WEBVTT - The Mystery That Makes Hospitals Sick

0:00:10.760 --> 0:00:13.600
<v Speaker 1>Hospitals are where we go to get better, not sick.

0:00:14.400 --> 0:00:17.200
<v Speaker 1>But the scary fact is hospitals are some of the

0:00:17.239 --> 0:00:21.560
<v Speaker 1>most hazardous places in the world. On any given day,

0:00:22.079 --> 0:00:25.320
<v Speaker 1>about one and thirty patients in the United States gets

0:00:25.320 --> 0:00:30.680
<v Speaker 1>a healthcare associated infection. Increasingly, the germs that are the

0:00:30.760 --> 0:00:34.440
<v Speaker 1>hardest to treat, the ones that are killing patients the fastest,

0:00:35.360 --> 0:00:39.760
<v Speaker 1>are coming from outside the hospital. They're being carried in

0:00:40.320 --> 0:00:47.560
<v Speaker 1>by the patients themselves. Welcome to Prognosis, a podcast about

0:00:47.560 --> 0:00:51.120
<v Speaker 1>health and science, medical technology, and the changes that are

0:00:51.200 --> 0:00:55.400
<v Speaker 1>underway across the world. I'm your host, Michelle fay Cortes.

0:00:56.640 --> 0:00:59.800
<v Speaker 1>This season, we're talking about the rising threat of superbugs,

0:01:00.480 --> 0:01:05.000
<v Speaker 1>bacteria that are resistant to the strongest infection fighting medications available.

0:01:05.800 --> 0:01:09.800
<v Speaker 1>In this episode, Bloomberg's Jason Gale explores how one hospital

0:01:10.120 --> 0:01:13.960
<v Speaker 1>became wrapped up in a global mystery and how solving

0:01:14.000 --> 0:01:17.280
<v Speaker 1>it created a new way to stop superbugs from sneaking

0:01:17.280 --> 0:01:22.360
<v Speaker 1>into the hospital and harming patients. The solution is incredibly simple,

0:01:23.000 --> 0:01:27.720
<v Speaker 1>and it's also incredibly important. These sorts of measures are

0:01:27.760 --> 0:01:31.000
<v Speaker 1>what we need for the war against superbugs to succeed.

0:01:32.319 --> 0:01:35.520
<v Speaker 1>And fair warning for the squeamish among our listeners. What

0:01:35.560 --> 0:01:37.520
<v Speaker 1>you're about to hear has a lot to do with

0:01:37.680 --> 0:01:47.440
<v Speaker 1>them well human poop. Lindsay Gryson is standing over an

0:01:47.440 --> 0:01:51.600
<v Speaker 1>empty hospital bed giving a demonstration. He's just rubbed his

0:01:51.680 --> 0:01:54.840
<v Speaker 1>hands with some alcohol based sanitizer and talking as if

0:01:54.880 --> 0:01:57.400
<v Speaker 1>he's admitting a patient. I'm glad you final him added

0:01:57.480 --> 0:02:01.080
<v Speaker 1>into hospital. I'm sorry you're being unwell. Professor Grayson is

0:02:01.200 --> 0:02:04.640
<v Speaker 1>head of the Department of Infectious Disease and Microbiology at

0:02:04.640 --> 0:02:08.480
<v Speaker 1>Austin Health, a three campus hospital system in suburban Melbourne.

0:02:08.960 --> 0:02:11.400
<v Speaker 1>He's rolled up the sleeves of his blue shirt and

0:02:11.520 --> 0:02:14.919
<v Speaker 1>tells the imaginary patient what to expect next. Over the

0:02:14.960 --> 0:02:16.919
<v Speaker 1>next few days, we're going to have to sort out

0:02:16.919 --> 0:02:20.400
<v Speaker 1>why you're so sick. Obviously, we're concerned about some infections.

0:02:20.800 --> 0:02:23.920
<v Speaker 1>Professor Grayson grabs a plastic pack off the stand next

0:02:23.919 --> 0:02:27.480
<v Speaker 1>to the bed. It contains a five inch long cotton

0:02:27.480 --> 0:02:31.040
<v Speaker 1>tipped stick in His team routinely use these sticks to

0:02:31.160 --> 0:02:35.880
<v Speaker 1>screen patients across the eight bed hospital system. They're looking

0:02:35.880 --> 0:02:43.280
<v Speaker 1>for antibiotic resistant bacteria or superbugs. Superbugs can result in

0:02:43.680 --> 0:02:48.120
<v Speaker 1>life threatening infections for patients. Screening alerts Professor Grayson and

