Clostridium Difficile - Was: Wounded soldier contracts MRSA

Goatman

ADC
Book Reviewer
#1
Accidental_discharge said:
Clostridium Difficile causes much more than just the trots, it may lead to multi organ failure then death, ETOH gels are inefective against C-Diff, as it does not kill the spores that remain on the hands after use with said gels. The spores need to be physically removed, soap and running water.

Methycillin Resistent Staph Aureus may appear colonized in asymptomatic individuals and passed on unknowingly, it may even be found colonized in family pets.

All hospitals, regardless of appearance are breeding grounds for all sorts of hideous bio killers.
The link in the earlier post is to a support Group set up by a woman whose mother died of infection brought on by C.difficile.

Some common dog practical measures on the site , culled from people posting their tips in the forum, may be worth reprinting here, FWIW:

Tips

These tips are a selection of the “best of” from this site’s discussion forums. The tips have been written by C-Diff sufferers who have tried them and found them to work. Most have been written by people who do not have a medical background and they are not a substitute for seeking proper medical advice from a qualified medical practitioner. We cannot accept responsibility for the advice given here. If you are at all concerned, please go and see your doctor.

Infection Control Measures

Handwashing

Hand Washing is the single most important method of controlling infection by C-Diff. C-Diff spores are highly resistant to most cleaning materials, therefore the physical action of hand washing is important. If you are visiting someone in hospital, the alcohol gel on wards will not help: it will simply rub the spores around your hands.
Hands should be washed: -

After visiting the toilet
Before helping someone with their food
Before handling, preparing, serving or eating food
When the hands are visibly soiled.

How to wash your hands

Studies show that handwashing techniques are often poor and the most commonly neglected areas are the tips of the fingers, palm of the hand, and the thumb.
It is important that hand washing is carried out correctly to prevent the spread of infection. Washing hands with soap and warm water will remove the majority of germs, preventing their spread to other people.

Wet your hands with warm, running water and apply liquid or clean bar soap. Lather well.
Rub your hands vigorously together for at least 15 seconds.
Scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
Rinse well.
Dry your hands with a clean or disposable towel


Cleaning Around the Home

Clostridium Difficile Spores are highly resistant to cleaning agents and will live for between 70-90 days outside the body and are only killed by cleaning agents containing Chlorine Bleach. Hard surfaces that will not be damaged by these cleaners such as toilets, (don’t forget the flush and door handles) baths and work surfaces should be cleaned with proprietary cleaning agents containing bleach. Obviously please use some common sense and don’t use cleaning products containing bleach on unsuitable surfaces such as carpets or soft furnishings.

Washing Clothes
There is some evidence that at low temperature washes (30 Degrees) Clostridium Difficile spores may be washed out of contaminated clothes and remain within the washing machine pipe work and sump. The spores could then be washed back onto clean clothes. Therefore, it is a good idea to use a washing powder containing chlorine bleach i.e. NOT a “colour” or non-bio product, and to use powder rather than liquid. This is because liquid detergents contain bleaching agents which may or may not contain chlorine bleach, whereas powders contain actual chlorine bleach.


It is also a good idea to run a 90 degree wash once a month with the machine empty and a full load of detergent to completely clean out your washing machine. This ensures that all potential c-diff spores are killed and also cleans out any old soap residue from your machine making for more efficient washes.

