and Galloway

Gender Equality is Everyones Business by Luis Pombo

What’s the issue with gender?

Gender can be an elusive concept but since it is so embedded in the fabric of our identities, and day to day life and culture, we perceive its nature to be as natural as the air we breathe. In other words the very nature of gender makes it almost impossible for us to think about it as what it really is; a code.

When we wake up in the morning, we do not usually think about gender, or how we are going to make our behaviour fit within the limits of the gender identities we have grown into, or how others expect this to be the case. Any alteration to the rules, any breaking of the code, will attract other people’s attention and sometimes their censure.

But what is gender?

Is it about what sex we are?…Identifying as a woman or a man? Being male or female? Being masculine or feminine? Behaving masculinely or femininely?…

Sex and gender are sometimes used interchangeably despite having different meanings; sex is about biology and gender is cultural.

A very useful gender definition is the one adopted by the World Health Organisation:

Gender refers to the array of socially constructed roles and relationships, personality traits, attitudes, behaviours, values, relative power and influence that society ascribes to the two sexes on a differential basis. […] Gender is an acquired identity that is learned, changes over time, and varies widely within and across cultures. Gender is relational and refers not simply to women or men but to the relationship between them.

 

Gender goes beyond identifying ourselves as men or women or being masculine or feminine; gender is a whole acquired identity and in the process of acquiring that identity we also acquire notions of power, influence, privilege, expectations and restrictions of what we can expect in life. We learn what is acceptable and unacceptable according to our acquired gender role and we also learn to accept these standards and not to challenge them due to their perceived naturalness.  In a way, it is a kind of code that we all generally share and agree to abide by; a code that cannot be challenged or changed straightforwardly and without consequences for the challenger.

To understand this we need to have a look at how we, humans, ‘get’ our gender.

“It’s a girl!”

As soon as we are born, or now with the help of scans even before then, a name is assigned to us, “appropriate” clothes are bought for us and our bedrooms are decorated according to what gender we are expected to grow into; images of footballs, Spiderman or Disney Princesses will feature in our lampshades, duvet covers and curtains, and toys will follow. A trip to any shop selling baby equipment, clothes or toys shows how entrenched such views are and how much is marketed in terms of learned gender norms.

As we grow, we see our parents and other people around us performing gender and the understanding that we get from those performances is reinforced by other similar consistent messages coming from the behaviour of other people, and from popular culture – songs, music videos, games, books, celebrities, films, cartoons, etc. –

After two years of a constant exposure to fairly consistent gender messages, we start internalising them and by the age of 3 we already know whether we are a boy or a girl. Moreover, by the age of 5 our ideas of gender stereotypes are well developed and by the age of 7 they are fully fixed.

So what?!

There would not be anything wrong with all this except that when we internalise our gender identities we also internalise other notions which will expand or limit our opportunities and expectations according to notions of relative power which, by the way, historically have been imbalanced and which informed a way of thinking and acting that resulted in inequalities some of them still happening these days.

For example:

• 2300 years ago, Aristotle thought that: “The male is by nature superior, and the female inferior, and the one rules and the other is ruled; this principle, of necessity, extends to all mankind.”
• Women were first allowed to inherit property in the UK only 133 years ago.
• Women were allowed to vote in the UK only 87 years ago; 39 years ago in Portugal; maybe this year women will be allowed to vote for the first time in the history of Saudi Arabia and there are no prospects of women being allowed to vote in Vatican City in the foreseeable future.  
• Out of 196 countries in the world today, only 17 have a woman president or prime minister.
• Out of 650 seats in the House of Commons, 191 are occupied by women. That’s 29%; compared with Rwanda 63.8% and Bolivia 53.1%.
• Women are portrayed in media and advertising as sexual objects which fit the male gaze; women’s bodies are objectified in everyday life.

• Children’s toys ………Dolls like Monster High are highly sexualised.