0:02:48.160 --> 0:02:51.240
<v Speaker 1>his team to these gems and prevents them from spreading

0:02:51.240 --> 0:02:55.360
<v Speaker 1>around the facility. The stick looks like a giant Q tip,

0:02:55.840 --> 0:02:59.560
<v Speaker 1>but Professor Grayson has another name for it. Here's erect

0:02:59.600 --> 0:03:03.760
<v Speaker 1>or swab. It's pretty straightforward, that's right. Professor Grayson collects

0:03:03.760 --> 0:03:07.680
<v Speaker 1>and screens hundreds of fecal samples annually. You can either

0:03:07.760 --> 0:03:10.160
<v Speaker 1>take it yourself or otherwise one of the nursing staff

0:03:10.160 --> 0:03:12.200
<v Speaker 1>can take it. The crucial things we need some fecal

0:03:12.240 --> 0:03:16.040
<v Speaker 1>material on it. The testing schedule works like this for

0:03:16.120 --> 0:03:19.480
<v Speaker 1>patients at high risk of getting an infection, such as

0:03:19.520 --> 0:03:24.000
<v Speaker 1>those receiving an organ transplant, undergoing cancer treatment, or having

0:03:24.040 --> 0:03:28.519
<v Speaker 1>spinal surgery. They're screened on admission and then weekly. Additionally,

0:03:28.560 --> 0:03:31.400
<v Speaker 1>the Austin carries out a spot check every six months,

0:03:31.760 --> 0:03:35.000
<v Speaker 1>subjecting every patient admitted over a one week period to

0:03:35.040 --> 0:03:38.680
<v Speaker 1>the awkward exam. Professor Grayson and his team don't just

0:03:38.840 --> 0:03:44.119
<v Speaker 1>test patients every month. Waiting room chairs, telephones in nurses stations,

0:03:44.520 --> 0:03:49.440
<v Speaker 1>and other hospital surfaces are also swab for drug resistant bacteria.

0:03:49.760 --> 0:03:52.440
<v Speaker 1>The reason all of this testing happens is because it

0:03:52.480 --> 0:03:55.800
<v Speaker 1>gives the hospital staff a snapshot of what superbugs are

0:03:55.880 --> 0:03:59.960
<v Speaker 1>lurking waiting to spark an outbreak. That knowledge is giving

0:04:00.080 --> 0:04:03.640
<v Speaker 1>Professor Grayson and his team more time to identify and

0:04:03.720 --> 0:04:09.400
<v Speaker 1>respond to problems before they turn into crises. Professor Grayson

0:04:09.440 --> 0:04:12.360
<v Speaker 1>says he became a doctor because of his interest in people.

0:04:13.040 --> 0:04:16.880
<v Speaker 1>What fascinates him about infectious diseases is the way microbes

0:04:16.920 --> 0:04:21.359
<v Speaker 1>are constantly evolving to circumvent our treatments. Understanding how the

0:04:21.400 --> 0:04:24.039
<v Speaker 1>microbes are changing requires him to be something of a

0:04:24.240 --> 0:04:28.240
<v Speaker 1>Sherlock Holmes of superbugs, always looking for clues about which

0:04:28.320 --> 0:04:31.880
<v Speaker 1>bugs are trying to sneak into his hospital like a detective.

0:04:32.000 --> 0:04:35.080
<v Speaker 1>You know, someone comes in with a problem. It's fairly undifferentiated.

0:04:35.920 --> 0:04:38.440
<v Speaker 1>You're investigating him. You find the barb, your workout which

0:04:38.960 --> 0:04:43.279
<v Speaker 1>antibiotics hopefully you can use. It's very satisfying. I like

0:04:43.520 --> 0:04:47.040
<v Speaker 1>hol like humans and talking to humans. This screening process

0:04:47.200 --> 0:04:52.440
<v Speaker 1>is revolutionary in how hospitals treat bacterial infections and use antibiotics.

0:04:52.960 --> 0:04:56.560
<v Speaker 1>But it wasn't always this way. The story of how

0:04:56.600 --> 0:04:59.800
<v Speaker 1>Professor Grayson came up with the rector swab came out

0:04:59.800 --> 0:05:05.520
<v Speaker 1>of the mystery. This mystery caused Professor Grayson to completely

0:05:05.600 --> 0:05:08.000
<v Speaker 1>change how we thought about how hospitals care for their

0:05:08.000 --> 0:05:12.960
<v Speaker 1>patients and even how hospitals are structured. Before this mystery

0:05:13.000 --> 0:05:16.200
<v Speaker 1>came to the Austin, Professor Grayson would just see hard

