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Revisiting setting the scene: Part 1

A video - Part 1 of the Scenario
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I’d been unwell for some time. And after loads of visits and antibiotic tests for a urine infection. The doctor told me I had prostate cancer.
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We decided together that Bill should have the operation, and we wanted to get it over with as quickly as we could. You see, Bill hasn’t been well for about five months, since we were on the cruise. He had a chest infection, and was given lots of different antibiotics from the GP, and then he got what the GP said was another urine infection, for which he also got antibiotics. And then our GP put him on a pill at night to try and stop these infections. We were worried, weren’t we, because you didn’t get better, and in fact he had diarrhoea and sickness twice. And the GP sent him along for stool tests because he was worried about that nasty C. diff.
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As far as we were concerned, this was a routine, elective operation and standard procedures were followed pre-operatively. Usually, patients start to recover well one or two days after prostate surgery. Unfortunately though Mr. Jenkins did remain unwell. His temperatures were high, and he had little energy. Cultures were ordered and specimens were taken from his catheter and his bloods done. There were still no major concerns at this point. The nurses and staff on the ward didn’t seem worried about hygiene. I didn’t see them washing their hands, and the doctor who put the catheter in wasn’t very hygienic, either. She took three attempts, and Bill was in agony. [BILL EXCLAIMS] There were lots of men in the same bay, all like Bill.
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They all had catheters, and looking back, there’s just so many ways he could’ve picked up that other infection.
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I just thought he’d be OK and protected, because, well, like I mentioned earlier to you, four months ago he had antibiotics when he got ill on the cruise in the Med. So I just thought he’d be immune and OK by the time he got into hospital. I suppose I should’ve said something, really, but you don’t like to, do you? Consultants know best, and I don’t want to upset anyone, especially when Bill’s relying on them to perform his operation.
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We do have lots of quite poorly patients on the ward, and elderly, in particular, can take some time to recover and can get secondary infections. So when the results came back, it wasn’t good news, but it wasn’t anything to be too concerned about. The microbiologist said he has a resistant infection. The consultant decided on IV antibiotics. Not the treatment that the microbiologist had actually recommended, but the blockbuster antibiotics he normally uses for such cases. He normally says about 14 to 28 days, frequently likes to use them to prevent such infections. Also, although it’s not on our policy, his wife was understandably concerned and not very happy. But after a long time on IV antibiotics, Bill began to improve.
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In fact, prior to discharge, he was able to entertain and help other patients on the ward. Little did we know at the time. I didn’t really think about it at the time, but Mr.Jenkins was always helping other patients. Hey, Fred. Especially Mr. Smith, who was quite weak and had poor coordination. Looking back, I suppose it wasn’t a good idea for him to be so close. He was probably spreading his germs even though he was getting better. There aren’t really any rules about patients contacting each other. Well, that’s not strictly true. When they’re in isolation, it’s all obvious– no patients or visitors can pop in without permission.
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Mind you, even if I thought it was wrong at the time, I wouldn’t have mentioned it. I mean, even the nurse was giving the thumbs up to Mr. Jenkins helping Mr. Smith with his lunch. Thanks, Bill. If he hadn’t fed him, who would have? Thank you. The nurses and other staff are just too busy to feed everybody, and do everything they need to all of the time.
In the introduction to the course, Professor Nathwani asked you to watch “Antimicrobial Stewardship: Managing Antibiotic Resistance Part 1” and consider a number of infection related questions in relation to the patient’s journey.
Please watch this video again, or read the transcript below, noting this time the key issues for antibiotic stewardship.
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Antimicrobial Stewardship: Managing Antibiotic Resistance

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