New buildings, old problems

Talk to many doctors and you will hear then say that their crumbling Victorian buildings had a charm and ambience (feng shui if you will) that is unmatched by a modern glass tower. But is the new building actually better? It may be filled with labour-saving and energy efficient devices but if the glass windows face into the midday sun it will get unbearably hot. And as it is air-conditioned you cannot open the windows. And maybe the air-conditioning cannot be used because the water cooling tanks harbour legionella. This may be why so many modern hospital wards stink – made worse because there are not enough nurses to wash the decrepit patients.

On a personal note I will exempt Torbay Hospital from this diatribe, because the personal care my mother received during her terminal illness was exemplary and gave me hope that if the NHS can return to standards like theirs, all could be well.

The Victorians knew a lot about cross-infection, which is why they built serried ranks of wards separated by open corridors to prevent transport of infectious agents across the whole hospital. Lots of nurses kept the patients clean. Any floating microbes would drift through the ward to the centre, where a coal fire burned constantly, so that air was sucked into the tall chimney and the bugs were incinerated as they followed the air flow. Of course there were side-wards for highly infectious folk and the windows were often left open (or more recently extractor fans maintained flow; one has of course to remember that if the sideroom contains the infection and the main ward holds the immunocompromised then the fan must suck out, not in[1], while if the patient with no white cells is in the sideroom for their own safety…).

I like the idea of burning bugs. So let’s redesign all hospitals to include a gas or coal heating system, complete with tall chimneys, so the MRSA, C. Diff and other such can be massacred.

[1] This was brought home to me as an SHO at the Hammersmith Hospital, when the team visited a sick and septic patient in a sideroom on the haematology ward, which was full of aplastic and neutropenic patients. My boss, neurologist Nigel Legg, spotted the fan was going the wrong way. As we shut the door to leave he looked down, stamped his foot carefully and grinned at us “Got one!” he said.


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