C-Diff Sufferer Care


Pro Biotics
While pro-biotics are highly beneficial in re-establishing gut flora, two important details must be considered:

It is of no use to take pro-biotics while you’re being treated with antibiotics for Clostridium Difficile. Any “friendly bacteria” will be killed off immediately by the antibiotics treating the C-Diff and will not get a chance to establish themselves. Wait until you have completed your course of antibiotics.
There is considerable debate in medical circles about how much bacteria is actually “live” in commercial pro-biotic products. There is concern that not many live bacteria get through the concentrated acid in the stomach. There is also debate about which strain of good bacteria is most beneficial. Pro-biotics are therefore a can of worms with large commercial interests at stake. Very few products have been medically tested and approved (with the exception of VSL3 from Sigma Tau Pharmaceuticals which at this point (Jan 2007) is not distributed in the UK. However this is going to change in the next few months
Therefore the best current advice is to make your own live yoghurt using an electric yoghurt maker with full cream UHT milk and a “live” starter such as “Total” yoghurt, or another brand of live yoghurt, and leave it to ferment for a full 24 hours. This gives a finished yoghurt that tastes great, has a bacterial yield in the trillions that you know are live, has not been through a long supply chain where the bacteria may have started to die, and the lactose in the milk has been broken down making it easier to digest. It is not a good idea to use the Easy-Yo Yoghurt Maker for pro-biotic yoghurt as it is not heated and therefore unsuitable for a 24-hour fermentation process.

Oats
Oats contain beta glucans that are highly beneficial in helping to re-establish the gut flora. If you can manage it try to include some oats in your diet in any form. For active C-Diff, fine ground oats like “Ready Brek” or fine oatmeal made into a simple porridge are easy to digest, but any products containing oats will help.


If you have a relative or friend in hospital with C diff

Here are some facts and figures about C. diff which should help you.

Getting Infected

Usually the patient will have been given a broad spectrum antibiotic. This kills off all bacteria, friendly and unfriendly, leaving the patient vulnerable to C. diff spores which are very resilient. The source of the infection can be anything from contaminated equipment (e.g. portable apparatus for measuring blood pressure) which goes from patient to patient, toilet handles and sink taps, cups of tea where the care assistant has previously cleared up another patient’s mess, or even through the air if another infected patient uses a commode nearby. The spores must be ingested. Infection rates are thought to be 10-20% for the first two weeks and over 50% after a month. C. diff 027 is particularly virulent strain.

Symptoms


We all know about the diarrhoea, but there is a period of incubation usually, but not always, after the original antibiotic has finished. Associated with C. diff are low grade fever, overgrowth of white blood cells, and episodes of low blood pressure. The patient feels unwell and will probably experience some abdominal discomfort. The diarrhoea is relentless, very watery, and may have blood and mucus in it. Loperamide (Immodium) is not recommended in the UK, but in parts of the US it is prescribed for C. diff diarrhoea. The thinking is that as long as waste products are still 'going through’; this is gentler on the colon and less debilitating for the patient. Blood in the stools is a strong indicator of pseudomembranous colitis. This is a potentially dangerous stage of C. diff where dead tissue forms a sort of plaque on the surface of the colon. When this dead tissue is shed into the stools, a raw surface is left on the colon. This can become infected with other bacteria leading to sepsis. This last causes toxic shock which can lead to organ failure and death.

Diagnosis and Treatment

A stool sample is tested for the presence of C. diff toxins A and B. Colon damage can be assessed during a sigmoid or colonoscopy which can diagnose pseudomembranous colitis. Thickening of the bowel wall is also seen in a CT scan. Usually testing is only carried out when diarrhoea is present, but you could push for a stool test if your relative/friend has any of the incubation symptoms.

Two antibiotics are most commonly used to treat C. diff: Metronidazole and Vancomycin. Metronidazole is the preferred first option. It is cheaper than Vancomycin and does not mutate certain gut bacteria. Metronidazole is very sick making but it is effective against C. diff. Unfortunately C. diff can recur. Again, if you suspect C. diff, don't wait for test results, badger the medics to start treatment with Metronidazole or Vancomycin. C. diff is very fast acting and if you wait for even a few days, irreversible damage may be done. Better safe than sorry.

