CHANGING BEHAVIOURAL patterns is always difficult, even when alternative approaches can benefit all concerned. An extreme example has been some employees at Our Lady of Lourdes Hospital in Drogheda’s reluctance to adopt best medical practice. Hand washing is the single most important procedure for preventing healthcare associated infections. Yet, despite that and the introduction of special guidelines in 2006, hospital staff persistently failed to adhere to good hand-hygiene practices. An outbreak of Clostridium difficile infections in the hospital and the death of several patients underlined the dangers involved.
In recent years, an excessive use of antibiotics has been recognised as a threat to public health because of the emergence of antibiotic-resistant bugs. As a consequence, doctors are taking more care in what they prescribe. But there is a long distance to travel, especially as some patients demand these medicines. The extent and complexity of the problem can be gauged from a report on antibiotic use in hospitals, issued by the Health Protection Surveillance Centre (HPSC) last week. It found that in at least 50 per cent of cases, their use was inappropriate. That is an extremely worrying situation.
To deal with this serious problem, the HPSC has recommended that all acute hospitals employ a medical microbiologist or infectious diseases consultant; that national guidelines be developed for treating common infections and that specific antibiotics be restricted within hospitals. In addition, it suggests that hospital managers should include careful antibiotic use as a strategic goal and that acute institutions should have 24 hour access to a microbiology laboratory.
At a time of extreme belt-tightening within the Department of Health, this programme of reform is highly ambitious. But it may generate a win-win situation in terms of lower costs and better patient care. Dr Robert Cunney of the HPSC insists this is “one of the few medical interventions that pays for itself”.
Medical practitioners would have to accept the advice and guidance of such experts if maximum benefits were to be achieved. And some members of the profession are not noted for their flexibility. But with goodwill and the implementation of new guidelines and procedures, patient care can be improved.