Huge rise in superbugs deaths (UK Socialised Medicine Alert!)

The Evening Standard ^ | 13 Dec 2002 | Colin Adamson

[UKCajun]

The number of deaths caused by hospital superbugs has tripled in the past decade with London worst hit, new figures show today.

The first major study of its kind into the most common infection, MRSA, comes two months after the Evening Standard alerted Londoners to the growing danger of superbugs, which thrive on dirty wards and poor staff hygiene.

A Standard investigation revealed that more than 100 patients a month in the capital are being struck down by the drug-resistant MRSA infection which, while not always fatal, can kill in hours. Now the situation is being officially recognised with a Public Health Laboratory Service study which says London is the highest risk area in the country. About 5,000 patients a year die due to infections acquired in hospital. significant number of these are a group known as staphylococcal infections which are normally treated with antibiotics. But MRSAmethicillin-resistant staphylococcus aureus - also known as Super Staph - resists the standard antibiotic, methicillin.

The new figures show that between 1993 and 1998 a total of 6,723 death certificates stated that staphylococcol infection contributed to death. MRSA was specifically blamed on 1,387 certificates. The proportion of certificates mentioning MRSA shot up from 7.5 per cent in 1993 to 25 per cent in 1998.

Dr Natasha Crowcroft, the public health consultant who carried out the research, warned: "It is shocking that in one of the strongest economies in the world, people are dying of an infection that can be prevented by staff washing their hands properly. If hundreds of people were dying because of mistakes in surgery there would be a public outcry, but this is a preventable problem."

She said hospitals should give high priority to infection control and she pointed out that nearly all other European countries have a much better record than the UK.

"But it is not fair to blame individual doctors and nurses working in difficult, busy environments when it is the whole system that needs improving," she said.

[ukbird]

OMG is right. I've moved to the UK following marriage to my husband who is a brit. The healthcare system is appalling over here. The NHS beyond visting the GP is a nightmare. And even the GPs don't always get it right. I've had to go private to get the care I need. It's worth the money.

[Winniesboy]

"As for the UK, new hospital building by and large ceased after 1948 when the system was socialized."

Er...not only is this not true, it so happens that the UK is in the middle of the biggest hospital building programme in its history, with over 70 major hospital projects in progress or planned. It's also a wee bit inconvenient, perhaps, for those who bandy about the 'socialized medicine' tag in such a carefree way that most of these new hospitals are being capitalised through the PFI scheme, which is a partnership of private and public capital.

I do get a little weary of the universal dismissive caricature of the UK National Health Service typified by most of these posts. Yes, there are major problems in the NHS, as there are in the health care provision of most countries - not excluding, dare I say it, the USA. But I can only speak from personal experience as a 'customer' of the NHS for 55 years, during which it has seen me through a pretty impressive spectrum of problems, both acute and chronic, that I have never encountered anything but the highest standards of skill and care. And never once a dirty ward.

As for the mutation of bacteria to antibiotic-resistant forms, I fear this is the result of decades of overuse and abuse of antibiotics worldwide, and has little to do with the shortcomings or otherwise of any national health service.

[UKCajun]

Have you ever seen the inside of a hospital here? If yes, what was your impression..........

[scouse]

I do get a little weary of the universal dismissive caricature of the UK National Health Service typified by most of these posts.

That's just a bit of flag-waving jingoism on your part. I left the UK in 1962, but my two sisters still live over there and they keep me informed what's happening. The BBC a few weeks ago had a story concerning the number of medical personnel from third world countries who themselves are infected with contagious diseases, but are still being allowed to work in UK hospitals.

[UKCajun]

Have a look at the casualty ward East Surrey hospital (Epsom) sometime! Or go to the Royal Surrey hospital in Guildford! Yick!

What kind of healthcare system ferries a kid about for 12 hours in an ambulance from hospital to hospital because there is no CT machine available and/or operator to work it. The kid died.

Or what about the recent case of the elderly woman left waiting on a hospital gurney in the hallways of a hospital for 3 days because there was no room available for her. Or the old man (week or 2 ago) who was plagued with excrutiating leg pain for years after an operation. He was dismissed for 20-30 years. Someone in the NHS finally decided it might be a good idea to Xray the leg. Guess what they found--metal surgical equipment left in him.

And this is just the tip of the iceberg. I could cite my own experiences too.

I'm a New Orleanian and am accustomed to hospitals like Ochsner, Turo, Baptist, Tulane Medical Center, etc. These are REAL hospitals. Even Charity hospital in New Orleans is decades ahead of what I have seen in UK hospitals.