Probiotics

Now on to the alternative medicine stuff. There is a lot of confusion here, and everyone has their own pet theories. Most of this information has been dissected from clinical trials and research papers in US and Canada and has been proved effective. In the UK probiotics are not prescribed. Probiotics are mostly friendly bacteria which can be obtained as yogurt drinks or tablets. You have probably seen advertisements on the telly for Benecol and Danone drinks. Most supermarkets have 'own label' ones which are very cheap and come in lots of flavours. If your relative/friend likes these then administer them, C.diff or not. They MAY help prevent infection. There are lots of different tablets which contain the same bacteria as the drinks. Multibionta, probiotic vitamins by Seven Seas, has lactobacilli and bifidobacterium, as well as useful vitamin and mineral supplements. It is relatively cheap and most chemists and supermarkets stock it. If your relative is on Metronidazole or Vancomycin it is still worth taking probiotics, but give them halfway through doses, otherwise they get killed off like the rest! See also advice above on homemade yoghurt. Now for the contentious one. You may have heard about Florastor, (Saccharomyces boulardii). In the US this is administered with Metronidazole and Vancomycin. This probiotic is actually a yeast and clinical trials have proved that it is very effective in preventing C.Diff toxin damage. Also, because it is not a bacteria, it is not destroyed by antibiotics. The assumption is that it produces an enzyme which inactivates the toxins. It is completely harmless and can be given any time and MAY play a role in prevention of C.diff infection. A word of warning here. Patients are starved and possibly purged before colonoscopies, flexible sigmoid scopes and operations. CT scans involve a short fasting and prep. Usually a 'nil by mouth' sign is put above the bed, so before giving yogurt drinks check that your loved one is not booked for a scan. Otherwise they are a harmless and nutritious addition to the diet.

Getting Information From Hospital Staff

Don't wait to be told! You have to be very persistent if you want information. Instead of asking open ended questions like 'Tell me about C.diff'. Ask specific ones like these: 'Has he had a C.diff positive stool sample?' ‘Does she have pseudomembranous colitis?' If the answer is no or not sure, ask what steps they are taking to find out. Get the idea? Don't ask for permission to give life saving probiotics to your relative. Just do it!!

Action

It goes without saying that a positive C.diff test should result in isolation from other patients. Does this always happen? Not on your life! The main reason is that there are not enough side rooms for the huge number of cases. Also nurses cheerfully drag the same equipment in and out of wards and side rooms. Again, you have to be insistent here. C.diff cases on an open ward are a danger to the other patients. So if your relative or another patient in the bay has C.diff, insist on isolation. If they refuse or procrastinate, say you will complain to the health authority or the newspapers. Take pencil and paper and get names and dates. Look obvious. Believe me, they will act! Also insist on dedicated 'Obs' equipment for infected patients.

TLC

If you have a good network of friends and family, try to organise a rota to be with your relative/friend as much as possible. C.diff does not just affect the colon. It does funny things to your head! Patients lose their 'spirit' and become apathetic and resigned. Yet it is very important that morale is maintained because you have to 'fight' C.diff, particularly the pseudomembranous colitis sepsis. Also, people can keep an eye on whether medications are being given properly and the patient is clean and comfortable. It is important to keep up fluid intake, through a drip if necessary, and try to get your relative to eat.

Click here to sign the online petition regarding C.Difficile


No disrespect is intended to nursing staff trying deperately to make wards work. If posting this dit prevents a single case of c.difficile in an elderly patient ( such as either of my parents) it will have been worth it.


Le Chevre
 
#2
All dead useful

Thanks for posting this

Mind you, as a nurse working many busy nights, it's not the lack of knowledge or motivation that means corners get cut - but sheer intensity of work - but it's always useful to have the info in b&w
 

Goatman

ADC
Book Reviewer
#3
Lawnt said:
All dead useful

Thanks for posting this

Mind you, as a nurse working many busy nights, it's not the lack of knowledge or motivation that means corners get cut - but sheer intensity of work - but it's always useful to have the info in b&w
No probs Lawn, and as I say, no disrespect to all the hard grafting folk who are doing their damnedest out there to keep this bloody thing at bay.