• It becomes natural for Young men to see pornographic images of women and to objectify them.
• Men feel pressure to be macho and not be emotional
• Men learn to direct emotions towards anger / Use of violence and link to masculinity is internalised / Power is constructed as a capacity to dominate and control
• Many expectations of masculinity are impossible to attain, six-packs, rich, decided, etc. 
• Men are in general at greater risk of suicide
• Men are subject to violence from other men if they don’t conform to the stereotype
• Poweris constructed as a capacity to dominate and control others.

• At least 85,000 women are raped on average each year in the UK.

• 72 million children around the world are not in school; girls are the majority.
• 759 million adults around the world cannot read or write; the majority are women.
• 25% of girls in relationships in the UK reported physical violence.
• 60,080 domestic abuse incidents were reported to the Police in Scotland in 2012/13; 45,916 (76%) were women abused by a man.
• 45% of women in Europe have suffered from men’s violence.
• In 2013, the gender pay gap in Europe is 2%. Women would need to work an extra 59 days in a year to match the amount earned by men.

• In the UK, men earn 17.5 % more than women on average per hour.

• Globally, 603 million women live in countries where domestic abuse is not yet considered a crime.
• Over 60 million girls worldwide are child brides, married before the age of 18.
• FGM (Female Genital Mutilation) is most commonly carried out when a girl is 5-8 years old but it can happen from infancy to the age of 15. More than 125 million girls and women alive today have been cut and at least 23,000 girls under 15 could be at riskof FGM in England and Wales.
• 1 billion women in the world will experience physical or sexual violence in their lifetime.
• Prostitution is still seen by some as “work” or as a “career” and some men (we are talking about millions here) feel entitled to buy sex.
• And this list could continue…!

Rewriting the Code

There is hope! … And everyone can make a difference, however ‘small’

We have to bear in mind that gender norms and parameters are not fixed and can be changed.

If we start looking at the ‘taken-for-granted’ reality of our everyday life with more inquisitive eyes and start spotting the gender rules we all follow we will be better prepared to start challenging and rewriting them.

A practical way of challenging these norms is by example; for instance, at home men could take responsibility for or share traditional ‘female’ tasks like doing the laundry, ironing, or cooking. At the same time, traditional ‘masculine’ tasks like mowing the lawn or doing home repairs could also be shared. These behaviours will be seen and adopted by the couple’s children and part of the norms will start being rewritten. 

Parents could buy gender neutral clothes and toys for their children and encourage gender neutral play; parents could also avoid encouraging boys to be strong and girls to be gentle as the stereotypes dictate. Comments like “Don’t kick the ball like a girl”, “Stop being such a wee girl”, “Stop crying, be a man” should be avoided.

We could also choose deliberate challenging behaviours in our professional worlds; e.g. a male colleague may offer to be in charge of the teas and coffees prior to a meeting or tidying up afterwards. What is more, people could deliberately look at what kind of language they use and favour gender neutral language like: ‘chair’ instead of ‘chairman’, ‘humankind’ instead of ‘mankind’, etc.

Developing our understanding of the restrictions imposed by gender norms and challenging the expectations associated with them can be the start of a process to rebalance the position of women and men in society, to develop a more equal and fairer society that can be enjoyed and built by both women and men equally for the benefit of all. 

Authors

Luis Pombo – Research and Information Officer, Domestic Abuse and Violence Against Women Partnership

With

Kerry Herriot – Development Officer, Domestic Abuse and Violence Against Women Partnership

Jo Kopela – Health and Wellbeing Specialist, DG Health and Wellbeing Team

Lynsey Fitzpatrick – Equality and Diversity Lead, NHS Dumfries and Galloway @lynseyfitzy

We would like to take this opportunity to warmly invite any NHS or Dumfries and Galloway Council staff to the second of our joint NHS/Council interactive events exploring the issue of gender equality. Through film, discussion, evidence, the influence of the media and the impact of privilege in society, we will continue to raise awareness and develop a shared understanding of how everyone can contribute towards promoting gender equality. This event is taking place on Monday 9^th November 2015 at 2pm at Garroch Training Centre, Dumfries. If you would be interested in coming along, please contact Lynsey Fitzpatrick on 01387 244030 or at lynsey.fitzpatrick@nhs.net