Tasmanian Times

The individual has always had to struggle to keep from being overwhelmed by the tribe. If you try it, you will be lonely often, and sometimes frightened. No price is too high for the privilege of owning yourself. ~ Friedrich Nietzsche

The individual has always had to struggle to keep from being overwhelmed by the tribe. If you try it, you will be lonely often, and sometimes frightened. No price is too high for the privilege of owning yourself. ~ Friedrich Nietzsche

Economy

When hospitals make patients sick …

Long ago ‒ 150 years or more ‒ it was noticed that pregnant women whose children were delivered by doctors were much more likely to die of childbed fever than those tended by midwives.

The reason was that doctors treated more patients and often delivered babies straight after dissecting cadavers in anatomy sessions, without first washing their hands. The doctors, then, were above embarrassment: they simply refused to accept the findings.

And so the deaths, of thousands upon thousands of women, continued. One famous obstetrician said: “Doctors are gentlemen, and gentlemen’s hands are clean”.

Two of Henry VIII’s wives, Jane Seymour and Catherine Parr, died of it. So did his mother. So did Mrs Beeton, who wrote the cookbook. Lucrezia Borgia. Mary Shelley, the poet’s wife and author of Frankenstein. Robespierre’s mother. Julius Caesar’s daughter.

Many bacteria, such as streptococci, are potentially involved in puerperal fever. But many infections can be transmitted by unwashed hands. With the advent of hygiene in hospitals and later of antibiotics, few women now die of the disease. But this problem has been replaced by others far more intractable ‒ including golden staph.

Staphylococcus aureus is a ubiquitous organism that most of us carry on our skin without even knowing. If it stays there, it’s not likely to cause many problems beyond a pimple or a boil.

But if it enters the bloodstream, it can kill us. According to the evidence, between 20% and 35% of all people with S. aureus bloodstream infection die.

Tasmania has a problem with this disease. Our rate of hospital-associated S. aureus bacteraemia (SAB) in 2015-16 was the second-highest in the country at 0.89 cases for each 10,000 days of patient care, narrowly behind Western Australia. And it’s more of a problem in the north than in the south.

The rates at which doctors, nurses and other staff wash their hands depends on the culture of the hospital. At the Royal Hobart Hospital some determined infectious diseases physicians and nurses have instilled in that hospital such a culture.

According to national figures just released, the rate at the RHH is well below the average of its peer-group hospitals elsewhere in Australia.

At the Launceston General Hospital, though, the situation appears to be different. Its rates were well above the average, and have been for several years.

We need to get this into context. Throughout Tasmania there were only 35 confirmed cases of hospital-associated golden staph bacteraemia among of almost 120,000 inpatients. And surveillance of other hospital-acquired infections by state authorities show the situation is reversed between the two hospitals ‒ the LGH lower, the RHH higher. And, with low numbers, the figures can be volatile.

But we can ‒ and must ‒ do a lot better. One way would be to reduce overcrowding in our two main hospitals. But that would mean spending more money, something the present government is unwilling to do.

Hand-washing, particularly among doctors, could be a lot better. Doctors in the state’s public hospitals are fully compliant with hand-washing only 67% of the time. Student doctors are worse, with only 61% compliance. Nurses and midwives do a lot better, at 83%. On these figures, even clerical staff are more compliant than the doctors.

There is no need for panic, or for anyone to think our hospitals are unduly dangerous places. They aren’t. Hand-washing and infection rates have improved massively over the decades.

But we need to improve. Doctors, however hard-pressed they may be, need to take another look at hand hygiene. Their patients’ lives may depend on it.

Thirty-five cases of S. aureus bloodstream infection a year may not seem like much. But if the usual death rate of 20% to 35% applies, that means between five and eight people die unnecessary deaths every year caused by their hospital care.

And even that doesn’t count the number of people made sick by this disease, or who are made ill or who die from other preventable hospital infections.

*Martyn Goddard is a Hobart-based policy analyst specialising in health issues. He is a former journalist and ABC documentary maker who became involved in health policy during the AIDS crisis in Sydney. Since then he has been a member of the main Commonwealth advisory bodies on AIDS and hepatitis and was the first consumer member of the committee that lists drugs on the PBS. He was also health policy officer for the Australian Consumers’ Association. For the past decade he has concentrated on examining and explaining Tasmania’s health issues. His extensive articles on Tasmanian Times are HERE .

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13 Comments

13 Comments

  1. Simon Warriner

    January 25, 2017 at 3:06 pm

    re 12, Thanks Lynne. Rather scary seeing how predictable people are though!

  2. Lynne Newington

    January 25, 2017 at 10:15 am

    #6 Simon. Been interstate and still waiting for a response in relation to how the statistics on the percentage of drs came about, meantime this was interesting……
    http://www.abc.net.au/radionational/programs/healthreport/how-to-get-doctors-to-wash-their-hands/6885950#transcript

  3. Annie

    January 22, 2017 at 12:51 pm

    all hospitals and health care facilities in Australia need to meet the 10 key NSQHS Standards for accreditation -see the Australian Commission on Safety and Quality in Health Care.

    Preventing and reducing health care infections is a key standard, consumer participation is another.

    People may like to look at the Charter of Health Care Rights as well.

