I have just submitted an invited chapter for a textbook on preventing health-care associated infections. The editor felt my novel The Reaper’s Rainbow significantly added to the debate. The novel’s theme allowed me to ask probing questions and he wanted the same in the chapter.

It’s not often I’m invited to push the boundaries in the hospital infection field. Infection control professionals (ICPs) follow best practices which are defined by committees and endorsed by the World Health Organisation. Evidence-based research found in peer-reviewed medical journals forms the foundation of these best practices. That combination is all encompassing. Any ICP who opts to venture outside the constraints of best practices and peer-reviewed articles is seen as reckless, even professionally negligent.

Should patients be happy and content to know this amount of effort goes into their protection? To answer that, let me put it another way. When a family is bereaved by a hospital infection, had that family been well served by these best practices? No. Their loved one is dead from a needless infection. That suggests a serious level of ‘disconnect’ between best practices and patient care.

Nobody wants the infections and highly qualified professionals all over the world are dedicating their lives to defining best practices. What is going so wrong that tens of thousands of patients still die from these needless infections every year? Was the answer inside or outside the boundaries?

There are good patient advocate groups like MRSA Action UK who do their best to introduce new ideas. I’ve worked with them to see where our respective activities could be best directed. I quickly appreciated they also often encountered the belief that all answers lay in the peer-reviewed articles within the medical literature. I routinely read those articles as part of keeping my technical knowledge current. This time I decided to re-read them from the perspective of a family that had lost someone to hospital infections. Might that change of view reveal something different?

I was appalled. What the peer-reviewed literature actually does is prove how bad things are. One article by a team of microbiologist for whom I have enormous professional respect, revealed that over half the healthcare workers in their survey only followed infection control procedures when they felt there was an infection threat to themselves!  Another article was written by a microbiologist who had been the editor of an acclaimed infection control journal. Following an accident, she became a patient, forcing her to view ‘best practices’ from the patient perspective. To paraphrase her story, she was also appalled. Despite her career history, she was not prepared to insist her careworkers undertook proper hand hygiene practices. If she won’t, what hope is there for mere members of the public who become patients? That is very scary.

To foster a larger debate, I suggest ‘best practices’ could be seen as ‘best of the failed practices’.

Dr Harley Farmer PhD BVSc(hons) BVBiol(path) MRCVS

Published author, campaigner, inspirational speaker, CEO of NewGenn

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