Here is some startling data from the UK hospitals, supposed to have high standards of cleanliness

“The very first requirement in a hospital is that it should do the sick no harm.”— Florence Nightingale.

In the 18th century, when hospitals opened in England, the mortality of hospitalised patients was almost 100%! So was the situation in Scutary in Istanbul during the Crimean War where all seriously injured soldiers died in the makeshift hospitals on the war front, until Florence Nightingale went there. This hospital-death syndrome was called hospitalism, for short. Florence brought it down to 40%, simply by cleaning the soldiers and their wounds, bandaging the wounds and feeding them with nutritious meals. She called herself the ‘General of buckets, soaps, food, bandages and scrubs’.

Now, with all the advances in hospital-care, including the fashionable intensive-care units (ICUs), surely things should be better. After all, even small hospitals in remote areas have so-called ICUs, even if they do not have round-the-clock medical cover. Well, I was reading in The Daily Mail of 17th April, en route to London, a story about hospital infection deaths in the UK which has the best infection-control care today. The highest body of medical audit in that country, National Institute of Clinical Excellence (NICE), was concerned about the very high mortality in seriously ill patients admitted to the hospitals there due to hospital-acquired infections (nosocomial).

In England, a small country, one in 16 patients is developing infections in NHS hospitals because of poor staff hygiene. NICE says that 300 patients a day, or 300,000 a year, are infected by a member of the hospital staff or by dirty equipment. This may directly kill 5,000 patients in one year and contribute to another 15,000 deaths. God only knows the figures for our hospitals in India, even as we seem to have borrowed the American practice of getting 90% of their profits by keeping dying patients, for the last 10 days of their sojourn on this planet, in the ICUs.

Also, in August, when the newly-qualified doctors join duty as house officers, the infective death rate goes up so sharply that the Association of British Medical Schools has come up with a graded joining date for them—half of them starting in September instead.
The deputy director of NICE, professor Gillian Leng, called a press conference to share the concern of the authorities as British hospitals are again going back to the 18th century hospitalism! This has been attributed to the staff, especially doctors, not washing their hands between seeing patients. The more senior the doctor, the less s/he washes hands! Doctors’ hands, their neck ties, stethoscope chest pieces, cell phones and their white aprons had more deadly germs than the hospital floors.

Hospital administrators have been warned to be very strict about compliance with the hand washing instructions and also with a new dress code. Some hospitals have banned cell phone use by doctors and nurses in the wards. Some ICUs have sterile stethoscopes and do not allow doctors to take their own inside.

Illness depresses the human immune system. This is worsened by antibiotics and other drugs that the patients are injected with which destroys the main organ that keeps our immune system fit, viz., the human gut. When the gut starves, the gut bacterial flora changes; the friendly germs die in large numbers. NICE now cautions British doctors to be parsimonious with antibiotic prescriptions. NICE says that no antibiotic should be administered for common cold, feverish cold, sore throat and flu-like illnesses, the so-called minor illness syndromes, which form the bulk of patients on a given day, especially in winter.

I am sure, the situation in Indian hospitals is worse than the one in the UK; but we do not keep our records accurately which are anyway rarely audited. Many smaller hospitals do not have mechanised laundry and the linen is washed by ordinary washer-men. We, the doctors, should be more careful and responsible in this. Let us make our hospitals patient-friendly and safe for the patients. Let us also do more research to find out how not to depress the human immune system in the hospitalised patients which might go a long way in reducing infection-related needless deaths.

Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.