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Scottish Parliament Speech: Clostridium Difficile-associated Disease (September 2008)

See this speech in context on They Work For You.

We meet in the light of the personal tragedies at the Vale of Leven, but many of us have our own experience of the problem and its environment. I spend a lot of time as carer to two 90-year-olds. My father has prostate problems, which mean regular hospital visits. Forty years ago, as a postgraduate student, I was the first archivist of Edinburgh royal infirmary, and found out that before the age of Lord Lister and antisepsis, patients often did not expect to leave hospital. Hospital-acquired infections are nothing new.

Are we reverting to the pre-Listerian time? Comparisons with Germany suggest that we have 10 times the occurrence of hospital-acquired infections, but why? Besides resistance to antibiotics, we have perhaps greater environmental problems, such as old buildings. We use inappropriate floor coverings, for example carpets instead of tiles or linoleum - I declare an interest as an MSP for the Kirkcaldy area - which is seen to have an antibiotic effect. I have never seen a carpet in a German hospital. Hospital notes, making their progress round the wards, can appear rather toxic, since they are grubby and, in the case of elderly patients, often date from a long time back.

There are social factors. Besides our alcohol problem, we have three times the German rate of drug addiction. Accident and emergency at Borders general hospital can be a scary place for the staff, let alone the patients. Can people from a chaotic background be expected to observe clinical rules? Inevitably, the problems will increase in areas that have profound social difficulties. There has been a lack of investment in the Vale of Leven, but even favourable developments, such as the replacement of a hospital or of facilities in a hospital, can have unfavourable effects. How many of us have been in a hospital that seems like a building site, where everything is in a temporary state, making one wonder whether everything is being kept up to the necessary standard?

Three and a half years ago, I was constantly in the Middlesex hospital in London. The condition of the hospital was poor because a new building - the new University College London hospital - was only weeks from opening. However, the new building could not affect the patient at whose bedside I waited, as she was in the last stages of cancer. She was tended by the Middlesex staff clinically - in the true Latin sense of the word - and with love. However, it was a hospital in its last weeks, and the sources of possible infection - ill-cleaned corridors and public toilets, and the absence of hand wipes and of facilities for adequate hand washing - were all too obvious. Hospital improvement is good, but it always leaves a vulnerable interval.

It is important that we establish the primacy of hygiene. That means keeping all infrastructural support in-house. In NHS Wales, which has a good record in combating HAI, all cleaning is done in-house, and the guiding principle is hygiene. Before that, many contractors had left it to cleaners to wash their uniforms at home and wear them when travelling to work, increasing the risk of infection transmission. How much of that still goes on?

The issue also involves the wider public. Earlier this year, I got stick from the Daily Record and The Sun for objecting to teenagers planting their shoes on bus seats. All the buses on which I travel pass the Borders general hospital, and medical staff use those seats. There is a major contamination possibility there - just consider where those shoes have been. That represents the sort of casually indifferent behaviour I have almost never seen among young people in Tübingen, which is a major hospital centre in Germany. I think that there is a reason for that, which might also be a way forward. Most German teenagers spend a year doing social service, often as a hospital orderly, a worker with the elderly or a paramedic. Such social service is far more demanding than any form of military service and, as anyone who has worked with youngsters here who have done first-aid training will know, that experience, particularly over a year, does not just change lives, but saves them.

 
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