It may seem daft to teach people HOW to wash their hands effectively but.....

Some good links to US info concerning c.difficile on the support group website too.


( Anyone who went to same school as Michael Palin can't be all bad ;-) )


Lee Shaver
 
#4
it's not daft sadly
but then if you are working with 20 patients on a shift, most of whom require some form of contact and you need to keep yr hands clean as well as answer phones/questions etc - well, let's just say it gets complicated. Me, if I'm stood still I disinfect my hands with gel as a kind of nervous tic ... but then I've caught OCD to go with my MRSA and CDiff :)
 

Goatman

ADC
Book Reviewer
#5
Blimey....comes to something when a nerdy microbiologist's arcane bug makes the front page of the Daily Mail.....

22/02/07 - News section

Superbugs kill 5,400 patients in one year
By JENNY HOPE

Deaths from hospital superbugs have soared to record levels.

Latest figures show Clostridium difficile and MRSA between them were involved in 5,436 deaths in a single year.

Experts fear the statistics are just the tip of an iceberg and say many infections go unrecorded.


• MRSA - It's even worse than you think

The toll has intensified concerns about poor hygiene in hospitals, aggravated by Health Service spending cuts, as well as fears over ward overcrowding and lack of isolation facilities.

Official surveys show one in three hospitals is flouting guidelines aimed at controlling C. diff.

Figures from the Office of National Statistics show deaths involving C. difficile shot up 69 per cent from 2,247 in 2004 to 3,807 in 2005.

MRSA fatalities rose by 39 per cent, from 1,168 to 1,629.

This means two in every 500 death certificates cited C. diff as a contributory or main factor, with one in 500 mentioning MRSA. The death toll was more than twice as high as that on the roads.

In 2004, the then health secretary, John Reid, promised to halve the MRSA rate by 2008. But campaigners said the figures showed the Government was failing miserably.

Graham Tanner, chairman of the National Concern for Healthcare Infections, said there was still "vast under-reporting" because many doctors failed to follow guidelines on certifying the cause of death.

He said the true toll could be as high as 27,600. There were at least 230,000 infections and their average mortality rate was 15 per cent.

Katherine Murphy, of the Patients' Association, said: "The data reinforces the picture we already have of a substantial increase in C. diff and MRSA rates. Our worry is these figures will continue to rise as other priorities take precedence.

"Inaccurate reporting on death certificates is a constant feature of calls to our helpline. Bereaved relatives should not have to fight for accuracy, doctors have a duty to provide it."

Clostridium difficile can trigger a catastrophic infection of the gut in elderly people.

The bug produces toxins which damage the lining of the bowel, resulting in a severe form of diarrhoea. it is usually spread via the hands of healthcare staff or contaminated surfaces.

Those over 65 are at highest risk especially when they are being treated with antibiotics which destroy the normal balance of the gut, allowing C.diff to take hold.

But there is concern that the bug be getting more severe and affecting younger people.

MRSA is unwittingly carried by many people on their skin. It becomes dangerous when it enters the body, meaning that patients who have had surgery or other invasive treatments are at particular risk. The cost of MRSA to the NHS is put at £1billion a year.

The pressure group Health Emergency warned that shortages of beds and staff mean it is impossible for UK hospitals to adopt the European model of isolating patients and decontaminating whole areas in order to control infection.

As a result the UK has levels of infection and and death rates are far higher than comparable countries in Western Europe.


Geoff Martin, the group's head of campaigns, said: "Over the past 12 months nearly 3,000 hospital beds have been closed in the NHS. That has created serious capacity problems and leads to "hot bedding", which makes a mockery of any attempts to control infection.

"With hospitals under instruction to hack back another £13 billion of deficits this year we will see more bed closures and staff cuts which will create a breeding ground for MRSA, C.diff and the rest of the killer infections gaining a foothold on the wards."

