Even the ‘little things’ are big things when you’re the patient

It’s often the little things that make the difference. Sitting on the hospital trolley, recovering from my latest nerve block procedure, watching the nurse flip open a treatment pack and lay out the instruments for the next patient, I marvelled at how deftly and intuitively she performed the procedure. It was like a mini-lesson in neuroscience: the hours of repeated practice laying down the neural pathways, the skills developing to the point where the actions ultimately become almost unconscious.

I was interested to see how often the nurse washed her hands – in the couple of minutes I observed her she did so maybe three times. You could see this too was an automatic action, but not to the same degree.

On the third occasion, I noticed she had to remind herself to go back to the sink; you could see this because she stopped and changed direction mid-stride. Why was that? Perhaps in performing repetitive actions, the brain becomes a little confused.

And therein lies the danger, right in the gap between semi-conscious, learned function and willed intention, between attention and inattention. It’s such a small thing, but a simple error like forgetting to wash hands makes little difference to me, a healthy adult undergoing a time-restricted and minimally invasive procedure as an outpatient. For others, a small mistake can be life-threatening.

I was reminded of this when I edited Clostridium difficile infection: nursing considerations, a thorough, excellent, clinical article by Brett Mitchell of Avondale College in Wahroonga, Australia, published in Nursing Standard on July 23 2014. A few years back, my beloved Nana died from complications arising from C. difficile infection. For her, it wasn’t the hospital, as we had all thought, but the community that proved fatal – a report showed the infection originated in the GP’s surgery. Apparently, C. difficile is becoming more common in the community.

Mitchell’s paper alludes to community-acquired infection as one of a number of pathways for C. difficile infection currently under investigation. There is plenty of other information for nurses to absorb too. For instance, did you know you could culture C. difficile from around 30 per cent of inpatients?

One message I took from the paper is the importance of environmental cleanliness, preventing ‘the contaminated environment… subsequently [acting] as a reservoir for transmission, for example via the healthcare worker’s hands’. Most of all, though, I was reminded of the apparently simple things that, during my training, I probably took for granted as ‘little’, namely aprons, gloves and handwashing.

Nurses are scapegoats when things go wrong. All manner of things, including evidence, pathogenic organisms and newspaper headlines, change and mutate around them. Hence the constant need to adapt and update. But perhaps we should be more thankful that so many, just like my nurse in the pain control clinic, get it right in so many important ‘little’ ways, day after day.

About the author

Ed Rowe trained at St Mary’s Hospital in Paddington, London, in the late 1980s and practised in general surgery. He now works on Nursing Standard’s art & science section as a clinical editor. Ed blogs in a personal capacity about the NHS and health-related issues at http://livesintheirhands.wordpress.com/