Dumbarton & Vale of Leven Reporter | News | Letter from Vale of Leven hospital chaplain

Published: Tuesday, 24th June, 2008 09:25

Letter from Vale of Leven hospital chaplain

It is with a great sadness that I watched the C diff story grab the media centre stage.

Sadness because families have lost their loved ones and sadness because I knew just how devastated a very loyal, committed and hardworking staff would be.

Staff are understandably reluctant to talk to the media. Regrettably there is something of a fear culture that operates within the NHS at many levels and staff are encouraged to remain silent. Though these directives seldom come from the top they are real enough. Staff are encouraged to believe that any kind of reported statement runs the risk of job loss or at best career restriction. Freedom of Speech and the NHS do not go hand in hand. During my involvement with the Health Board I enjoyed a few “carpetings” for public statements made. We are asked to believe that there is both transparency and openness. The reality is, however, that the culture does not encourage it.

After many years of hospital involvement I would like to think that staff can speak to me in confidence and I am indebted to those who have tried to enlighten me on this issue and trust that they do not think I am betraying their confidence by passing on my understanding.

Those that I spoke to were first of all anxious to express the deepest of sympathy to all patients who have contracted C Diff and to the bereaved families who have lost a loved one through this outbreak. Their sorrow and sadness was most strongly and consistently expressed.

They are understandable concerned about some of the reporting both locally and nationally and were anxious to explain to me some of the issues.

Clostridium Difficile (C Diff) is a bacteria found in the intestines healthy and ill-people alike. It can become a problem when the use of antibiotics destroys the good bacteria in the gut leading to multiplication of the C Diff bacteria. It is then transmitted via faeces (the faecal-oral route), by direct contact between patients, on the hands of healthcare workers or via contact with contaminated surfaces. Rigorous cleaning with warm water and detergent is probably the most effective means of removing spores from the contaminated environment, and staff should observe good hand washing practice. Although antibiotics are usually the initial cause of developing the disease, specific types of antibiotics are used to target and treat outbreaks of C Diff.

Most people develop the infection in hospitals or other healthcare institutions although infections acquired in the community are on the increase. C. Diff spores are resistant to heat, alcohol and some disinfectants and may therefore persist for months in a hospital ward environment. It is estimated that up to 3% of healthy adults and about 20% of hospitalised patients carry it. Both infected patients and healthy carriers are known to be sources of infection.

However, elderly patients with other underlying conditions can suffer severe symptoms and the infection in such circumstamstances can be life threatening. It has been noted that over 80% of cases reported are over 65 years.

The domestic and nursing staff within our hospital work extremely hard and their hygiene standards are monitored daily. The Audit General (www.audit-Scotland.gov.uk) reviewed cleanliness within Scottish hospitals and our hospital was graded at a level 2 - ie the cleanliness within the wards were mostly very good.

As you know our hospital has been under intense scrutiny over the last few years and the nursing staff are acutely aware of this. It is because of good nursing practice that potential infections are identified early via stool sample collation to identify C. difficile toxins. Patients are isolated where at all possible in a side room or in a bed space with the adjacent bed space unoccupied.

Visitors are encouraged to be more responsible by hand washing before and after visiting. This can also help reduce the spread of the bacterium. The increase in visiting hours and frequency again increases risks of infection being brought in from outside. The policy of two patients per bed is sometimes difficult to enforce without relatives understanding of why it is done. This policy is being enforced with greatest consideration for the patients.

Since our hospital has been downgraded and services reduced, the type of patients admitted to the hospital has also changed. The hospital now looks after an aging population, these patients usually have other associated health problems and people who have poor immunity are known to be at a high risk. The high number of transfers from other hospital and nursing homes has again raised the risk of infection being brought into the hospital.

C Diff is a problem within many hospitals, the overuse of antibiotics being the main cause. Greater Glasgow Health Board has responded quickly to public outcry, the restriction of various antibiotics which are known to reduce the bodies natural defence against C Diff is now in place. Hand hygiene is being closely monitored with expert agencies advising staff and managers. A new ward has been opened to reduce the number of patients per ward and to help improve the facilities for hand washing for all patients. There have been no closures of wards but there has been a minimal reduction of beds. An independent review is now investigating all patients diagnosed with C Diff within the last 6 months and infection control procedures are being reviewed. The involvement of the Health Minister Nicola Sturgeon has been welcomed by the nursing staff. It is hoped that the independent inquiry will help identify any shortcomings and enable resources to be accessed. It is to be hoped that these procedures and the restriction of antibiotic usage will be implemented across the health board and not just within the Vale. As we have seen within the last few days C Diff is not just a Vale issue.

The staff have repeatedly expressed to me their gratitude for the continued support that the public have given for their hospital. I remain optimistic. I believe that Nicola Sturgeon has shown the courage to stand up to GGHB. She has let it be known that they will not have it all their own way. I salute her integrity and applaud the efforts of Ian Robertson and all the WDC councillors, the national politicians for their efforts and co chairs of Hospital Watch, Jim Moohan and Vivien Dance. The fight goes on and I pray that the continued unity of all on this issue will ensure a positive outcome.

As I left the hospital I did so with two overriding impressions. Firstly the genuine sadness and sorrow that the staff feel for those so affected by this outbreak and secondly the honesty and commitment of a staff who have had to work with a continual threat hanging over them. They are worthy of our trust and support. As the NHS nears its 60th birthday I would appeal to NHS Greater Glasgow and Clyde to discover some hitherto unfound characteristics and demonstrate that they can listen to a disadvantaged community. So far their efforts at consultation have simply been poor efforts at communication. I trust that, even now, they might develop a more flexible approach and take note of our needs rather than seeking to shoehorn our requirements into a pre existent Greater Glasgow Plan.

Reverend Ian Miller (Hospital Chaplain)

Social Bookmarking What are these?