Shadow Health Secretary Andrew Lansley said: "Ministers are failing to face up to the dangers of MRSA and C. diff.

"Hardworking NHS staff are not getting the support they need to deliver a comprehensive strategy against hospital acquired infections.

"The staggering increase in deaths from C. diff and MRSA is worrying enough and the increasing presence of more dangerous strains will become an even bigger problem without an urgent and rigorous strategy now.

"Labour's savage bed cuts over the past two years have allowed deaths from C. diff and MRSA to grow to this appalling level."


Liberal Democrat spokesman Norman Lamb said: "The Government's drive to cut waiting times at all costs conflicts with what should be an absolute priority of cutting infection rates.

"The simple truth is that in hospitals where targets dictate where patients are kept, and beds are filled to bursting point, nurses are not able to isolate patients and clean wards in order to beat the bugs.

"There must be an urgent reassessment of the reporting procedure for hospital acquired infections. Some death certificates are still failing to document where an infection led to a patient's death."

But Health Minister, Lord Hunt, said "vastly improved recording" was responsible for the apparent rise.

He said: "We have set very tough targets for trusts to reduce infections and put a hygiene code and a tougher inspection regime into law, to drive up standards of hygiene and infection control. As a result we are now starting to see significant reductions in rates of MRSA infections.

"Many people who have healthcare-associated infections are very sick and vulnerable to infections, not all of which are avoidable. We are ensuring that the NHS has good hand hygiene and correct clinical procedures to prevent the ones that are."

Health Secretary Patricia Hewitt announced in December that hospital trusts can bid for up to £300,000 each from a £50million fund to help combat C. diff.


In November 2004 Mr Reid said: "I have made it clear that lowering rates of healthcare-acquired infections is a top priority.

"I expect MRSA bloodstream infection rates to be halved by 2008. NHS Acute Trusts will be tasked with achieving a year on year reduction up to and beyond March 2008."

Some experts warn that bugs are here to stay as the price to pay for advances in medicine.

Even with the perfect environment and perfect infection control practice, there would still be infection because increasingly frail people are being saved who would have died a few years ago.


--------------------------------------------------------------------------------
Le Chevre
 
#6
Without wishing to be disrespectful to anyone on this site whose family have suffered C. difficile, MRSA or any other hospital acquired infection some of what has been quoted is utter fecking nonsense. For example:-

C.difficile is spread "through the air if another infected patient uses a commode nearby". No, C. difficile is NOT an airborne infection.

"Infection rates are thought to be 10-20% for the first two weeks and over 50% after a month". This is meaningless drivel, it has no value what so ever.

"It is also a good idea to run a 90 degree wash once a month with the machine empty and a full load of detergent to completely clean out your washing machine. This ensures that all potential c-diff spores are killed and also cleans out any old soap residue from your machine making for more efficient washes". A 90 degree wash will NOT kill bacterial spores, you need 134 degrees at 2.25 bar for 3 mins to achieve a sporicidal effect.

"there is a period of incubation usually, but not always, after the original antibiotic has finished". The symptoms frequently start before the original antibiotics are finished, which is why stopping the antibiotics (if it is safe to do so) can sometimes be all that is needed for the diarrhoea to cease.

"but you could push for a stool test if your relative/friend has any of the incubation symptoms". There are NO incubation symptoms.

"The cost of MRSA to the NHS is put at £1billion a year". More bollocks from the Daily Wail. Whilst it is true hospital acquired infections cost £1 billion per year it is not true that MRSA costs £1 billion per year.

Lord Hunt said "As a result we are now starting to see significant reductions in rates of MRSA infections". I wish this was true, especially in the Trust where I work. The truth is that with one year to go to reach the 50% MRSA reduction that John Ried set as a target the overall reduction is only about 5% over the past 3 years. Of course Lord Hunt is quoting the actual number of cases, if you look at the rate (per 10, 000 bed days per trust) it is unchanged compared with 3 years ago (about 0.16 cases per 10,000 bed days).

