Volume 2
Resistance to antibiotics and other antimicrobial agents / Select Committee on Science and Technology.
- Great Britain. Parliament. House of Lords. Science and Technology Committee.
- Date:
- 1998
Licence: Open Government Licence
Credit: Resistance to antibiotics and other antimicrobial agents / Select Committee on Science and Technology. Source: Wellcome Collection.
39/580 (page 31)
![[Baroness Platt of Writtle Contd] multi-resistant bacteria the first thing you want to do is to create some space.’ Florence Nightingale taught us the importance of space between patients in terms of spread of infection. It is difficult to create that space any more because of this high bed occupancy. So from having two patients colonised you end up with half the ward colonised and then you cannot close the ward and so the organism spreads and becomes endemic in the hospital. It is compounded by increased patient movement. It is difficult to find patients sometimes nowadays as they are shunted from ward to ward so quickly to find an empty bed. There is also a lot of pressure to keep wards open. It is very difficult to close them. There is also a pressure on domestic services. It can be difficult even to clean thoroughly a bed space in between patients. It is compounded by lack of isolation facilities. Many United Kingdom hospitals have very few separate rooms where we can put patients who are colonized or infected by multi-resistant organisms. I am sorry, my Lord Chairman, to finish on such a negative note but I think it is important you understand some of the problems we face because it is important in how we combat the spread of anti-resistant organisms particularly in hospitals. Lord Rea 40. We would like to know how you feel about the costs and consequences for the Health Service. We have already had some mention of the things which cost money and perhaps where we should be spending a little bit more money. (Dr Hastings) Could I deflect that slightly because I know Professor Reeves has got some slides which directly address costs? 41. Yes. (Dr Hastings) You are quite right, the acquisition of resistant organisms in hospital and infection arising from being in hospital, so-called nosocomial infection, does add on costs quite considerably and there are figures on that and Professor Reeves will show you them. Baroness Masham of Ilton 42. My experience has shown that a terrible wastage to the National Health Service was the cost of patients having to sue for enormous amounts of money and if only there had been more isolation beds they might not have got an infection. Your point is very important, it is such a waste. (Dr Hastings) At the moment there are cases of patients suing health authorities for becoming infected with multi-resistant organisms and you are right, there is knock-on waste because Trusts must now take on their own medico-legal cases. Sometimes hospital managers and finance directors do not always see it that way though. That is the next finance director’s job! ' Note from witness: i.e., infection control teams try to isolate and “cohort nurse” the patients, to prevent spread. (Professor Reeves) There is an appendix to the document and in it there is some parochial data from my own hospital which shows the impact of MRSA and I quote a couple of costs in there. That is just the tip of the iceberg because one had the tremendous task of trying to control the infection by cohorting patients on wards and losing bed space, and so on. It is very difficult to add up all these costs, but they are absolutely enormous. Lord Rea 43. Do you think that spending money on the sort of things which Dr Hastings said were lacking would actually help us to save some of these costs which you mentioned in your appendix? (Professor Reeves) 1 certainly think that some of the problems in controlling infection in hospitals stem from the pressure under which most hospitals now run. Hospital staff, particularly the nurses and the domestic staff on the wards, are under such pressure that have high levels of absenteeism and then you have to fill the gaps by getting in agency nurses who are not necessarily well versed in the infection control practices of your institution. It is actually extremely difficult now to control infection. Dr Hastings also mentioned the fact that patients are often housed on as many as three wards during the course of a really quite short stay in hospital because of the difficulty of finding appropriate beds for them. If they are carrying infection they may move once or twice before you realise they are infected, so the sort of pressures we are working under does compound the situation enormously. We do recognise that to correct those would cost a great deal of money to the National Health Service. Baroness McFarlane of Llandaff 44. In one of the pieces of evidence we were given we were told that nursing homes and residential homes are now refusing patients with MRSA. Is that a knock-on cost in turn to the Health Service because in the end the Health Service has to take them back? (Dr Slack) It is indeed a problem, though this has been addressed by the Department of Health to some extent in issuing guidance through our own professional organisation about MRSA in nursing/residential homes and meeting with the homes and particularly with the large insurance companies that insure homes to try to alleviate that problem. In spite of those measures there are still delays in admitting patients to nursing homes and indeed, they stay longer on the hospital premises and therefore are using the resources and blocking beds that could be used by other patients. Chairman 45. Professor Reeves, I understand you have a presentation. (Professor Reeves) 1 am going to talk about the actions we might take to try and control resistance in the future. I thought I would first review the way we](https://iiif.wellcomecollection.org/image/b32219234_0002_0039.jp2/full/800%2C/0/default.jpg)
