Secret Life Of The Hospital (2018) Movie Script
NHS hospitals treat over
a quarter of a million of us every day.
That is an
abnormal pumping of the heart.
Open 24/7,
hospitals help begin life,
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save life, and provide
care when life ends.
If you think hospitals are kept running
by doctors and nurses,
think again.
It looks like a chip
shop menu, doesn't it?
This is where we actually store
the donated bones.
We tend to be the pixie service.
The whole trust is connected by
very primitive drain pipes, essentially.
How are you feeling?
Exclusive
access to one of Britain's
busiest hospitals...
Royal Devon and Exeter.
Allows us behind the scenes
to explore a secret world,
where pharmacists make food
for the most vulnerable patients.
One bacteria inside the product
could cause death to the patient.
Cleaners spray poisonous gas
with strange robots.
Infection kills.
I couldn't contemplate
not doing the deep clean.
A topsy turvy
world where engineers
resuscitate dead machines.
If it fails, it's absolute chaos.
And doctors
screw people together.
Where maintenance is a
matter of life and death.
If it was your relative
being brought in here
to be operated on, to
have their life saved,
you'd want everything working.
Hundreds of
thousands of unseen hands
keep our hospitals running.
This is the ultimate access
all areas backstage pass
to the secret life of the hospital.
The NHS has 1.7 million staff,
making it the biggest employer in Europe.
Logging over 125 million visits a year,
hospitals around the UK
are busier than ever,
treating 1 million of us every 36 hours.
But none of us sees how a major hospital
gears up around us when we're ill.
In Southwest England, the
Royal Devon and Exeter
is a typical large, modern hospital.
With 750 beds,
7,200 staff,
caring for 750,000 patients a year.
Hello RD&E resus.
It's full on, 24/7.
Medical or trauma.
Incoming ambulance crews
give 10 minutes warning.
The switchboard operators act fast,
alerting the right people
with the right expertise.
Right now.
It's literally the
worst feeling in the world
when that goes off.
It bleeps and instantly it goes
to the pit of your stomach.
The NHS uses 130,000 pagers,
more than any organization on Earth.
Blood can be ordered.
Xray imaging put on standby.
Operating theaters prepped.
Laboratories readied.
Anesthetists woken up.
Porters called in.
In minutes, the switchboard
can mobilize an army.
So, we get specialties and expertise
from all around the hospital
to manage the patient
so that they're there
waiting before he arrives.
Everybody ready for a lift?
Ready?
Steady, go.
So, this is Margaret Dodd.
She's 76.
Intercranial hemorrhage
is the primary diagnosis.
The assembled
team swings into action,
fighting to save Margaret's life.
And you've basically got
someone's life in your hands
and if you delay, then
that's gonna have an impact
on whether they survive or not.
As they rush her
to xray for critical scans,
her blood samples are rushed
to the lab for testing.
The problem is the hospital
is half a mile long
and every second counts.
The solution?
The estates department
rapid transit system.
The system is basically
the email for solid objects.
Key in the address to
where you want it to go,
as if by magic, it goes.
The pods fly
to and from 63 locations
throughout the hospital.
Loads of up to two kilos are propelled
by powerful air pumps at
six meters per second.
It's very fast.
I don't think I would like to be a pod.
They rocket
along the hospital's arteries
of six inch tubes,
unseen inside the ceilings and walls.
It would probably be three
to four minutes maximum
from one end of the hospital to the other.
The emergency
samples are whisked
to a place we never see,
the blood sciences lab.
So the whole trust is
connected by this network
of very primitive drain
pipes, essentially.
But it allows us to get
the specimens rapidly
to the lab from A&E,
so we can start that process
of getting those results
back to the clinician so they
can get a patient sorted out.
Blood tests
are so crucial in diagnosis
that 95% of emergency patients
have blood sent for analysis.
On top of that, hundreds
of vials of blood arrive
from all 30 wards in
the morning rush hour.
I can hear another pod coming.
So how do they
pick out the urgent ones
like Margaret's from
A&E, or intensive care?
Everybody else have their clear bags.
The red bags come from an urgent place
such as the emergency department.
So we can tell at a glance
that it's an urgent one
rather than a normal one.
If a sample from A&E arrived now,
we'd expected that to be done
and dusted within one hour.
That first hour is key
for a seriously injured
patient like Margaret.
Medics need information fast,
from scans, from blood tests
and from medical records.
Any calls that come through
the emergency phone line,
we have to get those notes within an hour
of receiving that request.
In one room,
health records keeps
the 75,000 files accessed
in the last two years.
Over 145,000 older ones
are also stored onsite.
But when you add the offsite archives,
there are around three
quarters of a million files
dating back to the 1950s.
With so many files stacked on the shelves,
how do they find an emergency
patient's medical notes?
We use our lovely PAS system to find
where the notes are.
Depending where the are is
then when the real fun starts.
Just like the blood test lab,
the health records
emergency desk is in a race
against the clock.
It is quite complicated when you think
that we run a 24 hour
service seven days a week.
It has been this way for a long
time, medical records, yes.
The NHS has been going since 1948,
and doctors have been using
paper long before then.
A squad of dedicated clerks
are well drilled to beat
the one hour target.
By hand.
It should be in here somewhere.
Hopefully they're in the right place,
cause when you've got
145,000 sets of notes,
they can be a nightmare to find.
The system does work well.
It's a very well oiled machine.
But in the next three years,
health records is going digital.
As the pod system pumps
in more and more samples,
the blood lab is under pressure.
Across the UK, 300,000
patients are tested a day.
That's 6.2 million tests
a year in this lab alone.
How can a handful of lab technicians
possibly process results fast enough
to beat that crucial one hour turnaround?
Automation plays a
massive part in what we do.
We will generate about
25,000 results a day.
The days of bubbling test tubes
and crazy scientists have gone.
Having said that, we have got a few
crazy scientists milling around.
But the automation is key these days
to diagnose and treat patients.
Doctors
can choose from a menu
of 900 different tests
for blood oxygen levels,
liver or kidney function,
or heart problems.
Even cancers can be
discovered or ruled out.
Some of the tests are equally as valid
as a negative result as they
are with a positive result.
The robot
analyzers are superfast
and ultra reliable, but not infallible.
What if they make a mistake?
The machines themselves
are constantly monitored.
If a result is generated that's abnormal,
that's where the human
element comes into it.
So automation is great,
but we still need that
mark one human eyeball
to look at that result
and decide what to do.
As the
emergency department admit
a stream of new casualties,
the first hour is almost up
for 76 year old Margaret.
She's still unconscious.
Her blood results revealed
good oxygen levels
and her brain scan is clear.
So she's now in the
catheterization laboratory,
where consultants inject a dye
to investigate her heart function.
Actually, her arteries are normal.
There's no blockage there,
so it's not a heart attack.
Now we can see the pumping.
So that is an abnormal
pumping of the heart.
It's very discordant
and you can see the dye
kind of hangs around.
That should not happen.
So, this is clearly a problem
with the muscle of the heart itself
rather than the blood supply.
While
Margaret is taken to a bed
in intensive care, on the
wards the hospital comes
face to face with its arch enemy.
Infection kills.
I couldn't contemplate
not doing the deep clean.
And goes
to war on killer bugs.
Hospitals are very unhealthy places.
Sick people go there,
taking a stream of bacteria
and viruses with them.
The foot soldiers in the
constant battle against infection
are the cleaners.
300,000 patients a year in England
acquire an infection
while under treatment,
at a cost to the NHS of 1 billion pounds.
There we are, your breakfast.
The danger of infection
is present on every hospital ward.
From bugs like norovirus and
Clostridium difficile and MRSA,
which is resistant to common antibiotics.
Resistant strains are a
very dangerous proposition
which we're facing at the moment.
If you have an organism which is resistant
to a majority or a vast
range of antibiotics,
then obviously we haven't got any options
to treat the patient with.
One in 30 of us
has MRSA living harmlessly
on our skin or in our nose.
But for patients with open wounds
or weakened immune systems,
MRSA can enter the body to
cause serious infection,
blood poisoning, and even death.
Hi, I'm Cat, one of the nurses.
We're gonna do a few swabs for MRSA.
One of your nose and one of your throat.
Okay.
Okay?
Hospitals
screen every patient for MRSA
before they get a bed.
Okay, and next is your throat.
So open wide for me.
Fantastic.
There we go.
All done.
A positive MRSA result
triggers a protective regime on the wards.
The medics would put that
patient into a side room
and isolate them so that
if there was a patient
with multi resistant organisms,
we try and contain that
and don't allow that
to spread around other
vulnerable patients.
So how do our
biggest hospitals defend patients
from such dangerous cross infections?
Obviously, we do environmental cleaning
every day in the hospital,
24/7, 365 days a year.
But once a year, we make
that decision to deep clean
all of the inpatient environment.
In deploying the deep clean,
they unleash Armageddon on killer bugs.
This is so important.
You know, it's once a
year, annual deep clean,
when everything is stripped right back
and cleaned throughout.
So we start at the top
and work our way down.
So we take curtains out,
everything comes out,
old hand towels, old gloves, and you know,
we clean the beds, we take
the beds apart completely.
That's a really difficult task to do
when a patient's lying on it.
The work that they're doing here today
is absolutely vital to the
running of the hospital.
We can't run a hospital
unless it's clean and safe.
The deep
clean puts these 10 beds
in the acute stroke unit out
of action for most of the day.
And NHS hospitals are
always short of beds.
Infection kills.
I couldn't contemplate
not doing the deep clean.
We have a duty to our
patients to make sure
it's as clean as possible.
The Royal
Devon and Exeter Hospital
has 60 departments spread over six acres.
So how does it link them all together?
Hello, porter, it's John
speaking, how can I help you?
There's
nowhere porters don't know.
Excuse me please.
No one they can't collect.
Thank you guys.
Nothing they can't deliver.
Cheers, thank you.
Day or night.
Lovely, thanks Keith.
They know all the departments,
they know all the bits of equipment,
and there's nothing
they don't know really,
except for surgery their selves.
Porters are
the lifeblood of a hospital,
reaching even the remotest parts on foot.
Average we do about
10 to 12 miles a shift,
in an eight hour shift.
So yeah, it's a hell of a lot of walking.
I did a 28,000 step day the other week.
But in five months, I'm on my
third pair of shoes already.
