Skip main navigation

Setting the scene: part 1

The video tells the fictional story of two patients, and how they are affected by an infection with a resistant organism.
No more lies! No more lies! No more lies! No more lies! We’re outside the Dunswood Hospital, where yesterday a second patient has died from a deadly resistant infection. As you can see, there are protesting families outside the hospital. With me is the CEO, the chief executive dealing with the incident, Dr Shona McFarland. We understand this is the most serious and possibly preventable outbreak you’ve had to face. Of the six patients who have been infected, two have lost their lives. Can you confirm this and tell us what is being done to bring an end to this worrying situation? Come on Shona, get out of this one.
Well, to begin with, I want to reassure the public that this outbreak is under control. Rubbish! Rubbish! I mean, whilst it’s not always possible to predict when an outbreak such as this will occur, we have put enhanced infection control and other measures in place. The ward and the operating theatres are running as usual. The situation is under control. And no new cases have been reported this week. We want the truth! We want the truth! No more lies! What other measures are you referring to? And why wasn’t it there from the start? Antibiotic prescribing. Well, to begin with, we have isolated any infected patient to halt the spread of infection in the ward.
And most importantly, we have reviewed our antibiotic prescribing practises, which has meant that patients are dealt with as quickly and effectively as possible. It’s too little, too late! Yeah! Too little, too late! What do you say to your critics who say too little, too late. And why weren’t the patients given the correct treatment from the outset so we could bring this infection outbreak to a stop earlier? Well, as I said earlier, I just want to reassure everyone that the correct infection control measures are now in place. But of equal importance is the treatment of the patients. Now, this can be very difficult to judge. With antibiotic resistance, it means is it not all antibiotics respond the same in all patients.
Now, we have reviewed our antibiotic prescribing policies, which has led to improvements for patients and a reduction in new cases. Dr. Shona McFarland, thank you. No more lies. No more lies. We’ll of course keep you up to date as the story progresses throughout the day. This is Matthew Foster, reporting for RK TV. No more lies! No more lies! No more lies!
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.
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 he 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.
As far as we were concerned, this was a routine elective operation and standard procedures were followed pre-operatively. Usually patients ought 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 was 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. Oh, oh. There were lots of men in the same bay, all like Bill.
They all had catheters. And looking back, there’s just so many ways he could’ve picked up that other infection. But 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 go into hospital. I suppose I should have 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 him to perform his operation.
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 he 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.
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 even think about it at the time. But Mr. Jenkins was always helping other patients, 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 obvious. No patients or visitors can pop in without permission.
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.

For your first activity you are asked to watch this video, which runs for 8 minutes and tells the story of two patients, Bill & Fred, and how they are affected by an infection with a resistant organism.

DISCLAIMER – All characters appearing in this work, both parts 1 & 2, are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.

As you watch the video consider the following:

  1. What deficiencies in infection control and clinical practice are depicted in the video?

  2. What are the key drivers for resistance?

  3. What are the key prescribing issues worthy of investigation in this video?

This article is from the free online

Antimicrobial Stewardship: Managing Antibiotic Resistance

Created by
FutureLearn - Learning For Life

Reach your personal and professional goals

Unlock access to hundreds of expert online courses and degrees from top universities and educators to gain accredited qualifications and professional CV-building certificates.

Join over 18 million learners to launch, switch or build upon your career, all at your own pace, across a wide range of topic areas.

Start Learning now