A friend of mine who was a teacher, used to complain bitterly that there were only two professions where everyone thought they knew better than the professional; the police, where you always had some Jessica Fletcher eejit running round, and teaching, where everyone thought they knew how to teach because they had been to school. Now we have a third to add to that; healthcare. The Herald reported on Monday that a new research project called the Scottish Infection Research Network (SIRN)had been launched. Their mission is to find out the source of hospital infections and to search for new treatments. So far, so good. The bit where I groaned out loud 'Haw naw', was when I read that there will be behavioural scientists and psychologists on the team. They will try to work out what prevents staff from washing their hands after every patient contact. Then they will try to come up with programmes to change staff behaviour,. If I know anything about these kind of programmes, it will probably involve a conference with lots of flip charts, brain storming diagrams, clicky pens and an eighty page handout. Can I save you a lot of bother, guys? Just ask the staff and they'll tell you what's up. In fact they have been trying to tell you what's up for the past few years, but nobody listens to them.
Let's get one thing out of the way. There is such a thing as a bad medic, who can't be bothered doing the right thing. If staff are not washing their hands, they should be disciplined, not 'understood'. A hospital is the most infectious place there is and there is no excuse for staff who behave like this. But the real problems of infection control are more complicated than that.
1.
Under staffing. You are a hospital cleaner. You have six rooms to clean, and not enough time to do it in. You can clean three rooms properly and not clean the other three at all. Or you can clean six rooms with a lick and polish. Which are you going to do?
2. You are a ward sister. The rooms in your ward are not being cleaned properly. You complain to the manager of the private cleaning company to whom the cleaning services have been contracted out to. He tells you that the cleaners are working to contract, and their contract has different expectations from yours.
3. You are the manager of the cleaning services. You have been given a certain amount of money to purchase bleach for the month. It is not enough for the whole month and you have been refused any more money, because the hospital is over budget. So you tell the cleaners to water down the bleach.
4. You are the named nurse for a certain patient. At visiting time, you have been given the job of standing by the Hibiscrub to get visitors to wash their hands as they come in. Some of the visitors are relatives of your patient and they need to speak you urgently. There is noone to cover for you. So you hope that the visitors coming in, will follow instructions and you go to deal with the relatives.
5. You are a visitor. You need the loo, so you go to the visitor's loo in the foyer. The loo has an automated flush which you trigger by waving your hand in front of the 'magic button'. The handbasin has a similar button. You take a paper handtowel, dry your hands and attempt to put it in the pedal bin. Only the pedal doesn't work. So you have to lift the bin lid manually to put the towel waste in, as every other visitor to the hospital has done before you, and you carry the germs through all the manually operated doors and lift buttons up to the ward that your patient is in. (I haven't made this one up; this is from my experience and the bin is still there, broken. Gauny do something about it?)
Guys, I promise you, at the end of your research it'll be a psychiatrist that you'll need, not a psychologist..