We pick up blood for general patients
and for emergencies.
We attend every cardiac arrest
that goes on in the hospital.
If there's an emergency down that end,
blood transfusions down at the other end,
and sometimes in one
call you could be running
backwards and forwards four or five times.
They've gotta work
really hard sometimes,
cause I'm the one that makes them work.
They don't call me any names on the radio,
but I can feel it.
They call me the Beastmaster sometimes.
This is a 750 bed hospital.
And I'll grab you some
fresh towels for tomorrow.
Ah, good, thank you very much.
On busy
wards, linen can be changed
many times a day.
To keep up, staff need
10 sets of linen per bed.
Two pillows enough?
Yes, quite enough.
Thank you very much.
But how
does the hospital cope
with thousands of dirty sheets?
In the hospital laundry they've mechanized
war against infection.
The laundry's stateoftheart machinery
cleans 260,000 articles a week,
over 14 million items a year.
It's not just linen that must be spotless.
Doctors' greens and nurses'
blues, scrubs and gowns,
all the hospital's dirty
clothing is resurrected here.
The guys at the bottom
are feeding the laundry up
to the top of the gantry
where the guys are then
sorting it out into sheets,
blankets, bath towels
pillowcases, patient gowns, nightwear,
theater scrub suits, everything.
You name it, we've got it in here.
Potentially infected linen
is double bagged at the hospital.
An outer red bag to alert
laundry staff to danger,
and an inner bag that dissolves in water.
It gets a different wash process.
It's getting a double wash.
So, we're definitely gonna
kill whatever's in it.
Laundry workers often find
a more pleasant surprise in the folds.
We occasionally get mobile
phones, iPads, laptops,
and things like scissors and needles,
which aren't really helpful.
We also quite a lot of personal jewelry,
rings, necklaces, earrings,
which is always nice to
find when people phone up
because sometimes they've lost a relative
and it means a lot to them to get it back,
and it's good to get it back to people.
They're very grateful.
Back in
the acute stroke unit,
after three hours of
scrubbing and steaming,
they wheel out the latest technology
in the arms race against infection.
The deep clean robot.
It will fill the air
with a powerful chemical
that's familiar to hairdressers,
hydrogen peroxide.
It's great at bleaching
hair, but as a vapor,
it's weaponized to
exterminate killer bugs.
We have to be outside
because the environment inside
we're gonna fill with a
hydrogen peroxide vapor.
This is going to kill the microorganisms.
The bleach vapor is so strong
it can't be allowed to leak out.
All the air vents are sealed and covered,
so the gas doesn't harm people
elsewhere in the hospital.
Obviously we don't want
that to escape from the room
whilst it's happening.
So we sealed the room up
completely with tape on the door,
and then we'll make sure
everything's ready before we start.
The misting
will keep this ward closed
for another two and a half hours.
The laundry's two huge
washing machines are brand new
and cost half a million pounds each.
They're hungry beasts, consuming
50 kilos of dirty linen,
eight domestic loads, every two minutes.
Three tons of washing an hour.
This is the first part of the area,
so this is doing our prewash.
This is wetting down and adding chemicals
to try and break up the
stains to start with.
In the center
sections is the main wash
and the real bug killer,
thermal disinfection.
65 degrees Celsius for
at least 10 minutes.
There's no spin cycle.
Every two minutes, a clean load emerges,
squeezed dry by enormous pressure.
350 tons total per load.
If we don't manage to find any items
back up in our sorting and grading area,
this will demolish it.
Staff clean
on an industrial scale,
a synchronized regiment with one aim,
killing bugs.
Yeah, I'm a bit OCD, I think.
It's like with me car,
I'm a bit OCD with that,
it's gotta be clean all the time.
You know.
I don't like dirty glass, I
don't like dirty paintwork,
wheels have gotta be spot on.
Yeah, attention to detail with me.
You're in the right job then.
I think so, yeah.
Shirley
inspects 800 sheets an hour.
Eagleeyed for any fault,
she rejects anything not perfectly clean.
My mum's been in hospital
quite a few times this year
and the sheets are always clean.
That's the main thing, innit?
If we send through clean sheets,
then, the patients can't
get any germs from here.
So we'll just go into
the ward to make sure
it's going to finish on time.
It's crucial that the beds
come back into the system
by the end of the day.
We'll have 10 empty beds by
the time we finish tonight.
In the acute stroke unit,
hydrogen peroxide vapor has
settled on every surface,
penetrated every nook and cranny,
killing any remaining bacteria or viruses.
I'm checking that
we've got no gas leaks.
So, we're safe.
Obviously inside the room
there'll be quite high levels,
but we need to make sure that
we've sealed the door correctly.
So far so good.
At the end of the cycle,
the robot reabsorbs the mist
and the room will be safe to enter.
Patients will be returned to
disinfected, freshly made beds.
How's it going?
So once the mister is finished in there,
we'll move the patients.
Brilliant.
Okay.
Good, good, good.
We need those beds.
The ward will
soon be back in action.
Cheers, thank you.
While upstairs,
another unseen team
keep the operating theaters
running on schedule.
14 year old Sid needs
lifechanging surgery
to straighten his spine.
It's quite painful a lot of the time.
Surgeons
will put in titanium rods
and colorcoded screws.
You'll be a bit like
Wolverine won't you?
Yeah.
But the vital
ingredient is a big surprise.
The anesthetist did say
that they use old lady bones.
Recycled bone.
Through the double doors here,
stairs on your left, lift on your right,
you need to go up one floor.
A&E is the most high profile
hospital department,
but our backstage pass to the
secret life of the hospital
reveals it's just a small cog
in this vast medical machine.
Good morning, Royal Devon and Exeter.
In fact, only 14% of patients
arrive at hospital unexpected,
seeking emergency treatment.
The vast majority have an appointment,
one of over a hundred million appointments
attended in NHS hospitals every year.
This level, straight
to the end, left, area C.
Getting ready for this deluge
is another mammoth task
for health records.
Every day, the records team must find
almost 2,500 sets of notes,
and prepare them for over
300 outpatient clinics.
I've had quite a few dreams
about stamping, prepping,
members of the team being in my dreams,
very, very odd dreams.
I think we pretty much do it in our sleep
as well as come in during the day
and stamping away as much as possible.
Consultants
must have a patient's
medical notes at their fingertips.
For a patient, you know,
there is an assumption
that when you're seen,
your notes will be there.
I've actually been in health
records in clinic prep for,
this will be 12 years coming up.
So I've kind of spent my youth here.
I think I've got about another
60 sets of notes to prep
and not a lot of time to do it in.
14 year old
Sid Hancock's appointment
is with the orthopedic surgeons,
who will be operating on his spine.
So this chap's 14 years
old and he has a scoliosis.
And scoliosis basically is a
threedimensional deformity.
And we can see that the curve
here is in the thoracic,
the chest region of his spine.
So what we're gonna try and do is rotate
this part of his spine
back to being straighter.
Morning.
Morning.
Sid's operation is just one
of 80 scheduled today.
Any problems today?
None.
It's a surgeon's
decision to operate,
but the power to organize the 24 theaters
is in the hands of the matrons.
All day.
So have you got xray?
Have you spoken to them this morning?
Yeah, that was already booked.
Any additional
comments and actions?
The beds are a bit tight,
but they think they'll all pan out.
Fine.
Any equipment issues so far this morning?
They call me the oracle.
When anybody comes in,
they can't find anything,
and they just all make a beeline,
Hil, where's this, Hil, where's that?
Is that all you need?
There's a few more
things on the other side.
Okay, give me a shout if
you can't find anything.
I've got a lot of knowledge
in surgical procedures
and in anesthetic procedures,
so unfortunately I was in the
wrong place at the wrong time
to be given this job.
I manage the stock for the department.
So anything runs out
here, it comes down to me.
In total, I manage about 4,000 lines,
and I take a lot of pride
knowing that everything is here.
With 30,000 procedures a day
and millions of potential patients,
the NHS supply chain never sleeps,
delivering over one and a
half billion pounds worth
of supplies a year,
including 10 million disposable scalpels,
250 million syringes of all sizes,
and over 1.7 billion pairs
of examination gloves.
We need to save money, and
over the last seven years,
I've saved hundreds
and thousands of pounds
by sourcing alternative suppliers.
Just things like this,
is our suction tubing,
used everywhere in the chest.
By just changing the
bore by one millimeter,
saved thousands and thousands of pounds.
Two capped spools.
Vaguely 18 ish.
Although frantically busy,
every operating theater is
shut down for maintenance
twice a year.
The estates department takes care of even
the tiniest backstage detail.
We try to catch anything
that might break down
to check it all and make sure it is gonna
last the next six months,
unless they do something silly with it.
Which is quite possible.
Every single
light bulb is replaced,
working or not.
Everything is doublechecked.
Making sure that
they've got full movement,
no obvious damage, excess
wear, things like that.
At the end of the day,
if it was your relative
or a friend being brought
in here to be operated on,
to have their life saved,
you'd want everything
working to its best ability,
to give the surgeons the
best chance they have
of saving their lives.
Sid is called into theater
only when everyone and
everything is ready for him.
Hello there.
All right?
Hello.
Come on in.
Hi there.
All right?
hi.
Let's get you settled down,
let's get you sat down.
So before we do...
Behind the
operating room doors
is a hidden world of precision tools.
Spinal surgery calls for trays and trays
of specialist surgical equipment.
Trish, could we have
a few more nuts, please?
And racks
and racks of screws.
They are colorcoded for diameter,
but each must be carefully
doublechecked for length,
by hand.
Finely machined from titanium,
they are light, strong
and will never corrode.
They cost up to 300 pounds each.
Sid will need 22.
When a patient is cut open,
they're vulnerable to infection.
A clean and sterile environment
is a matter of life and death.
But bugs can still get
in, carried by the air.
The plant rooms in the
roof of the hospital
are a far cry from the
quiet, pristine theaters.
But in this noisy, dirty
place is one of the most
important pieces of theater equipment.
Its air handling unit.
This is the dedicated
AHU, air handling unit.
It takes the air from outside in,
it puts it through various filters,
sensors, things like that,
and then it'll go through a chilling coil
or a heating coil so that the air can be
chilled or heated as
required by the theater.
Pushing clean
air into the operating theater
has a vital extra role.
Dirty, potentially infectious
air, is pushed out.
The air inside the
theater is pressurized.
