Hospital acquired infection, Covid, Coroners and the solstice

It is established that hospital acquired infection is bad.

This, the collective term for infections contracted during a patient’s time in hospital care; there have been other iterations of the term, for example, healthcare acquired or associated infection, in order to not place all the onus on hospitals, yet, when you analyse the situation, really, the worst ones tend to happen in hospital.

If you are at home, perhaps 90 years old, immobile, with a bad back or other disorder and a nurse or therapist brings Covid into you, that would I agree be healthcare acquired, yet, the ones we read about in the headlines, the ones that seem to do the greatest harm are those people contract during their time in hospital.

When our care workers become infected with Covid, is that also considered heathcare and social care associated?

There are several reasons for this situation, the most likely being the juxtaposition of lots of people (i.e. patients and staff) alongside those with a reduced ability to fight infection (patients).

It is a toxic cocktail.

This is one of the reasons I suspect most people will be reluctant to return to the old-fashioned GP waiting rooms of pre-Covid.

I have not heard much discussion about a reduction in the numbers of patients per ward and certainly in my experience I have found in previous winters six patients occupying spaces that are designed for four; presumably that will be considered in the planning.

Despite the highfalutin science involved in understanding the biochemical pathways of disease and immunity, the basics are as always, the same.

What is important is to wash your hands.

In the media this has been missed, lost in the rush to work out when and where people should use facemasks, the distance required to minimise infection, how to queue for B&Q.

The most recent announcement that all staff in GP surgeries will have to wear facemasks from tomorrow (15/6/2020) (Just as summer is upon us) is yet another distraction from the focus on washing the hands. (Oh, and no fans or air-conditioners either).

Ignaz would be turning in his grave; had he not spent the past 200 years spinning.

And so, your receptionist, as they battle to understand your message will be fiddling with a facemask so as to reduce the risk of them infecting someone, perhaps the person sitting next to them.

It is OK if you pop to Tesco; their till operators don’t spread germs.

We don’t know how this will operate – whether sense will prevail.

I popped into the office last week and found that with the introduction of generalised facemasks to care environments (including the back-offices) the numbers of staff had dropped; it was a ghost-town.

I didn’t mind wearing my mask although my breath became a little stale – fortunately, as I was wearing a mask, no one else could smell it.

It was interesting speaking with the tech staff (I had gone in as my laptop was playing-up) – I often struggle at the best of times with technical personnel who are often happier sitting in front of a screen – take away facial expression, add 2 meters separation and the whole encounter was odd.

I know we are all contending with new insights into how to get on with others, how to shop, communicate, chat and laugh.

It will surely find a balance; perhaps when the government becomes distracted by something else and leaves us alone.

Returning hospital acquire infection (HAI) if you like, I have been reflecting on the patients I have met (remotely, of course) who have caught Covid during their time on a hospital ward.

Those who were admitted around about the March-April time were, I suspect the most vulnerable; this was when the supply of PPE was a joke and no one truly understood the risks.

I have subsequently written death certificates for older people who fell at home, fractured their hips, recovered, only to contract Covid in rehabilitation and die.

Ironically, when we as doctors report deaths to the coroner – raising concerns of so called un-natural deaths, Covid is not considered; only had the person died as a complication of the surgery would there be an inquest.

I am sure processes will change and in time this will be considered along the lines of MRSA as a cause of death – this now a condition that requires multiple lines of investigation and analysis to determine the how and why of what has happened; for now, as the pandemic grumbles on, Covid caught in hospital is considered just another tragedy.

I am unsure why I have written this;

My blogs are usually provoked by a sense of frustration or angst at current systems or practice.

There is not much we can do about where we are.

The government screwed-up and is now trying to put in place all the measures that should have happened two months ago.

Who to blame? You can’t really blame the government as they had just been voted-in again; do you blame Corbyn for being unelectable? Do you blame the Chinese government or marker traders? Globalisation?

Or perhaps, accepting the reality of our world.

The fragility that comes with our interconnectedness and interdependence.

Ignaz might not be happy, but Donne would be chuffed.

For many, this has been a springtime of nature – listening to birdsong, watching wildlife recover from the overwhelming presence of traffic; it has been a time to learn and watch our children grow, to slow down and reflect on the lengthening days (I feel we are on countdown until the 20th.)

It was interesting this morning to hear the first headline of the news – a man has been arrested for peeing on a memorial to Keith Palmer.

Bringing the focus to one man seemed odd amidst the riots; the injustice – Grenfell happened three years ago.

It is perhaps my aspiration to make sense that is the paradox.