0:05:16.279 --> 0:05:20.200
<v Speaker 1>to treat infections and patients with weakened immune systems, and

0:05:20.279 --> 0:05:23.599
<v Speaker 1>often we thrashed them with antibodics to say of their life,

0:05:23.760 --> 0:05:26.840
<v Speaker 1>and you know, there's no surprise that they developed a

0:05:26.839 --> 0:05:30.640
<v Speaker 1>superbug or they picked up a supermark. But something changed

0:05:30.720 --> 0:05:34.760
<v Speaker 1>a little over ten years ago. Increasingly he started seeing

0:05:34.920 --> 0:05:39.679
<v Speaker 1>healthy people getting these superbugs. Middle aged businessmen were among

0:05:39.720 --> 0:05:44.000
<v Speaker 1>the first cases. Even though they were fine otherwise, they

0:05:44.000 --> 0:05:47.599
<v Speaker 1>were getting critically ill from a bacterial infection that required

0:05:47.720 --> 0:05:52.719
<v Speaker 1>potent antibiotics. Professor Grayson had never seen cases like these before,

0:05:53.400 --> 0:05:57.320
<v Speaker 1>but he noticed a common history. These patients had recently

0:05:57.400 --> 0:06:01.200
<v Speaker 1>undergone a biopsy of their prostate land. Back then, the

0:06:01.240 --> 0:06:05.200
<v Speaker 1>procedure was pretty routine for checking for prostate cancer. It

0:06:05.320 --> 0:06:08.520
<v Speaker 1>involved inserting a probe in the rectum and the probe

0:06:08.520 --> 0:06:11.200
<v Speaker 1>would be fitted with a needle that would collect a

0:06:11.200 --> 0:06:15.960
<v Speaker 1>dozen specimens for analysis. So the neurologists went put a

0:06:16.040 --> 0:06:18.240
<v Speaker 1>scope in the rectum and then punched a hole through

0:06:18.279 --> 0:06:23.600
<v Speaker 1>the erectal wall into the prostate. Very standard procedure, piercing

0:06:23.640 --> 0:06:26.440
<v Speaker 1>the rector wall can enable bacteria from the bowel to

0:06:26.480 --> 0:06:30.680
<v Speaker 1>get into the prostate, bladder and bloodstream. An antibiotic like

0:06:30.800 --> 0:06:34.680
<v Speaker 1>cipro was typically given to prevent an infection. Obviously, the

0:06:34.680 --> 0:06:39.160
<v Speaker 1>patients worried about cancer, but in the past they would

0:06:39.160 --> 0:06:43.240
<v Speaker 1>have got as of antibodys just before that procedure, so

0:06:43.279 --> 0:06:47.120
<v Speaker 1>there wasn't transmission of bugs from their bowl into their prostate.

0:06:47.920 --> 0:06:50.760
<v Speaker 1>But now we're seeing patients who the next day were

0:06:50.880 --> 0:06:53.720
<v Speaker 1>suddenly had their super bug in their blood. These men

0:06:53.760 --> 0:06:57.400
<v Speaker 1>were getting critically ill. They were sick because the cipro

0:06:57.560 --> 0:07:01.440
<v Speaker 1>didn't work. The drug didn't work because bacteria in their

0:07:01.480 --> 0:07:05.599
<v Speaker 1>intestines were chewing it up and spedding it out. You know,

0:07:05.640 --> 0:07:08.720
<v Speaker 1>we have liver transplant, regnal transplant, phone marriage and we've

0:07:08.720 --> 0:07:10.320
<v Speaker 1>got a lot of high risk patients here. So we've

0:07:10.320 --> 0:07:12.880
<v Speaker 1>got a pretty high risk population and we have to

0:07:12.880 --> 0:07:15.280
<v Speaker 1>be very careful with those patients. But we were seeing

0:07:15.400 --> 0:07:19.280
<v Speaker 1>otherwise healthy people coming. Professor Grayson told me about these

0:07:19.320 --> 0:07:23.160
<v Speaker 1>cases a decade ago at an Infectious Diseases meeting. It

0:07:23.280 --> 0:07:27.240
<v Speaker 1>seemed an interesting anecdote, but a month later a doctor

0:07:27.280 --> 0:07:30.760
<v Speaker 1>in Canberra said he was seeing the same thing that

0:07:30.840 --> 0:07:35.160
<v Speaker 1>sounded like a trend, and some googling confirmed it. Doctors

0:07:35.200 --> 0:07:39.280
<v Speaker 1>around the world were reporting prostate biopsy patients were developing

0:07:39.280 --> 0:07:43.760
<v Speaker 1>bloodstream infections and ending up seriously ill in the hospital