You've got invasive surgery going on.
You don't want outside air
full of germs coming in,
so we try to keep out as much as possible.
Right, shall we
do an xray now of the screws?
An xray of Sid's spine
shows that all the screws
are well positioned
to hold the titanium rods
that will straighten his back.
The screws grip hold of the spine,
and then the rods have a certain shape
and so you attach the rods to the screws
to put the spine into the shape
you're hoping to get it to.
Somewhat straighter.
And then you want it to stay there.
But the metalwork
is only half the story.
Over time, the rods may break
or the screws come loose.
So to fuse his spine straight for life,
Sid needs a bone graft.
We want the correction to be maintained
by the rods and screws
while the bone graft
heals in the same position,
to create a fusion so
that it's solid bone.
But where will
his bone graft come from?
Over 120,000 hip
replacements are carried out
in NHS hospitals each year.
Successfully treating what was
once a crippling condition.
You get pain in the
hip when you're walking,
going downhill, and as it gets
really bad, you can't sleep.
So how does
getting a new metal hip
help with bone grafts?
This is your thigh bone, as it would be,
as you can see from
this, it'll go this way.
When you have a hip replacement,
the surgeons will actually cut across here
and this bit will be removed.
Yeah, all looks good.
The old femoral heads
can be donated for recycling.
For all the hightech
equipment in theater,
bone graft preparation comes
down to what looks like
a good old fashioned mincer.
To get a femoral head, operating
staff make a withdrawal
from the bone bank.
That's it, at the very back.
Fivesixeighttwo.
Kept deep frozen way down
at minus 80 degrees C,
the donated femoral heads
can be stored for five years.
I don't think I've ever known
that we've actually discarded,
as we call discarded,
a femoral head that has actually
reached its sell by date.
They are always implanted prior
to that actually happening.
It's marvelous that people have donated
and we don't want to
waste anything at all.
I'm just taking off the soft tissue
and cartilage from the head.
Cause we just want the
cancellous bone that's inside.
30 femoral heads
are donated every month,
making the hospital selfsufficient
in bone graft material.
And even better, it's free.
It's a winwin situation really.
People like it cause it's upcycling.
It's time to
add the milled femoral head
that will fuse Sid's spine in position.
So the femoral head, milled up,
will activate it as a scaffolding
for this young man's bone
cells to grow through,
to create the fusion.
Once the bone has been used,
Louise, the bone bank coordinator,
organizers a surprise thank
you letter from the hospital.
It gives them a feel good factor.
I've actually had patients phone up
and say to me that they
were so chuffed to bits,
because obviously it's
a long time sometimes
from the point of donation
to the point of implantation,
can be up to four and a
half, nearly five years.
And sometimes they forget
that they've done that.
It feels nice to get it.
It's an acknowledgement
that you've done something,
that somebody, you know,
definitely has benefited from that.
Sid's operation has taken
four and a half hours.
And now staff have a lot
of clearing up to do.
Medicine is a messy business,
and a third of the waste it generates
is classed as infectious.
As it can't go to landfill,
it's expensive to get rid of.
Costing from 400 to 22,000 pounds per ton.
The logistics team collect
it in their electric trucks
and take it away.
Three, four,
five, six, seven, eight.
But the
contaminated surgical instruments
are much too valuable to throw away.
They are precision engineered
for specialist procedures,
costing from 600 up to 8,000 pounds each.
So where do they go after the surgeons
have finished with them?
When used surgical instruments arrive
at the hospital sterilization
and decontamination unit,
they are filthy, bloody
and potentially infectious.
They have to leave pristine and sterile,
ready to go again and again and again.
That figure there is the
amount of times it's been used.
So that's 1,238 that's been through.
500 sets
a day are sent through
these powerful industrial dishwashers.
Just make sure it starts.
It's the first
step in a four hour process.
Next, each instrument must
be thoroughly checked.
I'm just checking all the instruments,
all the joints, to make
sure that they've all
come through the wash clean.
If you come across anything that doesn't
look like it's meeting
or it's a bit broken,
you send it off and it'll go for repair.
We actually have to
know all the instruments
so that we can make sure they're all there
in the first place.
That's the littlewoods.
There's an Addison's, that's a forcep.
When I first started I
thought it was a tweezer,
but it's not.
That's a retractor,
sort of pulling you open
while the surgeon's operating.
I've seen a couple of operations.
Really interesting.
You do get the chance
to go up and watch some.
What's your favorite?
Hip.
Really interesting how
they throw your leg around
to get to the hip.
Before sterilization,
each set of washed and checked
instruments is wrapped.
It looks like a simple parcel,
but the cloths and the sticky tape
are designed with hidden qualities.
Once steam sterilized under pressure
at 135 degrees C for
three and a half minutes,
the stripes on the table have
changed from green to black.
What I'm just checking
is that the indicators
have all changed color.
Staff can tell at a glance
that a pack has been sterilized.
The weave of the cloths
has closed up in the heat,
sealing in the sterilized instruments.
The sets are ready for surgery again.
Yeah, just do a
little bit, don't force it.
After his spinal operation,
Sid's in the recovery area.
I'm feeling like I've
been stabbed in the back
a few times, but like, yeah,
pretty good to be honest.
It's gone
really well, hasn't it?
Yeah.
It's a little weird to think there are
titanium rods in my back.
If I have a hip replacement
or two hip replacements
and a knee replacement
You'd be a bionic man.
We have rebuilt you.
Gonna be like Wolverine.
Wolverine, yeah.
And it'll only be a matter of time
before I can move into my cyborg body.
The secret
life of the hospital
is full of contradictions.
While one department is killing bugs,
another is feeding them,
growing them as fast as possible
because another patient's
life hangs in the balance.
Ready, steady, slide.
The emergency
department is dealing with
the aftermath of a serious crash.
8:30, you know, five people in a van
and the van hit the central Armco,
you know, the central reservation.
Bounced, flipped and then crashed into
one of the bridge parapets.
And the rest of them
have gone somewhere else?
No, the driver's dead on the scene.
Okay.
Right, Justin.
So this is the CT scan, okay?
The bed is going to move
into this donut, okay?
It will be noisy, but you'll be okay.
Justin has
suffered possibly serious
head and facial injuries.
So a CT scan will reveal
really vital information.
So all patients who have major trauma
will have a CT scan of
virtually their entire body.
Quite often it's possible to
miss quite important injuries.
Medical
imaging is a magic window
for doctors to see inside the body.
There's certainly no
major amount of blood there.
There's an anterior skull fracture,
probably running just about down here
in relation to the eye.
He's quite drowsy intermittently.
I did notice that, yeah.
The history goes against this being
a significant head injury, doesn't it?
Because he crawled out and
immediately was speaking,
crawled out through a rear window.
Medical
imaging is such a vital tool
in diagnosis that 42
million scans of all types
were made in England last year.
Doctors rely on them.
The scanners simply have to work.
At 6:00 AM this morning, this
room looked very different,
when the engineer woke the CT scanners.
These giant xray machines
are one of the most
complex in the hospital.
And there was a hitch.
Something's not picked up.
Something's not synced as
this system's coming up.
So it's not happy.
They break down quite a lot.
There's an awful lot of systems.
There's a big computer under here,
there's various computers
actually within the CT itself.
They've all got to come up
and they've all got to sync
so that they all know what they're doing.
The cost of
one CT scanner is 480,000,
before installation.
The human cost of a
breakdown is incalculable.
If it fails this test now
and the system's not working,
it's absolute chaos.
Modern medicine demands
a vast number of electronic devices
of all shapes and sizes working 24/7.
We have many machines.
We have something like 30,000 assets
actually on the hospital site.
That does vary from a standard
little handheld thermometer
up to ventilators and critical
care and anesthetic machines.
So within this hospital,
we look after anything
that is attached to the patient.
So that's the ECGs,
defibrillators, monitors,
equipment that patients are connected to,
such as the incubators.
Born 10 weeks early,
weighing just three pounds seven ounces,
Beatrix has spent her first four days
either on her mum Jess or in an incubator.
She's still on 61% humidity,
so it's nice and warm in there.
And it's also quite humid.
Nice tropical environment.
Yeah.
Parents Jess
and Mike have been told
jaundice is common in preterm babies,
and Beatrix is being
treated in the incubator
with ultraviolet light.
And she's been sunbathing
because the UV lights,
the phototherapy that she's having,
which is why she's quite dark.
It sounds like a nice
holiday really, doesn't it?
At Becky's
workbench is an incubator
just like Beatrix's.
So the problem with
this piece of equipment
is this sensor here.
It wasn't picking up the
temperature very well
on the planned maintenance.
I have a new one that I can replace with.
Infant
respiratory distress syndrome
is the leading cause of neonatal death.
An incubator malfunction
could be disastrous.
And we actually replace
parts before they fail.
So it is very much a proactive
rather than reactive.
The incubators are always
left at a running temperature
so they can swap the babies
safely into that incubator.
We tend to be the pixie service.
We go in, they don't see us,
we pick up the equipment that's failed,
and we drop it back when we've
tested it and it's fixed.
Good morning.
Would you like some breakfast?
Sometimes I feel that a nice cup of tea
is just as good as any medicine.
Tracy Witcome, go back to Creedy.
Yeah, she's not quite ready yet.
As porters move people
through the hospital maze,
the patients are in their care.
Part of our job is actually
sort of reading the patient.
A lot of people that come
in here are quite scared,
nervous about what's gonna happen.
Sometimes they will confide in you
when you're on your way
down to xray at 3:00 AM,
rather than talk to the nurse.
How are you today, sir?
I'm okay, thank you.
A very happy chappy.
That's the main thing.
I'm going home.
What, today?
Yeah.
You get the ones who
want to talk, you know,
who will tell you their life stories.
Going to see my wife again.
The only times we've been apart
is when I've been in hospital.
If you go onto oncology,
a palliative section of the hospital,
you've gotta be sensitive,
respectful and dignified.
Do you wanna sit in the bed or a chair?
I'll probably sit in
this chair, I think.
Chair, all right.
Goes right from the
bottom right up to the top,
consultants and things.
We're all doing the
same job in a sense of,
you know, patient care.
Good afternoon, Royal Devon and Exeter.
Yes, certainly.
Everyday
the switchboard staff
double check the emergency
team's pagers are working
before they're needed.
Testing for speech on 099.