Sorry, can't agree with you on this one.

[Riflema]

Surely you are kidding. I left the UK thirteen years ago and had the misfortune to have a heart attack in the UK while visiting this summer.

This was in Tunbridge Wells, Kent, not some inner city hellhole:

Yes, I got prompt attention. The attention consisted of getting morphine and some blood thinning / pressure reduction agents.

The on-call doctor told me this was not a heart attack, but rather something else, but definitely caused by smoking. He was essentially useless and rude to boot.

Later during my heart attack I saw a consultant cardiologist who carried his own sonogram equipment and confirmed the MI in progress. He also told me how I could expect to wait 30 days for an Angiogram under the NHS (socialized) system since they, er, didn't have too many cath labs to work with. He told me (in hushed tones) to get seen privately if I wanted to get meaningful treatment.

The hospital *did* have blood stains on most of the corridor and elevator walls. Also used latex gloves left willy- nilly on the floor of elevators etc. My wife thought she had travelled back to the "middle ages".

So pray tell - how does a system that can't afford cath labs treat heart attacks such as mine? Answer - it doesn't bother.

[ukbird]

Ironically, yes... just this past weekend. My husband had severe lower abdomen pains last Friday and his GP told him to go to the A&E because it might be appendicitis. After being examined, our local hospital said, yes, it was probably appendicits, but they don't operate in that facility, so he had to go two towns over to another hospital.

He got to the second hospital at 11am and laid on a gurney in the hallway with an IV for 24 hours until they found him a bed. While in A&E, blood work came back irregular and two doctors examined him, saying he would probably have to have his appendics removed, but nothing could progress because the bed still wasn't available. He finally got one Sat evening. After being wait-listed another 24 hours for surgery, the doctor in his ward decided on Sunday that he wasn't convinced it was appendicitis, cancelled the surgery and kept him another 24 hours for observation, during which they gave my husband antibiotics and pain killers. Monday came, blood work was normal again and the doctor said he didn't think it was appendicitis. He was discharged Monday evening. Maybe we should have gotten the cleaning lady's opinion???

Meanwhile, my husband's lower ab is still tender, although not as bad as it was originally.

As for the state of the hospital... 6 beds to a room, relatively clean, lots of unused furniture and equipment sitting about in the hallways. Let's just say it didn't feel state of the art. I definitely felt like I stepped back in time. It's a bit distressing, and I hope to god nothing major happens to me while we are living here. I could just be in that adjustment phase still, as we only settled here 6 months ago. Although I hate to think that I might become used to the kind of care my husband received.

On the flip side, my husband did have laproscopic knee surgery earlier in the summer through private healthcare and that experience was very efficient. At every stage we felt completely informed and everything happened in a timely manner.

[Prodigal Son]

It is likly that the antibodic hand washing that does go on enhances the resistance of the bacteria. If it's resistant to methicillin what makes you think hand washing will kill it. I think it's an easy scape goat for something they don't understand.

Exactly. You could have a hospital that was to the highest standard of hygiene and still have MRSA. Staph bacteria lives on you at this very moment. Every time people walk in and out of the hospital, they are carrying this bacteria around with them. The higher standards of hygiene in hospitals and the liberal use of antibiotics is what created the Super Staph in the first place. If you have it living on your skin, in your nose whatever and then you get sick and go in the hospital for an operation, there is basically no way the hospital can cleanse you of it. While you're sick or recovering from your operation, your immune system is going to be depressed and you are much likelier to come down with one of these infections.

The bacteria also spread from hospital to hospital with patient transfers. We've created these super bacteria and now we can't get rid of them. I understand the Evening Standard wants to have a nice juicy story and people here like to beat up on social medicine (I really like beating up on social medicine myself) but this isn't really a social medicine issue. These Super Staph bacteria will become more of a problem in the US as well as time goes by...

[Prodigal Son]

Maybe we should have gotten the cleaning lady's opinion???

Appendicitus is one of the most difficult surgical diagnoses to make. I commiserate with your husband's suffering surrounding the incident- but seriously, it is a difficult diagnosis.

[cosine]

There are a number of web sites that do this. The Fraser Institute in Vancouver documents the mess that is Canadian care at http://www.fraserinstitute.ca/health/index.asp?snav=he. The National Center for Policy Analysis has a whole segment of its constantly updated web page devoted to health care abroad http://www.ncpa.org/pi/health/. For a complete description of what really goes on abroad take a look at John Goodman and David Herrick's Twenty Myths About Single-Payer Health Insurance, a PDF file at http://www.debate-central.org/topics/2002/book2.pdf. Then there's Cato Institute, the Heritage Foundation, CAHI, Galen, and the Heartland Institute which publishes Health Care Reform News and has the PolicyBot collection of work from around the U.S.