0:07:43.880 --> 0:07:48.120
<v Speaker 1>days after the procedure. One doctor in Toronto calculated a

0:07:48.320 --> 0:07:52.720
<v Speaker 1>mortality rate associated with a fifteen minute procedure. It was small,

0:07:52.880 --> 0:07:55.800
<v Speaker 1>but it was growing. I wrote about it. The story

0:07:55.840 --> 0:07:59.640
<v Speaker 1>got polished in many newspapers, researchers cited it in scientific

0:07:59.760 --> 0:08:04.239
<v Speaker 1>journal articles, and the American Neurological Association released a statement

0:08:04.280 --> 0:08:08.080
<v Speaker 1>acknowledging the risk. Urologists around the globe didn't know what

0:08:08.160 --> 0:08:10.640
<v Speaker 1>to make of these cases. For this was kind of

0:08:10.720 --> 0:08:18.240
<v Speaker 1>a big shift. So why were superbugs suddenly appearing and

0:08:18.440 --> 0:08:22.040
<v Speaker 1>healthy people? How were they getting there in the first place.

0:08:22.680 --> 0:08:26.160
<v Speaker 1>Professor Grayson was on the case. We started to talk

0:08:26.200 --> 0:08:29.920
<v Speaker 1>to those in the cases, men needing biopsies. Quite often,

0:08:29.920 --> 0:08:36.080
<v Speaker 1>they've burn overseas recently. That was no coincidence. Around the

0:08:36.120 --> 0:08:40.040
<v Speaker 1>same time, researchers in Australia and Sweden had published studies

0:08:40.080 --> 0:08:44.000
<v Speaker 1>looking at the risks of acquiring superbugs while traveling overseas.

0:08:44.920 --> 0:08:48.440
<v Speaker 1>The scientists swabbed the butts of dozens of travelers before

0:08:48.480 --> 0:08:51.600
<v Speaker 1>departure and again on their return to see whether they're

0:08:51.679 --> 0:08:57.320
<v Speaker 1>normal intestinal bacteria or microflora contain multi drug resistant germs.

0:08:58.040 --> 0:09:03.560
<v Speaker 1>The results were consistent. Most travelers to Asia, especially India,

0:09:04.040 --> 0:09:07.760
<v Speaker 1>came back with bacteria capable of destroying some of the

0:09:07.840 --> 0:09:12.840
<v Speaker 1>strongest antibiotics. The researchers speculated they had ingested food or

0:09:12.840 --> 0:09:16.640
<v Speaker 1>water that had been contaminated with drug resistant fecal germs,

0:09:17.280 --> 0:09:20.920
<v Speaker 1>and those germs took up residency in their intestines, becoming

0:09:21.000 --> 0:09:26.240
<v Speaker 1>part of the normal gut flora, like silent stowaways. Later,

0:09:26.320 --> 0:09:29.520
<v Speaker 1>when these patients got their biopsy and the needle punctured

0:09:29.520 --> 0:09:32.360
<v Speaker 1>the wall of their rectums, it opened the door for

0:09:32.480 --> 0:09:36.520
<v Speaker 1>superbugs to escape into the prostrate, bladder and bloodstream. We

0:09:36.640 --> 0:09:39.520
<v Speaker 1>had been looking at these high risk patients and screening

0:09:39.559 --> 0:09:42.040
<v Speaker 1>them for their own safety and to make sure they

0:09:42.040 --> 0:09:46.640
<v Speaker 1>didn't spread bugs around the hospital. But something we realized

0:09:46.679 --> 0:09:50.560
<v Speaker 1>that the picture was getting bigger than this, you know.

0:09:50.640 --> 0:09:53.360
<v Speaker 1>But now we're seeing otherwise healthy people. And there was

0:09:53.440 --> 0:09:58.240
<v Speaker 1>this link with travel or occasionally misuse of antibiotics out

0:09:58.240 --> 0:10:00.560
<v Speaker 1>in the community, but more more off a the NATO's

0:10:00.600 --> 0:10:05.200
<v Speaker 1>travel globalization and the international movement of people and food

0:10:05.679 --> 0:10:09.360
<v Speaker 1>helped explain a large part of the mystery. Another element

0:10:09.559 --> 0:10:11.959
<v Speaker 1>has to do with the type of bacteria in our

0:10:12.000 --> 0:10:15.920
<v Speaker 1>intestinal tract. These germs have a certain type of cell

0:10:16.000 --> 0:10:19.480
<v Speaker 1>wall that appears differently under the microscope in response to