Testing for speech on 099.
Thank you.
Thank you very much.
We do a cardiac in the mornings,
lunchtimes it's the gynae teams,
evenings it's trauma.
The important ones that
go to the crash calls.
We go out to the air ambulance
and you never know what's
gonna come in off there.
Doing a lot of helicopters.
We get it through on the bleep,
it says helicopter's
landing in five minutes.
If I've got two porters free and available
I send them straight down.
They stop all the traffic.
And then they bring a patient
in from the helicopter.
And we do the same again for takeoff.
Charlotte
Blackman is finding it
increasingly hard to breathe.
It's an emergency because she has
the genetic lung
condition cystic fibrosis.
The problem with cystic
fibrosis is the lungs
don't clear secretions as well,
so all the gunk sits in the lungs
and is more likely to get infected.
We'll just take some blood.
Let us know if you feel dizzy,
we can lay you back a bit.
Scratch coming.
Healthy blood is sterile.
Your body kills off invading
bacteria in minutes.
But Charlotte has a weak immune system
and could easily develop blood poisoning.
Sepsis.
Sepsis is a big
problem because it can be
such a lifethreatening illness.
Then we need to be on top
of it as soon as possible.
A quarter of a million people
develop sepsis every year, often deadly.
It kills one in six.
Patients with a bacterial infection
are immediately prescribed a
generally effective antibiotic,
but there's a danger it might not work.
The problem is that once miraculous,
all powerful antibiotics are now defeated
by resistant strains of bugs.
So hospitals counterattack
with another weapon
in their armory, microbiology.
It's critical.
Without microbiology we wouldn't know
what the bacterias are,
we wouldn't know what
antibiotics we are able to use,
and more importantly, what
antibiotics we can't use.
Charlotte's
blood is drawn into
special blood culture
bottles and sent by air pod
out across the hospital site
to the microbiology lab.
But flying possibly infected blood
around the hospital in
a pod can be dangerous,
if it breaks.
This is Stargate.
The heart of the pod system.
A giant router of 16 threeway switches.
And of course, miles of tubes.
Paul is one of the
engineers whose job it is
to fix the pod system when it goes wrong.
It's really reliable.
It does break down, it
does give us headaches,
big headaches at times.
If the bands come off or the lids break,
it could cause jam ups in the system.
So you'll get end up with
a pod stuck in the tube
and other pods will back in onto it.
Then you end up having to
take the tube system apart
to rod out, push out the damaged pods.
A damaged pod can mean a leak
of infectious body fluids
spread throughout the hospital.
You do get spillages
of items that are sent.
Some of them aren't pleasant.
So how'd you
clean a system like this?
We've got a second pod, which...
We load it with a chlorine
cleaning chemical,
and then as the pod's being forced
through the system by the air,
the chlorine solution
comes out of the pod,
which disinfects the line as it goes.
In the microbiology lab,
how do the scientists
know Charlotte's blood
even has bacteria in it?
Just have to try and give
them the best environment
for them to grow as quickly as possible.
So the blood bottles are kept
at body temperature, 37 degrees C.
We've got this machine,
which monitors the bloods
every 10 minutes, and if
there are any bugs growing
they will flag positive.
That is a positive.
It just tells us that there
is something going on.
We need to take the bottle off
and then do some more testing.
Next, they
encouraged them to grow even more,
into colonies of over a hundred thousand,
big enough to clearly see the damage
they're doing in the blood.
So those bugs are producing a toxin,
which lies in the red cells.
So it's actually breaking,
rupturing the red cells.
So if you can imagine that's
what's happening in the blood,
then the blood cells are being ruptured.
How serious is that?
It could be very serious.
Very serious.
If you don't
find out which antibiotic
is the best one, what's gonna happen here?
If you don't find out straight away,
or as soon as possible,
then this could be a
lifethreatening situation.
So how do they find out
which antibiotic will kill the bug
before the bug kills the patient?
We've got some paper discs impregnated
with different antibiotics.
After many
hours on a culture plate
coated in the bacteria,
one antibiotic has
clearly lost the battle.
This antibiotic has no
effect against this bacteria.
If the organism grew up to a disc
and the patient was on that antibiotic,
then that wouldn't be
beneficial to the patient
and we would try and get the
patient off of that antibiotic
and onto something more
effective as soon as possible.
Fortunately,
for this patient,
there's also a clear winner.
This antibiotic here has
created a big zone of inhibition.
And so the organism will
be killed in the patient
if they were on this antibiotic.
Thanks to the lab,
the bug causing Charlotte's
chest infection is identified
and quickly treated.
We're trying to save lives.
We don't actually see patients themselves.
We see little pots of people,
little bits of things
which come into the lab,
and we do our bit to try
to get the right result
back to the medics so that they can then
affect change in the patient
and hopefully get them home
as soon as possible.
The microbiology
lab is full of bugs,
but now the secret life
of the hospital leads us
into it's brand new bug free facility.
Not just the cleanest
place in the hospital,
but one of the cleanest places on Earth.
One bacteria inside the product
could cause death to the patient.
Can you confirm who you are?
I'm Cameron Brooking.
Yeah.
16th of the 10th 2002.
Correct.
15 year old
Cameron is halfway through
a 16 week course of chemotherapy.
All right?
Thank you.
Fabulous.
Well done.
Cheers.
A diagnosis of
cancer is always a shock.
So it's Hodgkin's lymphoma.
It's a lymph node in my neck
that's got cancerous cells
and it's gone down into my chest and lung.
Yeah, a big tumor on the chest.
Yeah, it's a tumor.
So, I didn't notice it at first,
I just found a lump.
Hodgkin's
lymphoma is one of the most
common cancers in 13 to 24 year olds.
And fortunately, one of the
most treatable, if found early.
It's all very new to
Cameron and his parents.
Your diagnosis
was quite recent then.
Yeah.
Eight weeks ago.
About eight weeks.
So it was very quick.
Very quick from diagnosis
to start of chemo, wasn't it?
Literally six days.
And you're on, you know, a
bit of a roller coaster there.
Your mind's not there,
and you're, you know,
we were swept along as a
family looking after Cameron.
And then the treatment started.
Intravenous
chemotherapy like Cameron's
is a poison to kill cancer,
and must be made especially
for each patient.
So how does this busy
hospital meet the demand
for 500 sterile bags of highly
toxic treatments a week?
This is an all new facility.
Aseptics.
It's not just the cleanest
place in the hospital,
but one of the cleanest
places in the world.
Staff are zealous in keeping
it a strictly germfree zone.
We can't have one
bacteria inside the product,
cause it could cause death to the patient.
The aseptics
facility doesn't only
make poisonous cocktails to kill cancers,
but also nourishing
liquid food called TPN,
for vulnerable patients in intensive care
and premature babies like Beatrix.
She is very small, and
when she was first born
her stomach's not developed
enough to take my breast milk.
And so she's on TPN, which
is, as far as I'm aware,
it's like a liquid full of nutrients
that she would have got from me,
but it's fed to her intravenously
while her stomach gets
used to my breast milk.
So the TPN in itself is
filtered through a line
and that one gets changed every four days.
So the TPN is in the bag, the
bag that's sealed from light,
so we do protect it from light,
and that comes down the orange line here
and then directly into her vein.
Cause that's the way that
she's getting her nutrition,
so she isn't gonna grow without it.
At the heart of
aseptics is a sterile room.
It's ringed with defenses
like a medieval fortress,
designed to be impregnable to bugs.
To get to work in there, staff
must negotiate five zones.
First, a gowning room.
Each zone is at a higher
air pressure than the last.
Bacteria are simply blown away.
We're having a cascade
of precious as well,
to ensure that the bacterias,
which is more or less our enemy,
doesn't come into our cleanest room.
But the fortress
has one terrible weakness.
The staff.
Although they scrub up like surgeons,
and even check that
their hands are bug free,
they just can't help bringing
in dirt against the flow.
The skin of humans is one
of our biggest problems.
Unfortunately the skin is shedding,
so particles are always
getting into the environment
which could be a risk of
contamination of any product.
So the staff going inside the facilities
are only gowned up to a maximum
so the exposure of skin
is kept to a minimum.
Anyone with dandruff
or dry skin problems can't go in.
Makeup is not allowed.
And even in surgical
clogs, feet are a curse.
So shoes are one of our
biggest enemies as well,
cause there's lots of dirt you could bring
through your footwear.
The countermeasure
is hightech tacky mats,
designed to snatch any
particles of dirt from shoes.
Regularly cleaned and
serviced, their tough,
specially formulated
polymers last for 25 years.
If it all seems a bit OTT,
remember, bacteria have no mercy.
We do not want to bring
even a smallest bacteria
into the room because we
could contaminate the product,
and then we could infect a patient.
The technicians
are only halfway through
their super clean journey to work.
Before they can make any
lifesaving intravenous fluids,
there is yet another gowning
room, at even higher pressure,
where they must add an extra
layer of sterile clothing
and an extra pair of sterile
gloves, just to be sure.
At last, the inner sanctum.
The preparation cabinet
is completely sterile,
and has a third pair of
gloves as a final barrier.
In there is the highest pressure of all,
and even a nicked glove
will trigger an alarm.
There has been shown
worldwide that products
have been contaminated during preparations
and then maybe infused into
patient and patient died
following contamination of the product,
or patient maybe died on overdose,
such as cause maybe the products
were not diluted appropriately.
The worst has
happened, but never here.
Check please.
Okay.
TPN.
Baby TPN.
Solivito.
Each preparation has a team
of at least three people.
Had to trace 2.5.
One making...
And water for injections, five mils.
One double
checking fluid volumes.
Correct.
Thank you.
And another triple
checking the whole process.
If there's any doubt, it gets rejected
and we have to restart again.
So there's never anywhere that we're not
a hundred percent happy with the product.
No, no, this
is the half hour one.
Oh, brilliant.
And then you have
the big long one after that.
Cameron's treatment
today will take some time.
Yeah, I've got a seven
hour one that's coming up.
So it's like a one hour infusion,
but then they need a six hour flush.
So that's what's keeping
us in for most of the day.
So you've got a starter,
main course and dessert today,
haven't you?
Yeah.
Cameron's chemotherapy fluid
flows in through a semipermanent catheter
or PICC line to a major vein by his heart.
I'm big on football and tables tennis,
but with the PICC line,
it's a bit of a struggle.