    Many of the landmark reviews in Australia as well as in the UK have also highlighted the need for system reform and cultural change, to have compulsory audits that are followed up etc and a change to a culture of open disclosure so that health care safety events are prevented or followed up.

    Having adequate levels of staff and specialist staff such as midwives is very important.

    Of course, good health is often dependent upon good public health policies and access to decent affordable housing, education, the right to income support and environmental protection not to mention social inclusion etc

  4. Birdz

    January 20, 2017 at 8:23 pm

    I told my doctor I wash my hands every 10 minutes. And she didn’t like it! No wonder we are all sick.

    She said I am oppressive repulsive. She gave me pills to calm me down, but I wasn’t even uptight, not until I saw her anyway.

    So now I have read this I will wash my hands every 5 minutes.

    Don’t let those doctors get into your head.

  5. Lynne Newington

    January 16, 2017 at 12:09 am

    Absolutely Simon, if they were caught on surveilance they could’ve been named and not just a statisic and reported.
    I’m not into skimming the surface whether I’m believed or not.
    Don’t worry, I’ll contact the relevant body and find out for myself and post it as a reference then we’ll all know, or those who care enough about the facts. .

  6. Leonard Colquhoun

    January 15, 2017 at 11:04 pm

  7. Leveller

    January 15, 2017 at 10:27 pm

    An example of recent open reporting in NSW “NSW hospital blunders have cost state taxpayers more than $262m in damages”

    http://www.dailytelegraph.com.au/news/nsw/nsw-hospital-blunders-have-cost-state-taxpayers-more-than-262m-in-damages/news-story/790676a5118531b4363af86695be0260

  8. Simon Warriner

    January 15, 2017 at 10:02 pm

    re #2, #5, oh for god’s sake, really? What concerns me and doubtless many others is that those stats are what they are, regardless of whether the offenders know they are being watched or not.

    These are health professionals. They should bloody well know they need to wash their hands, and if they don’t then with absolute clarity they are not behaving in a professional manner, and should be well and truly chipped for it. They should expect to be watched and monitored, and it is clearly needed. People can suffer needlessly and even DIE when they don’t observe the most basic of professional rules. What other rules are getting broken and at what cost is the question that goes begging here.

    I say all that as someone whose has a close relative who has gone through several years of pain, depression, humiliation and financial purgatory because one of this states medical profession failed to perform in a competent manner. I also have a neighbour in similar circumstances for the same reason, and know of several other cases.

    If a little observant supervision prevents only one more of those stuff ups it is far more than worth the cost! The precious feelings of the guilty are the least important issue here. They can just lift their game. Meanwhile my relative cannot lift a bloody thing and my neighbour is so depressed she can barely lift herself from her chair most days.

  9. Lynne Newington

    January 15, 2017 at 6:24 pm

    @2 reply
    You mean to say that infection surveillance body that statistics are made up of is spying on all staff without them being aware of it?

  10. Brian P.Khan

    January 15, 2017 at 4:47 pm

    Concern over Launceston General Hospital down grading of its teaching and accreditation status , will be a major issue at the Legislative Council elections in May for the electorate of Launceston.

    Once John Kerwin,s position of C.E.O was made untenable , it was evident the Hobart powers in D.H.H.S were jealous of his achievements.

    Former Health Minister Lara Giddings can attest when the Indians in Launceston become proactive a swing in support to independents and other parties can take place.

    The Launceston City Council is mute over the loss of accreditation and teaching status.?

    Minister Fergusson needs to embrace Launceston Medical professionals who achieved accreditation , recent appointments and management from the Hobart capital are not listening to our Launceston specialists who have operated under the ” private patient plan ” with great success.
    Martyn Goddard would be aware that under the state service act those employed by the Government can not register a complaint unless they go to their D.H.H.S superior first , however as a former chairman of the Northern Regional Health Board this can be over come by a politician in the lower or upper house approaching the specialists and doctors direct.

  11. Leveller

    January 15, 2017 at 3:13 pm

    In every other State and Territory of Australia hospital’s are required to report on negligence, preventable death’s etc etc. But not in Tasmania, try putting in a “Right to Information Act 2009” request. The $1.65 Billion dollar Department of Health and Human Services denies such request’s which in both the Public’s and the Communities best interest’s of Open Disclosure, Probity, Transparency and Accountability should all be readily published each month. With the LGH recently having it’s teaching and accreditation status down-graded just speak’s for it-self. Considering we pay the Secretary of the DHHS more than the Prime Minister of Australia is paid, also speak’s for it-self. It is widely known for those health professional’s that Tasmania has the worst public health system in Australia. For just one example, how many Tasmanian’s have dies while on a waiting list year in year out?.

  12. Martyn Goddard

    January 15, 2017 at 11:34 am

    On comment 1: Those hand-washing statistics come from the state government’s Healthcare Associated Infection Surveillance Annual Report for 2015-16. These are the results of regular expert audits. The national figures come from the Australian Institute of Health and Welfare.

  13. Lynne Newington

    January 15, 2017 at 10:11 am

    With due respect I believe it’s only fair Mr Goddard show where he obtains his statistics re the washing of hands, it’s pretty damning and would be difficult to prove in my opinion.

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