0:10:19.520 --> 0:10:22.240
<v Speaker 1>a dye. The dye is known as a gram stain,

0:10:22.960 --> 0:10:25.560
<v Speaker 1>and so that's quite important because the structure of the

0:10:25.600 --> 0:10:28.240
<v Speaker 1>cell wall gives us a cluse to which antibiotics are

0:10:28.280 --> 0:10:33.880
<v Speaker 1>going to work better on the bacteria. Now, feces poo

0:10:34.080 --> 0:10:38.800
<v Speaker 1>is very interesting compound because it's made up of both

0:10:38.840 --> 0:10:43.400
<v Speaker 1>Gram positive and Gram negative bacteria. But the ones which

0:10:43.920 --> 0:10:49.120
<v Speaker 1>make you sick quickest and cancute you very quickly are

0:10:49.200 --> 0:10:53.040
<v Speaker 1>these gram negative bacteria which constitute a large portion of

0:10:53.080 --> 0:10:56.800
<v Speaker 1>our pooh. It's the Gram negative bacteria that are becoming

0:10:56.920 --> 0:11:00.959
<v Speaker 1>more and more resistant to antibiotics. If that's not enough,

0:11:01.280 --> 0:11:05.040
<v Speaker 1>Once these bacteria into your bloodstream, but they can release

0:11:05.080 --> 0:11:09.760
<v Speaker 1>a toxin which is like a prepackaged hand grenade that

0:11:09.880 --> 0:11:13.800
<v Speaker 1>drops your blood pressure, alters your whole body dynamics, and

0:11:13.920 --> 0:11:17.080
<v Speaker 1>you go into septic shock without the need for the

0:11:17.200 --> 0:11:23.000
<v Speaker 1>germ to actually multiply match. The mystery of why these

0:11:23.040 --> 0:11:27.840
<v Speaker 1>men were getting set was solved. Men had become susceptible

0:11:27.880 --> 0:11:32.160
<v Speaker 1>to serious infections because they traveled overseas and picked up

0:11:32.160 --> 0:11:37.079
<v Speaker 1>a superbug. Then, after they'd had their prostrates biopsied, those

0:11:37.120 --> 0:11:40.640
<v Speaker 1>bugs were able to get into places they weren't supposed to,

0:11:40.920 --> 0:11:44.680
<v Speaker 1>like the blood stream, and cause these infections. But the

0:11:44.760 --> 0:11:49.480
<v Speaker 1>story wasn't over. Solving this mystery made Professor Grayson realized

0:11:49.520 --> 0:11:54.680
<v Speaker 1>something that would change his entire perception of how hospitals work.

0:11:55.720 --> 0:11:59.559
<v Speaker 1>He realized that if travelers are carrying around these antibiotic

0:11:59.559 --> 0:12:04.079
<v Speaker 1>resistant bacteria, you likely meant most people like you and

0:12:04.440 --> 0:12:08.320
<v Speaker 1>me are walking around all day with these tiny heart

0:12:08.400 --> 0:12:11.760
<v Speaker 1>to diffuse grenades in their bowls, even though we seem

0:12:12.000 --> 0:12:17.360
<v Speaker 1>fine otherwise. The term for this is colonization. Bolonization is

0:12:17.400 --> 0:12:20.080
<v Speaker 1>where the buggers in your system, but it's not causing

0:12:20.080 --> 0:12:25.240
<v Speaker 1>any trouble. And obviously infection is now causing trouble. If

0:12:25.320 --> 0:12:27.600
<v Speaker 1>more and more of us are carrying these hand grenades

0:12:27.600 --> 0:12:32.240
<v Speaker 1>and air intestines, then danger could lurk anywhere, and Professor

0:12:32.240 --> 0:12:34.800
<v Speaker 1>Grayson could no longer think about the Austin as a

0:12:34.840 --> 0:12:38.319
<v Speaker 1>place where superbugs were spread by only a handful of

0:12:38.480 --> 0:12:41.280
<v Speaker 1>high risk patients. You know, we're one of the first

0:12:41.320 --> 0:12:46.120
<v Speaker 1>hospitals in Australia to say we're going to assume the

0:12:46.160 --> 0:12:50.400
<v Speaker 1>whole hospitals assess pit. Why don't we just assume the

0:12:50.440 --> 0:12:53.480
<v Speaker 1>hospital is filthy. It's with that idea in mind that

0:12:53.520 --> 0:12:57.920
<v Speaker 1>Professor Grayson instituted a back to basic strategy when fighting

0:12:57.920 --> 0:13:02.360
<v Speaker 1>superbugs at the Austin. For example, of something's dirty, bleach

0:13:02.520 --> 0:13:05.120
<v Speaker 1>is a good way to clean it. So Professor Grayson

0:13:05.160 --> 0:13:08.760
<v Speaker 1>backed in overhaul of the hospital's cleaning regime that includes bleach,

0:13:09.440 --> 0:13:13.120
<v Speaker 1>lots of bleach. Professor of Medicine here said, lindsay, the

0:13:13.120 --> 0:13:16.199
<v Speaker 1>hospital smells like it did when I was an intern.