So I'm not allowed to play in goal,
which is where I played.
And I'm not allowed to
play table tennis, but...
Hey.
Temporary.
Temporary
It's temporary.
Yeah, exactly.
We go to
hospital to get better,
but it's a fact of life that
some of us will not go home.
Hello, it's John speaking,
how can I help you?
For the Royal
Devon and Exeter hospital,
it's a daily event.
Deceased patient.
All booked for you.
Bye.
We rely on our hospitals
for treatment throughout our lives.
Specialist departments are there for us
at the start of life, and at the end.
Hello, Greg?
Okay go ahead.
Can you take you and young Ryan with you
and do a Rosie please, down on ERT?
Okay, will do.
Got a patient to go to the Rose Cottage,
which is the mortuary.
It's the first one today.
It sounds better over
the radio, Rose Cottage,
than taking someone to the mortuary.
Does that happen a lot?
Yeah.
If it's in a ward, they make sure that
all the curtains are closed
around all the other patients,
check all patient's details,
patient is in a bag,
make sure they've got no jewelry
and stuff like that on them.
You transfer the bag onto the trolley
and then put a blue cover on.
Nobody sees you do it.
And then they go down to the mortuary.
Placed in a secluded corner,
the mortuary is one of the
most sensitive departments
in the hospital.
The staff receive 1,700 deceased people
from the hospital every year.
Well, anyone that
comes to our department
is still a patient.
They're still in the care of the hospital.
And by saying patient,
it really reinforces
the fact that that is still a person
that someone has lost and still loves.
Inside this closed off world,
there are 79 refrigerated spaces,
concealed from visiting relatives.
They see their loved
ones specially laid out
in the viewing room.
Our role is really to
look after those people.
There's a lot of different
things that we need to do
to make sure that that journey
is as smooth as possible
for bereaved people.
Just simple things like making sure that
their hair's shampooed and blow dried
so that their relatives
can see them again.
That's what makes our jobs worthwhile.
Hyper aware that
even the smallest mistake
could be devastating, staff
double check everything
by using very important fridge magnets.
We, first of all, will
check that we don't have
any patients with the same or similar name
in the department.
If we do, we'll make sure
that there's an alert in place
so that we always are
showing the right patient
to the right family.
We don't get second chances.
We're one of the few areas of medicine
where you can't put something right.
If we make a mistake, it's wrong.
And it'll be wrong for the family
for the rest of their lives.
Advanced medical technology
is used throughout the hospital.
So the mortuary staff
must be aware of devices
like heart pacemakers or defibrillators.
These must be removed,
as batteries explode during cremation.
And there's an added danger.
With the internal defibrillator,
they will still continue to shock,
so they're like the big
paddles that you'd see in A&E.
They'll still continue
to shock after death.
So, if we were doing a
postmortem examination,
we'd need to know that
patient has a defibrillator in
and that it's switched off so
that we don't get that shock.
If it's enough to start a heart,
it's enough to stop a heart.
The adults you get used to,
but the babies you never do.
You never get over taking
babies to the mortuary.
I've been doing it for 25 years
and it never gets any easier really.
Yeah, it's difficult.
Difficult.
Our hospitals
are so familiar to us
we think we know them intimately.
But we don't.
There are hundreds of
backstage departments
and thousands of people
working behind the scenes,
keeping the hospital show on the road.
Every minute of every hour of every day,
they are living the secret
life of the hospital.
a quarter of a million of us every day.
That is an
abnormal pumping of the heart.
Open 24/7,
hospitals help begin life,
Official YIFY movies site:
YTS.MX
save life, and provide
care when life ends.
If you think hospitals are kept running
by doctors and nurses,
think again.
It looks like a chip
shop menu, doesn't it?
This is where we actually store
the donated bones.
We tend to be the pixie service.
The whole trust is connected by
very primitive drain pipes, essentially.
How are you feeling?
Exclusive
access to one of Britain's
busiest hospitals...
Royal Devon and Exeter.
Allows us behind the scenes
to explore a secret world,
where pharmacists make food
for the most vulnerable patients.
One bacteria inside the product
could cause death to the patient.
Cleaners spray poisonous gas
with strange robots.
Infection kills.
I couldn't contemplate
not doing the deep clean.
A topsy turvy
world where engineers
resuscitate dead machines.
If it fails, it's absolute chaos.
And doctors
screw people together.
Where maintenance is a
matter of life and death.
If it was your relative
being brought in here
to be operated on, to
have their life saved,
you'd want everything working.
Hundreds of
thousands of unseen hands
keep our hospitals running.
This is the ultimate access
all areas backstage pass
to the secret life of the hospital.
The NHS has 1.7 million staff,
making it the biggest employer in Europe.
Logging over 125 million visits a year,
hospitals around the UK
are busier than ever,
treating 1 million of us every 36 hours.
But none of us sees how a major hospital
gears up around us when we're ill.
In Southwest England, the
Royal Devon and Exeter
is a typical large, modern hospital.
With 750 beds,
7,200 staff,
caring for 750,000 patients a year.
Hello RD&E resus.
It's full on, 24/7.
Medical or trauma.
Incoming ambulance crews
give 10 minutes warning.
The switchboard operators act fast,
alerting the right people
with the right expertise.
Right now.
It's literally the
worst feeling in the world
when that goes off.
It bleeps and instantly it goes
to the pit of your stomach.
The NHS uses 130,000 pagers,
more than any organization on Earth.
Blood can be ordered.
Xray imaging put on standby.
Operating theaters prepped.
Laboratories readied.
Anesthetists woken up.
Porters called in.
In minutes, the switchboard
can mobilize an army.
So, we get specialties and expertise
from all around the hospital
to manage the patient
so that they're there
waiting before he arrives.
Everybody ready for a lift?
Ready?
Steady, go.
So, this is Margaret Dodd.
She's 76.
Intercranial hemorrhage
is the primary diagnosis.
The assembled
team swings into action,
fighting to save Margaret's life.
And you've basically got
someone's life in your hands
and if you delay, then
that's gonna have an impact
on whether they survive or not.
As they rush her
to xray for critical scans,
her blood samples are rushed
to the lab for testing.
The problem is the hospital
is half a mile long
and every second counts.
The solution?
The estates department
rapid transit system.
The system is basically
the email for solid objects.
Key in the address to
where you want it to go,
as if by magic, it goes.
The pods fly
to and from 63 locations
throughout the hospital.
Loads of up to two kilos are propelled
by powerful air pumps at
six meters per second.
It's very fast.
I don't think I would like to be a pod.
They rocket
along the hospital's arteries
of six inch tubes,
unseen inside the ceilings and walls.
It would probably be three
to four minutes maximum
from one end of the hospital to the other.
The emergency
samples are whisked
to a place we never see,
the blood sciences lab.
So the whole trust is
connected by this network
of very primitive drain
pipes, essentially.
But it allows us to get
the specimens rapidly
to the lab from A&E,
so we can start that process
of getting those results
back to the clinician so they
can get a patient sorted out.
Blood tests
are so crucial in diagnosis
that 95% of emergency patients
have blood sent for analysis.
On top of that, hundreds
of vials of blood arrive
from all 30 wards in
the morning rush hour.
I can hear another pod coming.
So how do they
pick out the urgent ones
like Margaret's from
A&E, or intensive care?
Everybody else have their clear bags.
The red bags come from an urgent place
such as the emergency department.
So we can tell at a glance
that it's an urgent one
rather than a normal one.
If a sample from A&E arrived now,
we'd expected that to be done
and dusted within one hour.
That first hour is key
for a seriously injured
patient like Margaret.
Medics need information fast,
from scans, from blood tests
and from medical records.
Any calls that come through
the emergency phone line,
we have to get those notes within an hour
of receiving that request.
In one room,
health records keeps
the 75,000 files accessed
in the last two years.
Over 145,000 older ones
are also stored onsite.
But when you add the offsite archives,
there are around three
quarters of a million files
dating back to the 1950s.
With so many files stacked on the shelves,
how do they find an emergency
patient's medical notes?
We use our lovely PAS system to find
where the notes are.
Depending where the are is
then when the real fun starts.
Just like the blood test lab,
the health records
emergency desk is in a race
against the clock.
It is quite complicated when you think
that we run a 24 hour
service seven days a week.
It has been this way for a long
time, medical records, yes.
The NHS has been going since 1948,
and doctors have been using
paper long before then.
A squad of dedicated clerks
are well drilled to beat
the one hour target.
By hand.
It should be in here somewhere.
Hopefully they're in the right place,
cause when you've got
145,000 sets of notes,
they can be a nightmare to find.
The system does work well.
It's a very well oiled machine.
But in the next three years,
health records is going digital.
As the pod system pumps
in more and more samples,
the blood lab is under pressure.
Across the UK, 300,000
patients are tested a day.
That's 6.2 million tests
a year in this lab alone.
How can a handful of lab technicians
possibly process results fast enough
to beat that crucial one hour turnaround?
Automation plays a
massive part in what we do.
We will generate about
25,000 results a day.
The days of bubbling test tubes
and crazy scientists have gone.
Having said that, we have got a few
crazy scientists milling around.
But the automation is key these days
to diagnose and treat patients.
Doctors
can choose from a menu
of 900 different tests
for blood oxygen levels,
liver or kidney function,
or heart problems.
Even cancers can be
discovered or ruled out.
Some of the tests are equally as valid
as a negative result as they
are with a positive result.
The robot
analyzers are superfast
and ultra reliable, but not infallible.
What if they make a mistake?
The machines themselves
are constantly monitored.
If a result is generated that's abnormal,
that's where the human
element comes into it.
So automation is great,
but we still need that
mark one human eyeball
to look at that result
and decide what to do.
As the
emergency department admit
a stream of new casualties,
the first hour is almost up
for 76 year old Margaret.
She's still unconscious.
Her blood results revealed
good oxygen levels
and her brain scan is clear.
So she's now in the
catheterization laboratory,
where consultants inject a dye
to investigate her heart function.
Actually, her arteries are normal.
There's no blockage there,
so it's not a heart attack.
Now we can see the pumping.
So that is an abnormal
pumping of the heart.
It's very discordant
and you can see the dye
kind of hangs around.
That should not happen.
So, this is clearly a problem
with the muscle of the heart itself
rather than the blood supply.
While
Margaret is taken to a bed
in intensive care, on the
wards the hospital comes
face to face with its arch enemy.
