Me, I love the NHS. I have travelled in enough health-infrastructure deprived countries to venerate a system that provides me with on-call doctors out of hours; clean and helpful walk-in clinics; hospital treatment that I don’t have to pay for (except for my National Insurance payments which I don’t notice) whenever I require it. But plenty of people of my acquaintance regularly castigate the NHS (and I agree that it’s flawed; what huge institution isn’t?). One of their most common complaints is that doctors and nurses never wash their hands, and how dirty the hospital wards are. A family friend who has been a nurse for 40 years remembers that in times past nurses would not only change the bedding between patients but also wash down the bed-frame. That is impossible now because of patient turnover. She told me that sometimes there are 5 patients a day in one bed, and that long-term patients sometimes have to be turfed out of their bed during the day so that day patients can use it. It is impossible, she said, to have high hygiene standards when you just don’t have the time. That’s one issue. Doctors and nurses who ignore the hand sanitizers all over the place are another. All this to say though, that the dirty NHS gets far more media attention, when it comes to discussing the growth of MRSA and other drug-resistant infections, than another, possibly deadlier source of infection.
Sewage, according to recent research published by the universities of Warwick and Birmingham (and reported in this article by Robin McKie of the Observer, is helping to spread drug-resistant bacteria because of all the powerful domestic cleaning and other household products it contains. Fabric softeners, shampoos, disinfectants, anti-bacterial this and that: they remain in both sewage effluent, thus getting into the drinking water supply; and in sewage sludge spread on farmland, which ends up in the food chain. The researchers were looking specifically at quatenary ammonium compounds (QACs), which zap bacteria in the high doses in which they’re found in household cleaning products. But in the diluted form they take on in sewage effluent – diluted of course by all the drinking water we flush down sinks and toilets – bacteria learn to resist them. “”If other bacteria are killed,” explained Dr. William Gaze of Warwick University, “those that are resistant to QACs will survive and, without competition, will multiply in vast numbers. However, it turns out that the piece of DNA that confers that resistance also contains genes that confer resistance to antibiotics. In this way, we have created an ideal environment for the emergence of antibiotic-resistant bacteria in our drains and sewers. These microbes are now being spread round the country in river water and in sewage sludge used on farms.”
And yet it wasn’t front-page news or even headlines. It should be. I’m getting a bit tired of banging my drum about the health consequences of ignoring the fact that the standard solution for disposing of human excrement has been rendered certainly inefficient and probably unsafe by modernity (population growth and our very chemical environment), but I will keep banging. A more detailed article by Dr. Gaze is published by the National Environment Research Council.