The most cost-effective ways to save lives?

We recently covered NICE's advice for doctors on hand-washing, I was wondering what other action or advice would have as big a potential health impact. Any ideas?

(Our article here: nhs.uk/news/2014/04April/Pa...

[JossS]

I think the link should be

nhs.uk/news/2014/04April/Pa...

[Mdaisy]

Hello RobfinchNHS Choices,

Just for a little background I am an ex nurse with an interest in infection control when I was in practice. Not only should washing hands and visitors taking precautions are needed in my opinion but also should Nurses/Carers at night who should be cleaning drug trolleys, computers, noted trolleys etc in my personal opinion. I often used to do this on night duty!

I think we should be thinking about door handles, toilet flush, turning on taps, lockers etc things we touch but do no normally think about in everyday life. It may sound a little bit OTT, but I do not think about these things in day to day life but in hospital you need to think of the sheer volume of people touching these objects. Ward cleaners who are a regular employees seem to be more determined to keep the ward clean rather than agency staff in my personal experience and more willing & understand the importance (possibly due to induction training)

However, this is where the issue of short staff becomes an issue as the immediate patient care/ emergency medications obviously take priority and if a night shift is extremely busy these extra tasks are not possible.

I wonder if (probably nor possible with the recent NHS crisis) employing people to clean these extra areas with a specialised cleaning agent (possibly weak solution of Saniclor) once a day would in turn reduce infections, save money as people do not need certain hospital treatments (IV's Drips & Antibiotics), reduce length of stay (reducing NHS costs again ) and more importantly save lives!

Sometimes simple changes can have a greater impact than you can imagine !

Best Wishes

Emma

[JossS]

@Mdaisy

A lot of this seems to be culture and habit. Two of my aged relatives were nurses in the 20s to 40s. Being much older now, they have spent odd spells in hospital. They have both commented on the way that keeping things clean seems to have become a very defined occupation rather than just part of normal actions.

They say when they practiced all those years ago keeping things wiped and clean was something they did automatically as they moved around the ward. When they stopped to talk to a patient, they thought nothing of tidying up around the bed as they chatted, wiped down the bedside table while waiting for the thermometre and so on.

They also think part of this maybe to do with the changing face of nursing. Nurses have far more clinical responsibility (and knowledge) than back then, which is important. However, in their training, the clinical study has sort of eclipsed some of the older, more practical day-to-day aspects of nursing rather than complimenting it.

I am not sure how right they are, but it is an interesting observation none the less.

[Mdaisy in reply to JossS]

Hello JossS,

Thank You for your reply

I agree, the strict matrons back in the day would check the wards and if not satisfactory Nurse were given their instructions! Sounds harsh , maybe it was however doesn't need to be but the Matron checking then used to encourage the nurses to ensure these simple things were done!

Obviously they are arguments against Nurses cleaning due to any infection they may pick up during this activity, if gowned and wearing gloves I feel certain items Nurses use regularly could be keep clean & tidy. Also adequate Training to HCA as to the importance of cleaning around the surfaces, patient tables after helping with patient care could help infection but also make our wards look better plus the patient appreciates a clan table with their drink in handy reach (especially as meals are served here!)

Again it all goes back to time management, staffing, training etc, if staff is very short the priority of making sure Mr John Doe gets the medication, care he needs obviously takes priority. Some wards have volunteers willing to help the local hospitals, this is great as they can do these little jobs and talk to patients which is another thing Nurses sometimes struggle to do due to the above. Nursing training promotes Holistic care with Maslow's Hierarchy of needs, unfortunately you soon realise it is harder to put into practice some days !

I wish there was an answer as improvement in this area could save NHS funds, reduce hospital acquired infection and most important save lives.

Nice to chat with you

Emma

[Bioburden]

Stronger consistent advice on weight management and activity could save thousands of lives as well as free up squeezed NHS resources.

The recent data from the Million Women Study showing that 1/8 hospital admissions of women over 50 were attributable to excess weight should sharpen the minds of healthcare practitioners in dealing with this growing issue. If GP's, specialists, nurses, midwives, etc reinforced the message that carrying excess weight has an immediate and long term impact on health, then this stops the 'normalisation' of obesity.

Sadly, GPs don't have the time and may feel they should not address the issue, and ever more sadly, so many health professionals are themselves overweight, that they don't set a good example.

As type 2 diabetes is a disease that is virtually always preventable, we could save the NHS millions by rolling back the tide of flab that is costing lives, as well as £££££

[JossS in reply to Bioburden]

AS someone who is seriously over weight, I am not sure this would achieve anything at all.

The problem with obesity is that though it can cause medical issues that will involve medical people, in itself it is not seen as a medical issue (although perhaps it should be)

The rise in obesity is down to one, very simple cultural phenomenon - we eat too much and we don't realise it. It is not about fast food, it is not about too much fat or too many carbs or too many calories in food we buy, it is simply about quantity; the average plate-size/portion size has increased, possibly doubled, in the last 70 years.

Its all very easy to say "stop eating fast food" or "read the packets" or "join a club," but how do you actually turn round to an individual or even an entire society and say, we eat too much - just eat less.

It does not fit with society as we know it where we want huge variety available at all times, want to save money by buying bulk offers and so on ... it effects every part of our society from marketing to jobs to how we want to be seen by our neighbours.

The amount and variety of food we put on our plate is really important to us - how do we change it?

I don't know the answer, but I suspect it really does not start with a medical professional.

[IanRob]

Is there any evidence that having a positive attitude has an effect in the clinic?

[JossS]

Actually, I think it is far simpler than that and is a mixture or marketing and availability.

Since the end of the last war, the range and quantity of food available in the West has grown hugely and the price of many items has, in relative terms come down. Items that were hugely expensive (like avocados, for instance) are now common place, increasing what is available to the ordinary consumer.

The rise in supermarkets and the competitive environment in that part of the food supply industry has meant that there has been a downward pressure on prices - supermarkets to be super profitable have needed to sell larger quantities to the same number of consumers. So the emphasis has been on bigger portions, for fewer people.

Take, for instance, a chicken. I have chatted about this with my mother - the size of chicken she bought to feed six of us in the 1960s was smaller than is currently sold to feed four.

The pressure from the food industry for us to keep eating is huge. Politicians have focused on things like McDonalds, but it is foolish to narrow it down to one sector. I am one of a huge number of people who really do not like junk food and I do not have a sweet tooth. I love fish and salad and good cheeses, bake my own bread and I grow wonderful veggies on my allotment.

foodloversdiary.com/

But over the years, the quantity of what I have eaten has caused me problems.

A few years ago for an experiment I cooked for my family the size of meals I had when I was young. I come from a comfortably off, middle class family with a really good cook for a mother, so this was far from rationing or a menu from a poor family.

But the complaints I got about the portions being too small, not enough meat, and the rest was amazing. "Why you giving us so little? Have we got money problems?"

We buy more and more, eat more and more and waste more and more. The food industry is partly to blame because they have encouraged us to increase our basket size to increase their profits. But it is not just them who are to blame but a society that has come to expect big portions whether that is a huge pizza or a massive roast with lots of frozen roast potatoes (buy 1 get 1 free, so why not eat the lot in one go?)

When you look at developing countries, particularly Asian countries, they are where we were 30 years ago. Their diet is changing, food has become more available, and they are beginning to eat more. And they are beginning to get fatter as a result.

It is easy to blame manufacturers who produce very fattening foods - bit it misses the point. Ban every bit of fast food in the country and we will still have a problem. We just eat too much.