Infection kills.
I couldn't contemplate
not doing the deep clean.
And goes
to war on killer bugs.
Hospitals are very unhealthy places.
Sick people go there,
taking a stream of bacteria
and viruses with them.
The foot soldiers in the
constant battle against infection
are the cleaners.
300,000 patients a year in England
acquire an infection
while under treatment,
at a cost to the NHS of 1 billion pounds.
There we are, your breakfast.
The danger of infection
is present on every hospital ward.
From bugs like norovirus and
Clostridium difficile and MRSA,
which is resistant to common antibiotics.
Resistant strains are a
very dangerous proposition
which we're facing at the moment.
If you have an organism which is resistant
to a majority or a vast
range of antibiotics,
then obviously we haven't got any options
to treat the patient with.
One in 30 of us
has MRSA living harmlessly
on our skin or in our nose.
But for patients with open wounds
or weakened immune systems,
MRSA can enter the body to
cause serious infection,
blood poisoning, and even death.
Hi, I'm Cat, one of the nurses.
We're gonna do a few swabs for MRSA.
One of your nose and one of your throat.
Okay.
Okay?
Hospitals
screen every patient for MRSA
before they get a bed.
Okay, and next is your throat.
So open wide for me.
Fantastic.
There we go.
All done.
A positive MRSA result
triggers a protective regime on the wards.
The medics would put that
patient into a side room
and isolate them so that
if there was a patient
with multi resistant organisms,
we try and contain that
and don't allow that
to spread around other
vulnerable patients.
So how do our
biggest hospitals defend patients
from such dangerous cross infections?
Obviously, we do environmental cleaning
every day in the hospital,
24/7, 365 days a year.
But once a year, we make
that decision to deep clean
all of the inpatient environment.
In deploying the deep clean,
they unleash Armageddon on killer bugs.
This is so important.
You know, it's once a
year, annual deep clean,
when everything is stripped right back
and cleaned throughout.
So we start at the top
and work our way down.
So we take curtains out,
everything comes out,
old hand towels, old gloves, and you know,
we clean the beds, we take
the beds apart completely.
That's a really difficult task to do
when a patient's lying on it.
The work that they're doing here today
is absolutely vital to the
running of the hospital.
We can't run a hospital
unless it's clean and safe.
The deep
clean puts these 10 beds
in the acute stroke unit out
of action for most of the day.
And NHS hospitals are
always short of beds.
Infection kills.
I couldn't contemplate
not doing the deep clean.
We have a duty to our
patients to make sure
it's as clean as possible.
The Royal
Devon and Exeter Hospital
has 60 departments spread over six acres.
So how does it link them all together?
Hello, porter, it's John
speaking, how can I help you?
There's
nowhere porters don't know.
Excuse me please.
No one they can't collect.
Thank you guys.
Nothing they can't deliver.
Cheers, thank you.
Day or night.
Lovely, thanks Keith.
They know all the departments,
they know all the bits of equipment,
and there's nothing
they don't know really,
except for surgery their selves.
Porters are
the lifeblood of a hospital,
reaching even the remotest parts on foot.
Average we do about
10 to 12 miles a shift,
in an eight hour shift.
So yeah, it's a hell of a lot of walking.
I did a 28,000 step day the other week.
But in five months, I'm on my
third pair of shoes already.
We pick up blood for general patients
and for emergencies.
We attend every cardiac arrest
that goes on in the hospital.
If there's an emergency down that end,
blood transfusions down at the other end,
and sometimes in one
call you could be running
backwards and forwards four or five times.
They've gotta work
really hard sometimes,
cause I'm the one that makes them work.
They don't call me any names on the radio,
but I can feel it.
They call me the Beastmaster sometimes.
This is a 750 bed hospital.
And I'll grab you some
fresh towels for tomorrow.
Ah, good, thank you very much.
On busy
wards, linen can be changed
many times a day.
To keep up, staff need
10 sets of linen per bed.
Two pillows enough?
Yes, quite enough.
Thank you very much.
But how
does the hospital cope
with thousands of dirty sheets?
In the hospital laundry they've mechanized
war against infection.
The laundry's stateoftheart machinery
cleans 260,000 articles a week,
over 14 million items a year.
It's not just linen that must be spotless.
Doctors' greens and nurses'
blues, scrubs and gowns,
all the hospital's dirty
clothing is resurrected here.
The guys at the bottom
are feeding the laundry up
to the top of the gantry
where the guys are then
sorting it out into sheets,
blankets, bath towels
pillowcases, patient gowns, nightwear,
theater scrub suits, everything.
You name it, we've got it in here.
Potentially infected linen
is double bagged at the hospital.
An outer red bag to alert
laundry staff to danger,
and an inner bag that dissolves in water.
It gets a different wash process.
It's getting a double wash.
So, we're definitely gonna
kill whatever's in it.
Laundry workers often find
a more pleasant surprise in the folds.
We occasionally get mobile
phones, iPads, laptops,
and things like scissors and needles,
which aren't really helpful.
We also quite a lot of personal jewelry,
rings, necklaces, earrings,
which is always nice to
find when people phone up
because sometimes they've lost a relative
and it means a lot to them to get it back,
and it's good to get it back to people.
They're very grateful.
Back in
the acute stroke unit,
after three hours of
scrubbing and steaming,
they wheel out the latest technology
in the arms race against infection.
The deep clean robot.
It will fill the air
with a powerful chemical
that's familiar to hairdressers,
hydrogen peroxide.
It's great at bleaching
hair, but as a vapor,
it's weaponized to
exterminate killer bugs.
We have to be outside
because the environment inside
we're gonna fill with a
hydrogen peroxide vapor.
This is going to kill the microorganisms.
The bleach vapor is so strong
it can't be allowed to leak out.
All the air vents are sealed and covered,
so the gas doesn't harm people
elsewhere in the hospital.
Obviously we don't want
that to escape from the room
whilst it's happening.
So we sealed the room up
completely with tape on the door,
and then we'll make sure
everything's ready before we start.
The misting
will keep this ward closed
for another two and a half hours.
The laundry's two huge
washing machines are brand new
and cost half a million pounds each.
They're hungry beasts, consuming
50 kilos of dirty linen,
eight domestic loads, every two minutes.
Three tons of washing an hour.
This is the first part of the area,
so this is doing our prewash.
This is wetting down and adding chemicals
to try and break up the
stains to start with.
In the center
sections is the main wash
and the real bug killer,
thermal disinfection.
65 degrees Celsius for
at least 10 minutes.
There's no spin cycle.
Every two minutes, a clean load emerges,
squeezed dry by enormous pressure.
350 tons total per load.
If we don't manage to find any items
back up in our sorting and grading area,
this will demolish it.
Staff clean
on an industrial scale,
a synchronized regiment with one aim,
killing bugs.
Yeah, I'm a bit OCD, I think.
It's like with me car,
I'm a bit OCD with that,
it's gotta be clean all the time.
You know.
I don't like dirty glass, I
don't like dirty paintwork,
wheels have gotta be spot on.
Yeah, attention to detail with me.
You're in the right job then.
I think so, yeah.
Shirley
inspects 800 sheets an hour.
Eagleeyed for any fault,
she rejects anything not perfectly clean.
My mum's been in hospital
quite a few times this year
and the sheets are always clean.
That's the main thing, innit?
If we send through clean sheets,
then, the patients can't
get any germs from here.
So we'll just go into
the ward to make sure
it's going to finish on time.
It's crucial that the beds
come back into the system
by the end of the day.
We'll have 10 empty beds by
the time we finish tonight.
In the acute stroke unit,
hydrogen peroxide vapor has
settled on every surface,
penetrated every nook and cranny,
killing any remaining bacteria or viruses.
I'm checking that
we've got no gas leaks.
So, we're safe.
Obviously inside the room
there'll be quite high levels,
but we need to make sure that
we've sealed the door correctly.
So far so good.
At the end of the cycle,
the robot reabsorbs the mist
and the room will be safe to enter.
Patients will be returned to
disinfected, freshly made beds.
How's it going?
So once the mister is finished in there,
we'll move the patients.
Brilliant.
Okay.
Good, good, good.
We need those beds.
The ward will
soon be back in action.
Cheers, thank you.
While upstairs,
another unseen team
keep the operating theaters
running on schedule.
14 year old Sid needs
lifechanging surgery
to straighten his spine.
It's quite painful a lot of the time.
Surgeons
will put in titanium rods
and colorcoded screws.
You'll be a bit like
Wolverine won't you?
Yeah.
But the vital
ingredient is a big surprise.
The anesthetist did say
that they use old lady bones.
Recycled bone.
Through the double doors here,
stairs on your left, lift on your right,
you need to go up one floor.
A&E is the most high profile
hospital department,
but our backstage pass to the
secret life of the hospital
reveals it's just a small cog
in this vast medical machine.
Good morning, Royal Devon and Exeter.
In fact, only 14% of patients
arrive at hospital unexpected,
seeking emergency treatment.
The vast majority have an appointment,
one of over a hundred million appointments
attended in NHS hospitals every year.
This level, straight
to the end, left, area C.
Getting ready for this deluge
is another mammoth task
for health records.
Every day, the records team must find
almost 2,500 sets of notes,
and prepare them for over
300 outpatient clinics.
I've had quite a few dreams
about stamping, prepping,
members of the team being in my dreams,
very, very odd dreams.
I think we pretty much do it in our sleep
as well as come in during the day
and stamping away as much as possible.
Consultants
must have a patient's
medical notes at their fingertips.
For a patient, you know,
there is an assumption
that when you're seen,
your notes will be there.
I've actually been in health
records in clinic prep for,
this will be 12 years coming up.
So I've kind of spent my youth here.
I think I've got about another
60 sets of notes to prep
and not a lot of time to do it in.
14 year old
Sid Hancock's appointment
is with the orthopedic surgeons,
who will be operating on his spine.
So this chap's 14 years
old and he has a scoliosis.
And scoliosis basically is a
threedimensional deformity.
And we can see that the curve
here is in the thoracic,
the chest region of his spine.
So what we're gonna try and do is rotate
this part of his spine
back to being straighter.
Morning.
Morning.
Sid's operation is just one
of 80 scheduled today.
Any problems today?
None.
It's a surgeon's
decision to operate,
but the power to organize the 24 theaters
is in the hands of the matrons.