[friendly]

The UK is in the middle of the biggest hospital building programme in its history, with over 70 major hospital projects in progress or planned.

I stand corrected if this is true that the UK's hospitals are all ultra-modern. Is this really true however? How come there is such a radical divergence of observations as to the physical palnt of what people witness? Some on this thread say you are not being truthful. What is the real story?

[Timesink]

OMG is right. I've moved to the UK following marriage to my husband who is a brit. The healthcare system is appalling over here. The NHS beyond visting the GP is a nightmare. And even the GPs don't always get it right. I've had to go private to get the care I need. It's worth the money.

At least you're allowed to. Under HitleryCare both the patient and the doctor would have been fined (big BIG fines, not just something like $50) and/or sentenced to long jail terms for daring to go against the Queen. Thank God our Queen has been demoted to Dame. (And not the good kind of Dame, either.)

[Prodigal Son]

I stand corrected if this is true that the UK's hospitals are all ultra-modern.

Hmmm. This is a a bit disengenuous. I don't think ukbird said all the hospitals here are now ultra-modern. He (she) said:

The UK is in the middle of the biggest hospital building programme in its history, with over 70 major hospital projects in progress or planned.

To me, this doesn't mean they tear down all the old hospitals, it says to me they are building or planning to build 70 new ones. This is a fairly ambitious project it seems to me, but even as small as the UK might seem to many Americans, 70 hospitals could fall into the UK and get lost and nobody in London would ever know what happened to them.

Here where I live in Scotland, we have a fairly new hospital. It was opened in 1988. I think you'd find a varying lot if you roamed across the UK- old hospitals and new.

One thing that happens with eyewitness reports... Let's say someone goes to the hospital and finds the floor dirty. Does this mean all the hospitals in the country are this way? No, of course not. I think papers like the Evening Standard and most of the citizens of London are very often guilty of forgetting that there is a whole big country out there beyond their city's borders and it isn't altogether comparable with London itself. Had the article's author toured Scotland's minor cities and towns he would have found hospitals that flew right in the face of the assertion he was making.

Take it for what it's worth. Here's a hospital in Pt Talbot, for example, that's being constructed right now. There is a programme here called PFI or Private Finance Iniative where the gov't is trying to move toward private sector funding of new hospitals. Here is an example of this (exerpts): Looking up the Hospital Front:

UNDER a UK Government initiative, new hospitals are being built and then operated for decades in partnership with private sector companies. AMEC is a leading player in the consortiums which are building and operating these new hospitals - recently completing Britain’s first and also winning the deal to build and run the latest and largest PFI hospital project in London . . .

...Built in the grounds of one of the old hospitals it replaces - which remained fully operational throughout construction - the £87 million, 444-bed hospital was financed, designed and constructed for Carlisle Hospitals NHS Trust in just 122 weeks by Health Management Carlisle (HMC), a consortium of AMEC and Building and Property Group...

...Meanwhile, a consortium that includes AMEC has won a £225 million deal to build and operate a magnificent new hospital in the heart of London. University College London Hospitals NHS Trust and private sector consortium Health Management UCLH plc, have finalised agreements for the design, financing, construction and operation of the huge project...

...When open, the state-of-the-art 669-bed facility will bring together all the NHS acute care facilities that are currently provided by The University College Hospital, The Middlesex Hospital, The Elizabeth Garrett Anderson Hospital and the Hospital for Tropical Diseases...

But the picture isn't quite as rosy as that. When you factor in trade unions you start to have complications.

Strike threat over private sector plan- source- BBC September 2001 (exerpts):

Union leaders are threatening strike action if the government's plans for public-private partnerships lead to worse conditions for workers...

The GMB released figures suggesting 24,000 hospital construction jobs could go as a result of lost investment due to PFI.

The union worked out that the £3bn it believes private companies will make out of PFI could have paid for 30 new hospitals, creating 75,000 posts for hospital staff besides the 24,000 jobs for construction workers.

It has emerged that three private finance hospital pilot schemes agreed in June have been put on hold.

So you see, new hospitals are being built but at the end of the day, a hospital is just a building. The UK is still facing shortages of doctors and key equipment. Concerns from Labor Unions, the huge cumbersome bureaucracy of the NHS, abuse of the "free" health system by citizens, doctor shortages, equipment shortages are all problems that make social medicine a substandard system. It's a much bigger, much more complicated problem...