John Reid said in 2004 "I expect MRSA bloodstream infection rates to be halved by 2008". I remember this quote like it was yesterday as everyone I know in microbiology and infection control thought it would not be achieved and thought Reid had set us up to fail. He chose not to consult with any experts before setting this target.

Also worth remembering that despite all the hype there has been NO increase in the prevalence of hospital acquired infection over the last 25 years. In the 1980s it was 9-10%, in the 1990s it was also 9-10%, in 2006 it was 7.6%.

If anyone wants to know about specific infections for fecks sake don't use these self help sites because if what was quoted above is really the "best" they can offer then they are misleading. Try the Health Protection Agency (UK) or the Centers for Disease Control (USA).
 

Goatman

ADC
Book Reviewer
#7
Thanks for that J-B - always good to get the professional viewpoint.
I appreciate this is every day stuff for you and I have no doubt you have forgotten more about microbiology than I'll ever know.

Instead of slagging off the views expressed in the Support Group, which I have quoted as seen, maybe you could get in touch with the Web-manager and point out the error of their ways? I'm sure they would welcome some input.

The site is http://www.cdiff-support.co.uk/about.htm

From my (dumb grunt) perspective what that site is about is trying to help people with elderly relatives in hospital, who are looking for something other than being fobbed off by over-stretched ( and occasionally I have to say, downright arrogant) NHS staff with a lot of half-truths about C.Diff.

As you say, many of the U.S sites give chapter and verse: always worth Googling on treatment and prevention.

At the very least what the Daily Wail article may have done is raise awareness of the problem - a 69 per cent increase in a year ffs - and if that means that a single patient goes home WITHOUT contracting C.Diff. well I guess that'll be a plus.

A general question to Med practitioners reading this thread:

What's the awareness campaign on C.Diff like in the hospital YOU work at ?

Le Chevre
 
#8
If any patient or relative has been fobbed off over C. difficile then clearly that is wrong, however half-truths from whatever source (including support groups) should be challenged. My point is that whoever wrote the "advice" quoted needs to realise that it is misleading and I will do as you have sensibly suggested and email them.

Yes rates of MRSA and C. difficile are increasing and patients and relatives have a right to be worried and concerned. What also concerns me is the number of lay people who pass themselves off as "experts". Let me give an example. A couple of years ago a company in Coventry called the Training Foundation launched a electronic web based learning package for NHS staff to use which was called "MRSA - You can make a difference". The marketing was at best pushy and at worst possibly illegal. They had got together with an organisation called MRSA Support and were threatening to name and shame any trust that had not brought the product. My Strategic Health Authority, like many other NHS organisations, bought a one year user license at a cost of £125,000.

Various people within infection control nationally were muttering that this package was not very good and I was tasked with looking at it in detail. What I saw really concerned me. One of the tests in the package was a scenario in which a post op hip replacement patient has a temperature and you were asked what to do next. The "right" answer according to this training package was to swab the patient's nose and groin to look for MRSA. Well you could do that but sadly it won't lead you to understand if the patient has an infection or what the cause might be. In such a patient if an infection was suspected then the respiratory tract, urinary tract and wound would be more likely to be affected. The presence of MRSA in the nose or groin is not going to give a patient a temperature as its almost certainly only colonisation rather than infection. Thus the learning package was advocating dangerous practice. I challenged the Training Foundation as to the background of the authors and it turned out, as I suspected that they were not really qualified to advise or train others in this area.

“What's the awareness campaign on C.Diff like in the hospital YOU work at ?”