All day.
So have you got xray?
Have you spoken to them this morning?
Yeah, that was already booked.
Any additional
comments and actions?
The beds are a bit tight,
but they think they'll all pan out.
Fine.
Any equipment issues so far this morning?
They call me the oracle.
When anybody comes in,
they can't find anything,
and they just all make a beeline,
Hil, where's this, Hil, where's that?
Is that all you need?
There's a few more
things on the other side.
Okay, give me a shout if
you can't find anything.
I've got a lot of knowledge
in surgical procedures
and in anesthetic procedures,
so unfortunately I was in the
wrong place at the wrong time
to be given this job.
I manage the stock for the department.
So anything runs out
here, it comes down to me.
In total, I manage about 4,000 lines,
and I take a lot of pride
knowing that everything is here.
With 30,000 procedures a day
and millions of potential patients,
the NHS supply chain never sleeps,
delivering over one and a
half billion pounds worth
of supplies a year,
including 10 million disposable scalpels,
250 million syringes of all sizes,
and over 1.7 billion pairs
of examination gloves.
We need to save money, and
over the last seven years,
I've saved hundreds
and thousands of pounds
by sourcing alternative suppliers.
Just things like this,
is our suction tubing,
used everywhere in the chest.
By just changing the
bore by one millimeter,
saved thousands and thousands of pounds.
Two capped spools.
Vaguely 18 ish.
Although frantically busy,
every operating theater is
shut down for maintenance
twice a year.
The estates department takes care of even
the tiniest backstage detail.
We try to catch anything
that might break down
to check it all and make sure it is gonna
last the next six months,
unless they do something silly with it.
Which is quite possible.
Every single
light bulb is replaced,
working or not.
Everything is doublechecked.
Making sure that
they've got full movement,
no obvious damage, excess
wear, things like that.
At the end of the day,
if it was your relative
or a friend being brought
in here to be operated on,
to have their life saved,
you'd want everything
working to its best ability,
to give the surgeons the
best chance they have
of saving their lives.
Sid is called into theater
only when everyone and
everything is ready for him.
Hello there.
All right?
Hello.
Come on in.
Hi there.
All right?
hi.
Let's get you settled down,
let's get you sat down.
So before we do...
Behind the
operating room doors
is a hidden world of precision tools.
Spinal surgery calls for trays and trays
of specialist surgical equipment.
Trish, could we have
a few more nuts, please?
And racks
and racks of screws.
They are colorcoded for diameter,
but each must be carefully
doublechecked for length,
by hand.
Finely machined from titanium,
they are light, strong
and will never corrode.
They cost up to 300 pounds each.
Sid will need 22.
When a patient is cut open,
they're vulnerable to infection.
A clean and sterile environment
is a matter of life and death.
But bugs can still get
in, carried by the air.
The plant rooms in the
roof of the hospital
are a far cry from the
quiet, pristine theaters.
But in this noisy, dirty
place is one of the most
important pieces of theater equipment.
Its air handling unit.
This is the dedicated
AHU, air handling unit.
It takes the air from outside in,
it puts it through various filters,
sensors, things like that,
and then it'll go through a chilling coil
or a heating coil so that the air can be
chilled or heated as
required by the theater.
Pushing clean
air into the operating theater
has a vital extra role.
Dirty, potentially infectious
air, is pushed out.
The air inside the
theater is pressurized.
You've got invasive surgery going on.
You don't want outside air
full of germs coming in,
so we try to keep out as much as possible.
Right, shall we
do an xray now of the screws?
An xray of Sid's spine
shows that all the screws
are well positioned
to hold the titanium rods
that will straighten his back.
The screws grip hold of the spine,
and then the rods have a certain shape
and so you attach the rods to the screws
to put the spine into the shape
you're hoping to get it to.
Somewhat straighter.
And then you want it to stay there.
But the metalwork
is only half the story.
Over time, the rods may break
or the screws come loose.
So to fuse his spine straight for life,
Sid needs a bone graft.
We want the correction to be maintained
by the rods and screws
while the bone graft
heals in the same position,
to create a fusion so
that it's solid bone.
But where will
his bone graft come from?
Over 120,000 hip
replacements are carried out
in NHS hospitals each year.
Successfully treating what was
once a crippling condition.
You get pain in the
hip when you're walking,
going downhill, and as it gets
really bad, you can't sleep.
So how does
getting a new metal hip
help with bone grafts?
This is your thigh bone, as it would be,
as you can see from
this, it'll go this way.
When you have a hip replacement,
the surgeons will actually cut across here
and this bit will be removed.
Yeah, all looks good.
The old femoral heads
can be donated for recycling.
For all the hightech
equipment in theater,
bone graft preparation comes
down to what looks like
a good old fashioned mincer.
To get a femoral head, operating
staff make a withdrawal
from the bone bank.
That's it, at the very back.
Fivesixeighttwo.
Kept deep frozen way down
at minus 80 degrees C,
the donated femoral heads
can be stored for five years.
I don't think I've ever known
that we've actually discarded,
as we call discarded,
a femoral head that has actually
reached its sell by date.
They are always implanted prior
to that actually happening.
It's marvelous that people have donated
and we don't want to
waste anything at all.
I'm just taking off the soft tissue
and cartilage from the head.
Cause we just want the
cancellous bone that's inside.
30 femoral heads
are donated every month,
making the hospital selfsufficient
in bone graft material.
And even better, it's free.
It's a winwin situation really.
People like it cause it's upcycling.
It's time to
add the milled femoral head
that will fuse Sid's spine in position.
So the femoral head, milled up,
will activate it as a scaffolding
for this young man's bone
cells to grow through,
to create the fusion.
Once the bone has been used,
Louise, the bone bank coordinator,
organizers a surprise thank
you letter from the hospital.
It gives them a feel good factor.
I've actually had patients phone up
and say to me that they
were so chuffed to bits,
because obviously it's
a long time sometimes
from the point of donation
to the point of implantation,
can be up to four and a
half, nearly five years.
And sometimes they forget
that they've done that.
It feels nice to get it.
It's an acknowledgement
that you've done something,
that somebody, you know,
definitely has benefited from that.
Sid's operation has taken
four and a half hours.
And now staff have a lot
of clearing up to do.
Medicine is a messy business,
and a third of the waste it generates
is classed as infectious.
As it can't go to landfill,
it's expensive to get rid of.
Costing from 400 to 22,000 pounds per ton.
The logistics team collect
it in their electric trucks
and take it away.
Three, four,
five, six, seven, eight.
But the
contaminated surgical instruments
are much too valuable to throw away.
They are precision engineered
for specialist procedures,
costing from 600 up to 8,000 pounds each.
So where do they go after the surgeons
have finished with them?
When used surgical instruments arrive
at the hospital sterilization
and decontamination unit,
they are filthy, bloody
and potentially infectious.
They have to leave pristine and sterile,
ready to go again and again and again.
That figure there is the
amount of times it's been used.
So that's 1,238 that's been through.
500 sets
a day are sent through
these powerful industrial dishwashers.
Just make sure it starts.
It's the first
step in a four hour process.
Next, each instrument must
be thoroughly checked.
I'm just checking all the instruments,
all the joints, to make
sure that they've all
come through the wash clean.
If you come across anything that doesn't
look like it's meeting
or it's a bit broken,
you send it off and it'll go for repair.
We actually have to
know all the instruments
so that we can make sure they're all there
in the first place.
That's the littlewoods.
There's an Addison's, that's a forcep.
When I first started I
thought it was a tweezer,
but it's not.
That's a retractor,
sort of pulling you open
while the surgeon's operating.
I've seen a couple of operations.
Really interesting.
You do get the chance
to go up and watch some.
What's your favorite?
Hip.
Really interesting how
they throw your leg around
to get to the hip.
Before sterilization,
each set of washed and checked
instruments is wrapped.
It looks like a simple parcel,
but the cloths and the sticky tape
are designed with hidden qualities.
Once steam sterilized under pressure
at 135 degrees C for
three and a half minutes,
the stripes on the table have
changed from green to black.
What I'm just checking
is that the indicators
have all changed color.
Staff can tell at a glance
that a pack has been sterilized.
The weave of the cloths
has closed up in the heat,
sealing in the sterilized instruments.
The sets are ready for surgery again.
Yeah, just do a
little bit, don't force it.
After his spinal operation,
Sid's in the recovery area.
I'm feeling like I've
been stabbed in the back
a few times, but like, yeah,
pretty good to be honest.
It's gone
really well, hasn't it?
Yeah.
It's a little weird to think there are
titanium rods in my back.
If I have a hip replacement
or two hip replacements
and a knee replacement
You'd be a bionic man.
We have rebuilt you.
Gonna be like Wolverine.
Wolverine, yeah.
And it'll only be a matter of time
before I can move into my cyborg body.
The secret
life of the hospital
is full of contradictions.
While one department is killing bugs,
another is feeding them,
growing them as fast as possible
because another patient's
life hangs in the balance.
Ready, steady, slide.
The emergency
department is dealing with
the aftermath of a serious crash.
8:30, you know, five people in a van
and the van hit the central Armco,
you know, the central reservation.
Bounced, flipped and then crashed into
one of the bridge parapets.
And the rest of them
have gone somewhere else?
No, the driver's dead on the scene.
Okay.
Right, Justin.
So this is the CT scan, okay?
The bed is going to move
into this donut, okay?
It will be noisy, but you'll be okay.
Justin has
suffered possibly serious
head and facial injuries.
So a CT scan will reveal
really vital information.
So all patients who have major trauma
will have a CT scan of
virtually their entire body.
Quite often it's possible to
miss quite important injuries.
Medical
imaging is a magic window
for doctors to see inside the body.
There's certainly no
major amount of blood there.
There's an anterior skull fracture,
probably running just about down here
in relation to the eye.
He's quite drowsy intermittently.
I did notice that, yeah.
The history goes against this being
a significant head injury, doesn't it?
Because he crawled out and
immediately was speaking,
crawled out through a rear window.
Medical
imaging is such a vital tool
in diagnosis that 42
million scans of all types
were made in England last year.
Doctors rely on them.
The scanners simply have to work.
At 6:00 AM this morning, this
room looked very different,
when the engineer woke the CT scanners.
These giant xray machines
are one of the most
complex in the hospital.
And there was a hitch.
Something's not picked up.
Something's not synced as
this system's coming up.
