Sunday, February 10, 2008

Washing Hands. by Anthony McCarthy

This piece in today’s Boston Globe Magazine is about Monica Sprague’s disastrous C-section delivery and the subsequent attack of flesh-eating bacteria which came close to killing her and which has left her with no limbs. It is very hard reading, mixing the story of her family with technical information about the problem. Maybe the second part in next week’s magazine will talk more about the general problem and its prevalence in the recently hospitalized.

Nick Daneman, an infectious disease consultant at Sunnybrook Health Sciences Centre in Toronto, studied all the literature on outbreaks of the bacteria from 1965 to 2004. He found outbreaks that involved as many as 56 patients, lasting from one day to three years. Most people became infected after a surgery or delivery. The most common ways people got it were from another patient or from a healthcare worker who was unknowingly infected. Adding to the mystery is how the infection takes hold differently in different people. "There's a lot to be learned," Daneman says, "about why some people will get simple strep throat and others severe fasciitis."

As you listen to the blather about Republicans’ “health care” policy think about this part of the article.

In a study Daneman published in the Annals of Internal Medicine last August, he reviewed 2,351 cases of invasive Group A strep from 1992 to 2000, of which 253 resulted in necrotizing fasciitis. He found that just 12 percent of all the patients caught their disease in a hospital - most picked it up in the community. Of the 291 who acquired it in a hospital, 10 percent were part of an outbreak and 90 percent were isolated cases.

"Once you have necrotizing fasciitis," says Stephen Zinner, an infectious disease specialist at Mount Auburn Hospital in Cambridge, "the treatment really is heroic type of surgery." He describes the disease as a "chance event," and he says doctors seeing it for the first time might even be puzzled initially. "It's a subtle diagnosis," says Zinner, who was not involved in Monica's case, "not initially so clear that every doctor would say, 'Ah, that's what it is.'"

Since the corporate sector will be attacking either Hillary Clinton’s or Barack Obama’s health care plans with all guns as the year goes on, we need to look into a previous defense of our indefensible for-profit system. That was the reaction to Michael Moore’s movie “Sicko”. That attack centered on the British Health Service’s record as the worst in Europe for MRSA infections. Unsaid by most of our media, bought and paid for by the insurance and drug industries, is that a lot of the problem in Britain is due to Republican style ‘reforms’.

The Thatcher governments privatization strategy in the 1980sthe introduction of competitive tendering and the contracting-out of servicesled directly to an escalation in MRSA rates. Over the next decade, efficiency drives saw the almost total destruction of the NHS culture, with nursing staff forced onto short-term contracts and cut to inappropriate and dangerous levels.

Prior to this, in the 1970s, cleaners were employed directly by the hospital. Each ward had its own cleaners who were part of the ward team. Porters, maintenance staff and cleaners had pride in their wards, and many worked for most of their careers in the same place.

The NHS Trust hospitals that emerged from the creeping privatization process are under enormous pressure to cut costs, and will invariably pick the cheapest option in choosing their contracted-out services. This almost necessarily leads to contractors cutting corners and subsequently to a less efficient or thorough job being undertaken. The cleaning companies operate on tightly drawn contracts, where every task is listed and timed, which leaves no place for anything not on the list, including accidents. An attitude of apathy and disregard for cleanliness pervades.

The pressure on hospitals to cut costs has also led to other factors that help spread infections. For example, in the past, hospital workers were issued uniforms for use only on the premises, and these were laundered on siteoften boil-washed. Nowadays, staff are responsible for their own uniforms, which they wear to and from work, via public transport, etc. Uniforms, therefore, gather many germs from the environment en-route, and are then probably often washed at home on normal domestic low-temperature washes, which do not kill many germs.

A journalist from the Daily Mail who worked undercover for Rentokil Initial, one of the firms with contracts to clean hospitals, revealed that he received only a 90-minute induction course and had no relevant experience. He reported finding bags of blooded bandages and plaster casts left overnight in the fracture clinic. He also found 2-inch (5-cm) insects, and heard of cleaners failing to clean areas properly because of their workload. The areas he was allocated were to be checked just once a month by the hospital trust and once a week by his Rentokil Initial supervisor, if she had time.

Privatization for profit, who would ever have expected penny pinching and corner cutting to be a part of that brilliant idea? Maybe it’s all right for cleaning government offices, though I’m sure neither Thatcher nor Blair skimped on their creature comforts, but it just doesn’t work where people are being operated on.

No Republican will provide a safe or affordable health care system in the United States, no ‘reform’ of the type done in Britain over the past Conservative and New Labor governments will either. You have to take the system out of the for-profit system, that is what has given us the system we have, that is what endangers public health care in countries that had put People ahead of profits. While neither Clinton nor Obama’s plans will get rid of the corporate cannibal that feeds on our bodies, both of them are at many steps away from the perennial Republican tax rebate fraud.

There are some other points to consider in this article.