0:13:16.240 --> 0:13:19.280
<v Speaker 1>I said, yes, Jeff, because we're using bleach like we

0:13:19.480 --> 0:13:22.680
<v Speaker 1>used to back in the seventies and eighties. Bleach is neat,

0:13:22.800 --> 0:13:27.560
<v Speaker 1>because it's good because it kills all of known super bugs.

0:13:27.920 --> 0:13:31.040
<v Speaker 1>The Austin's programs are cutting edge by today's standards for

0:13:31.080 --> 0:13:35.040
<v Speaker 1>how hospitals treat patients, but Professor Grayson says a lot

0:13:35.040 --> 0:13:39.120
<v Speaker 1>of these practices ironically are rooted in the meticulous attention

0:13:39.160 --> 0:13:43.200
<v Speaker 1>paid to cleaning and scrubbing that Florence Nightingale, the founder

0:13:43.240 --> 0:13:46.280
<v Speaker 1>of modern nursing, pioneered in the eighteen hundreds there were

0:13:46.280 --> 0:13:50.760
<v Speaker 1>some basic principles which over the years had been forgotten

0:13:50.880 --> 0:13:54.680
<v Speaker 1>because of we had antibiotics. You know, my mom was

0:13:54.720 --> 0:13:59.280
<v Speaker 1>born in and when they had a scarlet fever outbreak

0:13:59.320 --> 0:14:01.559
<v Speaker 1>at their primary school, everyone was sent home in the

0:14:01.679 --> 0:14:04.240
<v Speaker 1>school was shut down for a week or two to

0:14:04.280 --> 0:14:07.600
<v Speaker 1>stop to spread a strap to cock eye spatial separation.

0:14:08.240 --> 0:14:16.240
<v Speaker 1>We don't do that anymore. This old school approach is

0:14:16.280 --> 0:14:20.840
<v Speaker 1>also why Professor Grayson started using the rectal swabs. Initially,

0:14:20.920 --> 0:14:25.800
<v Speaker 1>the program costs the Austin Australian dollars or about one

0:14:27.000 --> 0:14:29.720
<v Speaker 1>U S dollars a year, but has since come down

0:14:29.840 --> 0:14:34.200
<v Speaker 1>by about half. Robotic equipment and technology has automated the

0:14:34.240 --> 0:14:38.600
<v Speaker 1>testing process. It's enabled doctors to know much faster whether

0:14:38.600 --> 0:14:41.920
<v Speaker 1>a patient is harboring drug resistant germs they could increase

0:14:41.960 --> 0:14:45.480
<v Speaker 1>the risk of a difficult to treat infection, and if so,

0:14:45.920 --> 0:14:49.800
<v Speaker 1>how best to manage that patient, Especially if an infection occurs.

0:14:51.320 --> 0:14:54.240
<v Speaker 1>This kind of screening program has enabled the hospital to

0:14:54.320 --> 0:15:00.200
<v Speaker 1>spot new dangers, making patients vastly safer. For example, the

0:15:00.240 --> 0:15:03.720
<v Speaker 1>Austin was the first hospital in Australia to identify a

0:15:03.760 --> 0:15:08.280
<v Speaker 1>fast spreading superbug that's especially problematic for liver transplant patients.

0:15:09.040 --> 0:15:13.520
<v Speaker 1>It's called vanke myce and resistant ENTRECOC, or just vr E.

0:15:14.280 --> 0:15:17.160
<v Speaker 1>About half of the liver transplant patients who get a

0:15:17.240 --> 0:15:20.520
<v Speaker 1>vr E bloodstream infection will die from it. We were

0:15:20.520 --> 0:15:23.320
<v Speaker 1>the first hospital in Australia to identify the r and

0:15:23.360 --> 0:15:27.200
<v Speaker 1>it wasn't because we're dirty, it's because we looked. We

0:15:27.200 --> 0:15:30.120
<v Speaker 1>were the first hospital to identify a number of the

0:15:30.280 --> 0:15:33.160
<v Speaker 1>multi resistant gram negatives was because we had a screening

0:15:33.160 --> 0:15:36.360
<v Speaker 1>program where we looked. If you don't look, you don't find.

