Home Improvements

The pressure to move healthcare out into the community is both ever-growing and indisputable. More and more procedures are being deemed suitable for the home or other non-hospital environments. Given the financial constraints currently affecting almost every aspect of life, it might be argued that this trend is fundamentally acceptable if it cuts costs. It is not acceptable, however, if it also cuts corners. According to data from across Europe, healthcare-associated infection (HAI) affects more than four million people a year and is a contributory factor in nearly 150,000 deaths. Put starkly, that means the odds are that someone in the UK will die from HIA in the time it takes you to read this article. A great many of these deaths are preventable. Unfortunately, as remarked in a study published three years ago in The Lancet Infectious Diseases, the effect of cleaning in a healthcare setting has never been accorded bona fide scientific status. That such a situation can endure in the 21st century is itself almost unconscionable. Yet now, as if to compound the issue, we find ourselves in the extraordinary position of determinedly exporting healthcare while neglecting to export hygiene. This is the disturbing corollary of two prevailing shortcomings. The first is a tendency to value functionality above infection control in the design of healthcare equipment. The second is the widespread failure of the profession and policymakers to implement the type of legislation that the shift to increasing healthcare delivery in the home so plainly demands. Imagine, if you will, a present-day doctor arriving for a house call astride a penny-farthing. Now imagine him removing from his bag a hacksaw, say, and a handful of mercury vials. Who wouldn’t be alarmed by such anachronistic behaviour? Of course, it simply wouldn’t happen, would it? Well, not quite. One element of it happens thousands of times every day without so much as raising an eyebrow. Needless to say, it is not the penny-farthing or the hacksaw or the mercury vials. It is the bag. The bag is as hopelessly 19th-century as everything else – and yet we take its suitability for the task entirely for granted. In truth – and perhaps inevitably, given that it has remained impervious to any significant redesign for around 150 years – it is far from suitable. Research conducted at the Royal College of Art and supported by the University of Huddersfield and NHS East Riding of Yorkshire as part of the NHS at Home project revealed one third of a sample of bags used by nurses in the community carried the MRSA bug; 55 per cent were never cleaned; and only six per cent were cleaned once a week. And these bags, according to diary analysis, are used by community nurses up to 17 times a day – usually for wound care. The response to these deeply disturbing findings was to create a radical new bag fit for the 21st century. The design was highly commended in the Department of Health’s recent NHS Innovation Challenge and is set be commercialised in 2013. This, though, is just one small step in the right direction. A far more significant contribution would be the introduction of meaningful legislation that addresses the issues surrounding the rapid expansion of home-based and other forms of mobile healthcare. For example, there are no rules in the UK governing the cleaning of doctors’ and nurses’ bags outside hospitals. The drawing up and implementing of guidelines would seem straightforward and largely obvious – even essential – but, incredibly, none currently exists. Whether the result of ignorance or apathy, this represents nothing less than a dereliction of duty. The inescapable truth is that we cannot export healthcare to the home without refining the fundamental practices that underpin it. Regardless of where it is delivered, treatment should enjoy the benefit and security of every conceivable effort towards sanitisation and the consequent safeguarding of the recipient. Community healthcare is on the rise. So, as a result, is the threat of HAI. We must not shy away from the fact that the medical profession risks a monumental betrayal of the patient population if the relevant standards of design and hygiene do not climb as well.