Florence Nightingale’s Legacy

NHS England sent the man from Infection Protection Control to inspect the practice this week. He was a very nice man with a rather long checklist. We are pleased to say that he found Elborough Street Surgery very clean and free of infection.

He was pleased that we are following all the right policies and procedures and trying to reduce risks of infection to our patients. We continue to improve things though and always welcome patient’s ideas. Keeping staff up to date is always important and our cleaning company’s schedule is due for another review. Interestingly, we were told that we have six months to change all of the chairs in clinical rooms, plus the seating in reception, to plastic wipeable ones. The inspector was rather pleased that we had no toys. I know parents used to comment on how we had lovely homely rooms filled with lots of toys for the children to play with. Health and Safety frown upon this now as a harbour for germs so we only have one large wipeable toy in reception for our little patients to while away the wait.

Health care settings can provide ideal conditions to transmit germs between those who give care and those who receive care. People often come to see us when they have infections or have a weakened immunity through illness. We have a responsibility to try and reduce the spread of infections. We also need to remember that not all bacteria are harmful though, and a certain amount of bacteria living in our bodies and environments can actually do us good. Interestingly there are 100 trillion bacterial cells in your body normally, and only ten trillion human cells. These forms of bacteria have been around for 3.8 billion years, without them we would not survive. In our gut we have bacteria living there normally, performing all sorts of useful roles for our digestion and immunity. Killing them off with certain antibiotics can sometimes do more harm than good.

It is also useful to have a think about the Hygeine Hypothesis. See www.allergyuk.org. This suggests that the immune system needs to come into contact with a variety of micro-organisms and bacteria while it is developing at the infant stage in order that it responds appropriately later in life. If we become too fixated on destroying germs then it may mean many of our children may not be developing adequate immune systems.

First born children are more likely to suffer from allergies due to a sterile home environment, while second borns seem to benefit from older siblings bringing home germs which allow their immune systems to develop and respond.


We know that the balance between good and bad bacteria is not always easy. There is no doubt that with the advent of immunisations in the last one hundred years we have eradicated many fatal illnesses. The development of antibiotics have certainly saved lives and improved outcomes to people’s health too. As human’s we have benefitted but now we cannot reply on this. We are now aware that antibiotic resistance is on the increase. This sadly means that the bacteria have outwitted us, and antibiotics no longer always work. The World Health Organisation’s top priority at present is to tackle this problem. At a GP level, we work with our patients to try and restrict antibiotic prescribing to only where it is strictly necessary. We have certainly seen patients at Elborough really aware of this. We can also offer testing when people have coughs and colds to determine whether our patients have viral illnesses, where antibiotic use does not help. The test involves taking a small sample of fluid from the nose with a little swab. It takes a few seconds and St Georges are really quick at getting the results back to us in a matter of days. This has really helped us cut down antibiotic prescribing for our patients. We also only use disposable instruments in smears and minor surgery to to minimise cross infection risks and we have liberal supplies of hand sanitiser everywhere as you may have noticed if you have been to Elborough.

Florence Nightingale , who was one of the most famous women in Victorian medical times, identified the need to create a clean, tidy medical environment to reduce germs. (I also love the fact that she also invented the pie chart). One of her pieces of advice was to leave a window open in wards. She noticed that fresh air inside was associated with less infections. Obviously, this might let outside infections in too. It is the balance we need between good and bad bacteria to help us stay healthy. Minimising risk is all well and good but we cannot live in completely sterile environment.

Anyway, this week we have satisfied the inspector and reviewed all the things that we need to be better at. I think Florence Nightingale would be fairly pleased with the progress.

Dr Q