0:15:36.640 --> 0:15:38.520
<v Speaker 1>And I think there's still a bit of a culture

0:15:38.560 --> 0:15:40.840
<v Speaker 1>in other places you don't look because you don't want

0:15:40.840 --> 0:15:44.400
<v Speaker 1>to know, whereas there's always been a culture. We want

0:15:44.440 --> 0:15:48.040
<v Speaker 1>to know, and it's only when you know that you

0:15:48.080 --> 0:15:53.160
<v Speaker 1>can design a solution. Looking for these superbugs has also

0:15:53.240 --> 0:15:57.440
<v Speaker 1>helped the hospital begin to predict how they spread. For example,

0:15:57.760 --> 0:16:00.520
<v Speaker 1>for every patient with an infection caused by vr E,

0:16:01.120 --> 0:16:04.680
<v Speaker 1>another twenty patients will be colonized with the gut bacteria

0:16:04.920 --> 0:16:08.400
<v Speaker 1>but not have the disease. There was a recognition that

0:16:08.600 --> 0:16:12.920
<v Speaker 1>most people who have an infection are colonized first, and

0:16:12.960 --> 0:16:15.400
<v Speaker 1>the type of German you've got defines how many people

0:16:15.400 --> 0:16:18.000
<v Speaker 1>are more likely to be colonized for every infection. So

0:16:18.040 --> 0:16:20.480
<v Speaker 1>if you've got one patient with her, you're only attract

0:16:20.520 --> 0:16:24.240
<v Speaker 1>infection with r You've probably got nineteen patients out there

0:16:24.280 --> 0:16:28.359
<v Speaker 1>in the ward who you don't know got R E colonization.

0:16:29.040 --> 0:16:31.440
<v Speaker 1>If you know how many people are likely to have

0:16:31.520 --> 0:16:34.920
<v Speaker 1>a superbug, it changes how you think about the layouts

0:16:34.960 --> 0:16:37.920
<v Speaker 1>of hospitals, as well as how much to invest in

0:16:38.240 --> 0:16:43.280
<v Speaker 1>infection control and surveillance. So here you can see these

0:16:43.320 --> 0:16:46.560
<v Speaker 1>pink colonies are quite different to these dark blue ones.

0:16:47.000 --> 0:16:49.240
<v Speaker 1>So whereas Professor Grayson gave me a tour of the

0:16:49.320 --> 0:16:54.480
<v Speaker 1>Austin's microbiology lab, it's teeming with technicians in white coats,

0:16:54.880 --> 0:16:58.520
<v Speaker 1>bacterial specimens, and robotic equipment used to culture and test

0:16:58.600 --> 0:17:02.480
<v Speaker 1>the microbes. Professor Grayson told me that superbug mystery made

0:17:02.560 --> 0:17:06.880
<v Speaker 1>him realize the importance of identifying patients colonize certain high

0:17:06.960 --> 0:17:10.639
<v Speaker 1>risk germs. For one thing, they should be given individual

0:17:10.760 --> 0:17:14.200
<v Speaker 1>rooms and not share bathrooms. But if you've got someone

0:17:14.200 --> 0:17:16.320
<v Speaker 1>who's carrying a super bug, I'm sorry, but they get

0:17:16.359 --> 0:17:19.639
<v Speaker 1>priority because that's the safety of the hospital at stakes.

0:17:19.680 --> 0:17:23.520
<v Speaker 1>So safety of patient care now dominates everything else, and

0:17:23.960 --> 0:17:27.879
<v Speaker 1>that's probably an important change. The Austin hospital was built

0:17:28.000 --> 0:17:30.600
<v Speaker 1>with private rooms making up a third of its capacity.

0:17:31.280 --> 0:17:34.960
<v Speaker 1>Professor Grayson says future hospitals will have to rethink that

0:17:35.119 --> 0:17:38.480
<v Speaker 1>design and it won't be cheap at least in the

0:17:38.560 --> 0:17:40.960
<v Speaker 1>short term. You know, I would often say the rule

0:17:41.080 --> 0:17:44.840
<v Speaker 1>is pretty simple, one bumper toilet. Well men. In the past,

0:17:44.960 --> 0:17:47.080
<v Speaker 1>many people say, well, isn't it too expensive to have

0:17:47.200 --> 0:17:50.560
<v Speaker 1>single rooms and a toilet for every patient? But actually

0:17:50.640 --> 0:17:53.720
<v Speaker 1>from an infection control point of view, and now in

0:17:53.760 --> 0:17:56.760
<v Speaker 1>the era of superbugs, this will be standard practice in

