As doctors, we passionately believe it is our “Ethical Duty” to help reduce introducing bacterial infections in hospitals and our community. This is not about clinical evidence, target or saving the cost but all about our medical ethics: "Do No Harm”.
Medicine was accepted as a profession only in 1800 and in 1900 nurses joined in to help patients get well and help prevent spreading infections. Antibiotic was invented in 1940s, since then we thought we have progressed but looks as if we are rapidly drifting backwards towards “Pre-Antibiotic era of 1800”.
When the model of DNA was created, we human though we can manipulate life, some even believed they were “GOD”. Soon we realised we are not as smart as the small virus “HIV”. These viruses know how to make DNA using RNA because they discovered an enzyme called “Reverse transcriptase”. I simply think we must call this virus “GOD”, because they know how to create life.
When every one concentrated on HIV in 1980s, a simple bacteria “Staphylococcus” was planning a massive assault on human and spreading in neonatal units in UK. Now in 2000, this antibiotic resistant bacterial has proved us just how vulnerable we are despite all our scientific expertise and advances in medicine. We have not only "Lost our human face of medicine" but also the one and the only cure we possessed “The Antibiotics”.
Why & How?
Since 1940s, doctors used antibiotics and in 196s, disposable medical device became very fashionable to help reduce cross contamination. Since then Antibiotic resistant bacterial infections have increased in tandem. Advances in medicine were made possible only after antibiotics and intravascular access was used to help treat and manage patients in hospitals.
Doctors and nurses use these devices often but never stop to thinking of the consequence. When I point out they are the contributing factor to spreading infection, Most think I am cynical.
I know some of these devices are essential to help manage critically ill patients in intensive care but most could be managed without using one. We know the safest route to give antibiotics is by mouth, yet a patient who can eat and drink has a drip and antibiotic administered via cannula.
"We must reduce contaminated hospital waste polluting our environment".
We must bring in changes by help healthcare workers reduce disposable devices and as patients, they must stop demand antibiotics and blood test. Most clinicians make provisional diagnosis based on history and clinical examination. If their clinical acumen is good and they have a good understanding of disease process they rarely need a blood test, X-Ray or a scan.
In 1980s, people were not keen on blood tests because they were expensive. Since 1990s, the private healthcare insurance companies and legal system demand blood tests because they feel it is essential to help them diagnose illness early in life. As doctors, we know blood tests are helpful only to conform our diagnosis and not a tool used to diagnose disease.
People don’t ask our opinion nowadays, but dictate what they need (thanks to information websites in the internet) and what should happen. I at times feel, what is my role in healthcare? If nurses and patients know more than what I do, then what am I doing here? Why do they need my help? Can’t these know all people get their own blood test and X Rays to help self-diagnosis?
Now I am thinking, how I can bring in changes that matter to the life of our children in the future and our life. I know its is too late for me to invent another “Miracle drug” like the antibiotic but may be if I speak the truth some one will wake up (Though Michael Jackson did not when I wrote to him asking his help in 2005) and bring in changes.
Antibiotic resistant bacteria are also said to be resistant to various biocides (antiseptics used to clean skin) and are colonised in the hands of every second health care worker and one in eight stet scope. We must discourage routing blood tests, excessive dependence on doctors and use of antibiotics.
I have on most occasions’ diagnosed illness based on clinical examination. Thanks to my teachers who told me, “The part between the ear pieces of a stethoscope is more important than the diaphragm”.
I know there are clinicians who have mastered this art and can diagnose most illness, but the pressure exerted on them by insurance companies, legal system and the patients themselves prevents them being frank about their finding. Performing blood test is not only increasing hospital-contaminated waste, cost, avoidable anxiety in patients and now the risk of infection.
As a patient, I would think twice before getting a needle stuck in my arm by a nurse or a doctor (48% are now colonised with bacteria in their hands). Over enthusiastic hand, wash and low concentrated chemical was increase bacterial count in our hands. The antiseptics (biocides) are now not killing the germs as they used. When I questioned nurses about “Drying Time", in UK no healthcare worker have heard about this in the hospitals.
Device manufacturers think their devices are not associated with infection but we do and know it does. It is not the sterile device they supply but the way it is contaminated before their use in patients. Healthcare agencies are warning healthcare workers that the standard and hygiene of some manufacturing companies are below standard.
As a doctor, I find myself in an ethical dilemma “If injecting a toxic drug to kill a person is unethical, how can we accept introducing infection that kill be not”
