Medicine is a serious business and when you hear harrowing stories of sepsis, how do you respond? Certainly, many of the accounts you will read, or perhaps you have witnessed through personal exposure to family or friends who have had some form of sepsis, can be very disturbing. Survivor accounts can be as equally distressing to all those allied to the caring professions and for all of us beg the question, what more can we do to improve diagnosis? In Wales, as in other parts of the UK early recognition and detection of sepsis is key to early interventions. The … Read the rest
I had a call this morning from one of our very talented staff nurses who wanted to check out carefully her understanding of when it is appropriate to send a sample for urine in a catheterised patient. She explained that she had an elderly patient and the patients daughter had suggested that the catheter urine should be sent to our laboratory on a weekly basis to check for infection.
The patient did not have any symptoms or signs to suggest urinary infection and had therefore advised that sampling was inappropriate but was facing a series of questions and could I … Read the rest
In a previous article I promised that I would share a measure of the improvement we are seeing in the clinical information on our request forms. As you may know, the Hywel Dda University Health Board is committed to seeing reductions in all aspects of healthcare associated infections and has set themselves the target of reducing E coli bacteraemias by 20% as a global surrogate of all infections across our area.
Why is clinical information important?
Microbiology does not provide explicit answers to the question, “Does this patient have an infection?” Our laboratories will grow bacteria but are bodies are … Read the rest
In a previous post I discussed the two simple rules that I ask colleagues to use to test interventions around the management of infections:
- First do no harm
- Second, find and take the positive action
All well and good offering this advice to others, but the challenge was also to me as a clinical microbiologist. In discussions with my colleagues, we agreed that a large number of our E coli bacteramias were probably as a result of urinary associated infection and if we were to make a difference, we needed to take a closer interest in how we managed the … Read the rest
I’ve used a variation of that title as part of the title for a number of presentations I’ve been giving across our local health board area, in an attempt to grab my audience attention.
What’s the issue?
Innapropriate use of antibiotics, particularly in our older population, to treat alledged urinary tract infection. Indeed, this article is prompted by a conversation this morning with one of my biomedical scientists in the lab. We were discussing the whole issue of interpretation of microbiology results and management of infection. She … Read the rest
I always welcome the opportunity to visit the National Botanic Garden of Wales so was delighted to be invited to discuss how the Hywel Dda’s paradigm shift in thinking about the management of healthcare associated will support our local care homes.
The conference, “Working together to promote health, wellbeing and quality of life” was opened by Sarah Rochira, Older People’s Commissioner for Wales where she discussed elements of her care home review, “A place to call home?”
I was struck by her messages around the wellbeing agenda for older people in our community and what “good” looked like in those … Read the rest
I’m pleased to see that the Hywel Dda Health Board’s new strategic direction for the management of Healthcare Associated Infections is available to view on their Internet site. The paper that outlines the proposals is
I wrote this paper for the board’s Quality and Safety Committee, which considered them in June, following a series of meetings that started in December 2013. The Quality and Safety Committee is one of the Statutory Committees of the board and the complete suite of documents are available … Read the rest
I’m struck by the desire of the Welsh Government Health Department to encourage Health Boards in Wales to increase transparency in relation to Healthcare Associated Infection, which is commendable but as my title suggests, if we are not careful, may confuse our local population and in the worst case scenario, lead to anxiety.
As regular readers will be aware, I have a long abiding concern over the harms we can inflict on our patients and their relatives and said much in this area in my article, “Should I be worried about Healthcare Associated Infections“. I became very interested … Read the rest
One of the most important microbiological investigations we undertake is the blood culture. This is because blood does not normally have bacteria swimming around in it and therefore unlike from non-sterile sites, we can view any organism from a blood culture as potentially serious.
That said, as with any test we undertake, the opportunity for a sample to become contaminated is ever present. This is just as true for blood culture because the sample is taken from a vein and access to the vein is via a needle through the skin. Skin is not sterile but is home to many … Read the rest
This is a healthy question for any potential patient to ask of their medical advisors, particularly if they are about to go into hospital for some form of healthcare intervention, be it surgery or some other form of therapy. Every potential patient should be advised of all the risks they may face – that’s part of understanding and determining their decision to proceed with the advice of their physician.
The unhealthy question is much more the specific: “Should I be worried about MRSA or C diff?” It’s understandable that people ask about specific organisms but it is rather a failure … Read the rest