0:17:56.800 --> 0:17:59.639
<v Speaker 1>the future. This needs to be built into government thinking

0:18:00.119 --> 0:18:03.200
<v Speaker 1>and funding that what seems expensive at the start will

0:18:03.200 --> 0:18:07.520
<v Speaker 1>pay off very quickly in terms of disease transmission. Professor

0:18:07.600 --> 0:18:11.159
<v Speaker 1>Grayson spends a lot of time thinking about superbugs and

0:18:11.280 --> 0:18:16.240
<v Speaker 1>how to fight them, something he's known for internationally. Harvard graduate,

0:18:16.560 --> 0:18:20.160
<v Speaker 1>he has a national hand hygiene initiative, advises the World

0:18:20.200 --> 0:18:23.840
<v Speaker 1>Health Organization on infection control, and as editor in chief

0:18:23.960 --> 0:18:27.280
<v Speaker 1>of a key academic text on antibiotics. It's now in

0:18:27.400 --> 0:18:30.359
<v Speaker 1>three volumes and sits among the reference books lining his office.

0:18:31.440 --> 0:18:35.320
<v Speaker 1>The next frontier, he says, will address the antibiotic resistance

0:18:35.600 --> 0:18:39.480
<v Speaker 1>genes that superbugs harbor. A microbiologist once told me that

0:18:39.680 --> 0:18:44.600
<v Speaker 1>these bacteria accumulate genetic mechanisms for fending off antibiotics like

0:18:44.760 --> 0:18:48.920
<v Speaker 1>trains attached carriages. A big difference is that bacteria of

0:18:49.080 --> 0:18:52.639
<v Speaker 1>different species can share these methods for evading drugs with

0:18:52.720 --> 0:18:55.959
<v Speaker 1>one another, giving modern medicine little time to catch up.

0:18:56.760 --> 0:18:59.720
<v Speaker 1>But for now, the practical efforts of the austin have

0:18:59.840 --> 0:19:03.160
<v Speaker 1>at least provided some balance in the fight against superbugs.

0:19:03.640 --> 0:19:06.520
<v Speaker 1>Even things as simple as a sign you know as

0:19:06.640 --> 0:19:08.200
<v Speaker 1>you will have seen when you came to the hospital,

0:19:08.320 --> 0:19:10.720
<v Speaker 1>is a big stand there saying oh, I'll rub your hands,

0:19:10.800 --> 0:19:13.760
<v Speaker 1>don't bring your bugs into the hospital, But secretly, as

0:19:13.760 --> 0:19:15.600
<v Speaker 1>you're walking out of the lifts, it actually says, don't

0:19:15.640 --> 0:19:19.040
<v Speaker 1>take our bugs home. As we face a post antibiotic

0:19:19.119 --> 0:19:22.320
<v Speaker 1>era in which something as simple as a scratch knee

0:19:22.400 --> 0:19:28.200
<v Speaker 1>could once again kill, these basic principles seem inexorably important.

0:19:29.119 --> 0:19:34.640
<v Speaker 1>Stopping bacteria at their source will be our key defense. Thankfully,

0:19:34.840 --> 0:19:38.240
<v Speaker 1>the century has given us better tools to do that.

0:20:07.359 --> 0:20:10.240
<v Speaker 1>And that's it for this week's prognosis. Thanks for listening.

0:20:11.359 --> 0:20:13.480
<v Speaker 1>Do you have a story about healthcare in the US

0:20:13.640 --> 0:20:15.720
<v Speaker 1>or around the world We want to hear from you.

0:20:16.440 --> 0:20:19.280
<v Speaker 1>Find me on Twitter at AA Cortes or send me

0:20:19.320 --> 0:20:22.920
<v Speaker 1>an email m Cortes at bloomberg dot net. If you

0:20:23.000 --> 0:20:25.480
<v Speaker 1>are a fan of this episode, please take a moment

0:20:25.560 --> 0:20:28.520
<v Speaker 1>to rate and review us. It really helps new listeners

0:20:28.560 --> 0:20:33.400
<v Speaker 1>find the show, and don't forget to subscribe. This episode

0:20:33.440 --> 0:20:36.960
<v Speaker 1>was produced by Toford Foreheads. Our story editor was Rick Shine.

0:20:37.840 --> 0:20:41.960
<v Speaker 1>Special thanks to Drew Armstrong, our healthcare team leader, francesco

0:20:42.000 --> 0:20:45.240
<v Speaker 1>Leivia's head of Bloomberg Podcasts. We'll be back next week

0:20:45.320 --> 0:20:46.920
<v Speaker 1>with a new episode. See you then,