[Prodigal Son]

Correction to above post:

I don't think ukbird said all the hospitals here are now ultra-modern.

Should read: I don't think Winniesboy said...

I got confused for a second there. Sorry...

[Winniesboy]

This is by now a pretty ancient thread, but I've only just caught up with your post. You've asked me a direct question, and do, of course, deserve the courtesy of a reply - my apologies that it's so belated.

In pointing out the current hospital building programme (which is, btw, exhaustively documented on UK government Dept of Health websites), I didn't mean to imply that ALL UK hospitals were as a consequence modern - far from it. There's an enormous diversity of old and new, and will be for years to come. But the essential point on the capital programme is that the picture is fluid and dynamic, not static as others on the thread implied. This point was well made by a later post from Prodigal Son. Even before the current programme, new hospitals were being built. My own nearest general hospital, for instance, which is in Exeter, has been completely rebuilt twice since the 1960s.

On the broader question of standards in the NHS, I simply stated my happy personal experience, without seeking to generalise from that experience. I do, of course, know that the experience of others has been very different, just as I know others who have been as fortunate as I have. I did acknowledge that there are huge problems in the NHS (many of which are currently being addressed, with varying degreees of success).

I'm wary of making sweeping generalisations, based on personal observation which is necessarily limited, about a very large organisation: and I'm consequently also wary of such generalisations made by others, including some on this thread.

The NHS is so large (I believe that, depending on how you measure it, it's the world's third or fourth largest employer) that even within a single hospital, personal experience will vary greatly. For instance, UKCajun cited the East Surrey Hospital in his/her litany of disgrace. Well, as it happens, I do know that hospital reasonably well. I have been a frequent visitor there to my elderly mother-in-law, who was at different times treated for three separate but serious problems, one surgical, one medical, and one psychiatric. On each occasion the care and outcome were excellent. But I wouldn't dream of claiming from this that the East Surrey Hospital is an unblemished institution - quite clearly, from the experience of UKCajun and others, it isn't. A similar point was, again, well made by Prodigal Son.

If I am to be tempted to generalise, I make, diffidently, the following, not particularly original conjecture:


In any very large organisation (and no-one seriously denies that the NHS is far TOO large) there is likely to be a mixture of the good and the bad;

Political, media and public scrutiny will quite properly concentrate on excoriating the bad rather than discovering and lauding the good;

A public perception therefore becomes established, both at home and abroad, that the bad typifies the whole, rather than that it is part of a much more complex and variable reality.

(Apologies, by the way, to any who are irritated by my use of UK spelling conventions!)

[friendly]

Good post. This is what we will have if the crooked trial lawyers and democrats (a redundency) ever complete their obvious plan to destroy the Greatest Health Care System on Earth.

[mdmathis6]

The surfactants in the soaps do most of the killing, though I fear I agree with you regarding the anti-biotics being put into soaps. Regular hand scrubbing with a good all purpose soap(not reusable bar soap), will kill most live bacteria due to the disruptions in their cell membranes caused by the surfactant action of the soap.

How do I know this? I'm an RN in an American ICU.

I doubt that even the most anti-biotic resistant bug(they tend to be less hardy out side of the hospital enviroments than their less anti-biotic resistant cousins) will ever become resistant to a good soap scrubbing and clean water rinsing. Fresh bar soap is good for cleansing out septic wounds as the continued control of bacterial counts is one of the main keys to effective wound healing.

[AnAmericanMother]

Fresh bar soap is good for cleansing out septic wounds as the continued control of bacterial counts is one of the main keys to effective wound healing.

Amen and amen!

A grizzled old carpenter who helped build our house was the de facto first aid man for the crew. I handed him things and listened as he worked. He told me his SOP was to grab warm water and soap and scrub the heck out of any wound received on the job, and deliver 'em to the hospital still all sudsed up. Said he never lost a patient (g).

It seemed sensible to me and I have followed his prescription with my family with good results - no infections or swelling and good clean healing. My son is "all boy" and fairly accident prone, so he presents frequently with cuts, abrasions, etc. The few times I have had to haul him in to the pediatrician to get stitched up, our first aid wound care has met with Doc's entire approval. (We deliver 'em clean and decent!)

The only time we have had to resort to antibiotics is when a cat bit him in the hand (he tried to break up a three-way cat-and-dog rumble without resort to a beach towel or pail of water) and he didn't TELL me about it until red streaks were running up his arm . . . on the usual principle of hoping nobody would find out about it . . . (sigh . . . little boys!)

[mdmathis6]

ouch...as the father of 2 girls and 2 boys...I know what you mean!