The labs inform the infection control team of every new case of c. diff
Each case is seen by an infection control nurse and if necessary isolation recommended (not every “case” actually has active symptoms)
First line treatment is commenced and if possible the original antibiotics stopped
An advice sheet is given to the nursing staff and a leaflet is available for patients and relatives
The patient remains in isolation until symptom free for 48 hours
The room is cleaned daily and on discharge with 1000ppm sodium hypochlorite using separate cleaning equipment
Staff routinely wear gloves and aprons for known or suspected cases.
The infection control team routinely keep tabs on the numbers of new cases per ward per week in case of an outbreak.
Like MRSA rates per month of C. diff are reported back to wards and managers
Antibiotic protocols are used to use only those drugs which lessen the risk of inducing C. difficile disease.
The trust’s c. diff policy is current and reviewed every 24 months.
The trust’s new e-learning package for infection control has a section specific to C. diff.
We are (as per DoH recommendations) currently in discussion with our local PCT to agree C. diff reduction targets for the next 12 months.

I could go on but that’s probably enough.
 
#9
BBC reported that UK infection rates are 44 times higher than those in Holland.

The solution would seem to be simple. Unless you are absolutely knackered, impaled on something or bleeding to death do the following:-

1 Nip home and grab your European Health Insurance Card
2 Hobble to the nearest airport
3 Jump on the next flight to Amsterdam
4 On arrival, take a taxi to the nearest hospital
5 Obtain 1st class treatment and live to tell the tale
 
#11
Jacques_Bustard said:
AM do you have a link for that BBC report? I've looked at the site and can't see it.
It was on the TV news about a week ago when the latest stats. were released by the Office for National Statistics. A bar chart was shown. IIRC it showed the percentage of blood borne infections that were caused by either MRSA or C.diff.

The chart showed Holland with the lowest levels at 1% and the UK with the highest levels in Europe at 44%.
 
#12
Ancient_Mariner said:
Jacques_Bustard said:
AM do you have a link for that BBC report? I've looked at the site and can't see it.
It was on the TV news about a week ago when the latest stats. were released by the Office for National Statistics. A bar chart was shown. IIRC it showed the percentage of blood borne infections that were caused by either MRSA or C.diff.

The chart showed Holland with the lowest levels at 1% and the UK with the highest levels in Europe at 44%.
Thanks AM, I think I know what the BBC are refering to. This is the proportion of Staphylococcus aureus which is methicillin resistant (i.e. MRSA) identified from blood cultures in various different countries. Holland along with Norway, Sweden and Finland have a very low incidence, <1%. In the UK we are indeed at about 44% and along with Ireland, Spain and Greece are at the bad end of the European picture. Globally it gets more interesting, the US and Canada have very different rates which is strange as they have very similar health care systems, with the USA at 38% but Canada only 2%. In the Far East its even worse especially Japan where 80% of Staph aureus from hospital blood cultures is MRSA.
 

Goatman

ADC
Book Reviewer
#13
I've never been in either a Cloggie or Scandiwegian hospital ( touch wood)....are they COLDER than UK hospitals as well as cleaner?

Why is it every NHS hospital I've ever been in seems to be kept at optimum temperature for growing orchids ( and presumably bugs ?)


Lee Shaver
 
#14
Goatman said:
I've never been in either a Cloggie or Scandiwegian hospital ( touch wood)....are they COLDER than UK hospitals as well as cleaner?

Why is it every NHS hospital I've ever been in seems to be kept at optimum temperature for growing orchids ( and presumably bugs ?)


Lee Shaver
Because they're full of pensioners who wear their overcoats to the shops during the summer, at noon, during a heatwave.
 

Goatman

ADC
Book Reviewer
#15
Neuroleptic said:
Because they're full of pensioners who wear their overcoats to the shops during the summer, at noon, during a heatwave.
...and medical staff who've seen ER and Scrubs and think floating around in sterile V neck Tshirts in December is cool.....


Le Chevre

PS you fit for squash yet ?
 

Goatman

ADC
Book Reviewer
#16
Coo...amazing what you find on the Nursing Standard website - check this printable doc out :

Hopefully that gives the straight and level goods....


Le Chevre
 

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