So it's not happy.
They break down quite a lot.
There's an awful lot of systems.
There's a big computer under here,
there's various computers
actually within the CT itself.
They've all got to come up
and they've all got to sync
so that they all know what they're doing.
The cost of
one CT scanner is 480,000,
before installation.
The human cost of a
breakdown is incalculable.
If it fails this test now
and the system's not working,
it's absolute chaos.
Modern medicine demands
a vast number of electronic devices
of all shapes and sizes working 24/7.
We have many machines.
We have something like 30,000 assets
actually on the hospital site.
That does vary from a standard
little handheld thermometer
up to ventilators and critical
care and anesthetic machines.
So within this hospital,
we look after anything
that is attached to the patient.
So that's the ECGs,
defibrillators, monitors,
equipment that patients are connected to,
such as the incubators.
Born 10 weeks early,
weighing just three pounds seven ounces,
Beatrix has spent her first four days
either on her mum Jess or in an incubator.
She's still on 61% humidity,
so it's nice and warm in there.
And it's also quite humid.
Nice tropical environment.
Yeah.
Parents Jess
and Mike have been told
jaundice is common in preterm babies,
and Beatrix is being
treated in the incubator
with ultraviolet light.
And she's been sunbathing
because the UV lights,
the phototherapy that she's having,
which is why she's quite dark.
It sounds like a nice
holiday really, doesn't it?
At Becky's
workbench is an incubator
just like Beatrix's.
So the problem with
this piece of equipment
is this sensor here.
It wasn't picking up the
temperature very well
on the planned maintenance.
I have a new one that I can replace with.
Infant
respiratory distress syndrome
is the leading cause of neonatal death.
An incubator malfunction
could be disastrous.
And we actually replace
parts before they fail.
So it is very much a proactive
rather than reactive.
The incubators are always
left at a running temperature
so they can swap the babies
safely into that incubator.
We tend to be the pixie service.
We go in, they don't see us,
we pick up the equipment that's failed,
and we drop it back when we've
tested it and it's fixed.
Good morning.
Would you like some breakfast?
Sometimes I feel that a nice cup of tea
is just as good as any medicine.
Tracy Witcome, go back to Creedy.
Yeah, she's not quite ready yet.
As porters move people
through the hospital maze,
the patients are in their care.
Part of our job is actually
sort of reading the patient.
A lot of people that come
in here are quite scared,
nervous about what's gonna happen.
Sometimes they will confide in you
when you're on your way
down to xray at 3:00 AM,
rather than talk to the nurse.
How are you today, sir?
I'm okay, thank you.
A very happy chappy.
That's the main thing.
I'm going home.
What, today?
Yeah.
You get the ones who
want to talk, you know,
who will tell you their life stories.
Going to see my wife again.
The only times we've been apart
is when I've been in hospital.
If you go onto oncology,
a palliative section of the hospital,
you've gotta be sensitive,
respectful and dignified.
Do you wanna sit in the bed or a chair?
I'll probably sit in
this chair, I think.
Chair, all right.
Goes right from the
bottom right up to the top,
consultants and things.
We're all doing the
same job in a sense of,
you know, patient care.
Good afternoon, Royal Devon and Exeter.
Yes, certainly.
Everyday
the switchboard staff
double check the emergency
team's pagers are working
before they're needed.
Testing for speech on 099.
Testing for speech on 099.
Thank you.
Thank you very much.
We do a cardiac in the mornings,
lunchtimes it's the gynae teams,
evenings it's trauma.
The important ones that
go to the crash calls.
We go out to the air ambulance
and you never know what's
gonna come in off there.
Doing a lot of helicopters.
We get it through on the bleep,
it says helicopter's
landing in five minutes.
If I've got two porters free and available
I send them straight down.
They stop all the traffic.
And then they bring a patient
in from the helicopter.
And we do the same again for takeoff.
Charlotte
Blackman is finding it
increasingly hard to breathe.
It's an emergency because she has
the genetic lung
condition cystic fibrosis.
The problem with cystic
fibrosis is the lungs
don't clear secretions as well,
so all the gunk sits in the lungs
and is more likely to get infected.
We'll just take some blood.
Let us know if you feel dizzy,
we can lay you back a bit.
Scratch coming.
Healthy blood is sterile.
Your body kills off invading
bacteria in minutes.
But Charlotte has a weak immune system
and could easily develop blood poisoning.
Sepsis.
Sepsis is a big
problem because it can be
such a lifethreatening illness.
Then we need to be on top
of it as soon as possible.
A quarter of a million people
develop sepsis every year, often deadly.
It kills one in six.
Patients with a bacterial infection
are immediately prescribed a
generally effective antibiotic,
but there's a danger it might not work.
The problem is that once miraculous,
all powerful antibiotics are now defeated
by resistant strains of bugs.
So hospitals counterattack
with another weapon
in their armory, microbiology.
It's critical.
Without microbiology we wouldn't know
what the bacterias are,
we wouldn't know what
antibiotics we are able to use,
and more importantly, what
antibiotics we can't use.
Charlotte's
blood is drawn into
special blood culture
bottles and sent by air pod
out across the hospital site
to the microbiology lab.
But flying possibly infected blood
around the hospital in
a pod can be dangerous,
if it breaks.
This is Stargate.
The heart of the pod system.
A giant router of 16 threeway switches.
And of course, miles of tubes.
Paul is one of the
engineers whose job it is
to fix the pod system when it goes wrong.
It's really reliable.
It does break down, it
does give us headaches,
big headaches at times.
If the bands come off or the lids break,
it could cause jam ups in the system.
So you'll get end up with
a pod stuck in the tube
and other pods will back in onto it.
Then you end up having to
take the tube system apart
to rod out, push out the damaged pods.
A damaged pod can mean a leak
of infectious body fluids
spread throughout the hospital.
You do get spillages
of items that are sent.
Some of them aren't pleasant.
So how'd you
clean a system like this?
We've got a second pod, which...
We load it with a chlorine
cleaning chemical,
and then as the pod's being forced
through the system by the air,
the chlorine solution
comes out of the pod,
which disinfects the line as it goes.
In the microbiology lab,
how do the scientists
know Charlotte's blood
even has bacteria in it?
Just have to try and give
them the best environment
for them to grow as quickly as possible.
So the blood bottles are kept
at body temperature, 37 degrees C.
We've got this machine,
which monitors the bloods
every 10 minutes, and if
there are any bugs growing
they will flag positive.
That is a positive.
It just tells us that there
is something going on.
We need to take the bottle off
and then do some more testing.
Next, they
encouraged them to grow even more,
into colonies of over a hundred thousand,
big enough to clearly see the damage
they're doing in the blood.
So those bugs are producing a toxin,
which lies in the red cells.
So it's actually breaking,
rupturing the red cells.
So if you can imagine that's
what's happening in the blood,
then the blood cells are being ruptured.
How serious is that?
It could be very serious.
Very serious.
If you don't
find out which antibiotic
is the best one, what's gonna happen here?
If you don't find out straight away,
or as soon as possible,
then this could be a
lifethreatening situation.
So how do they find out
which antibiotic will kill the bug
before the bug kills the patient?
We've got some paper discs impregnated
with different antibiotics.
After many
hours on a culture plate
coated in the bacteria,
one antibiotic has
clearly lost the battle.
This antibiotic has no
effect against this bacteria.
If the organism grew up to a disc
and the patient was on that antibiotic,
then that wouldn't be
beneficial to the patient
and we would try and get the
patient off of that antibiotic
and onto something more
effective as soon as possible.
Fortunately,
for this patient,
there's also a clear winner.
This antibiotic here has
created a big zone of inhibition.
And so the organism will
be killed in the patient
if they were on this antibiotic.
Thanks to the lab,
the bug causing Charlotte's
chest infection is identified
and quickly treated.
We're trying to save lives.
We don't actually see patients themselves.
We see little pots of people,
little bits of things
which come into the lab,
and we do our bit to try
to get the right result
back to the medics so that they can then
affect change in the patient
and hopefully get them home
as soon as possible.
The microbiology
lab is full of bugs,
but now the secret life
of the hospital leads us
into it's brand new bug free facility.
Not just the cleanest
place in the hospital,
but one of the cleanest places on Earth.
One bacteria inside the product
could cause death to the patient.
Can you confirm who you are?
I'm Cameron Brooking.
Yeah.
16th of the 10th 2002.
Correct.
15 year old
Cameron is halfway through
a 16 week course of chemotherapy.
All right?
Thank you.
Fabulous.
Well done.
Cheers.
A diagnosis of
cancer is always a shock.
So it's Hodgkin's lymphoma.
It's a lymph node in my neck
that's got cancerous cells
and it's gone down into my chest and lung.
Yeah, a big tumor on the chest.
Yeah, it's a tumor.
So, I didn't notice it at first,
I just found a lump.
Hodgkin's
lymphoma is one of the most
common cancers in 13 to 24 year olds.
And fortunately, one of the
most treatable, if found early.
It's all very new to
Cameron and his parents.
Your diagnosis
was quite recent then.
Yeah.
Eight weeks ago.
About eight weeks.
So it was very quick.
Very quick from diagnosis
to start of chemo, wasn't it?
Literally six days.
And you're on, you know, a
bit of a roller coaster there.
Your mind's not there,
and you're, you know,
we were swept along as a
family looking after Cameron.
And then the treatment started.
Intravenous
chemotherapy like Cameron's
is a poison to kill cancer,
and must be made especially
for each patient.
So how does this busy
hospital meet the demand
for 500 sterile bags of highly
toxic treatments a week?
This is an all new facility.
Aseptics.
It's not just the cleanest
place in the hospital,
but one of the cleanest
places in the world.
Staff are zealous in keeping
it a strictly germfree zone.
We can't have one
bacteria inside the product,
cause it could cause death to the patient.
The aseptics
facility doesn't only
make poisonous cocktails to kill cancers,
but also nourishing
liquid food called TPN,
for vulnerable patients in intensive care
and premature babies like Beatrix.
She is very small, and
when she was first born
her stomach's not developed
enough to take my breast milk.
And so she's on TPN, which
is, as far as I'm aware,
it's like a liquid full of nutrients
that she would have got from me,
but it's fed to her intravenously
while her stomach gets
used to my breast milk.
So the TPN in itself is
filtered through a line
and that one gets changed every four days.
So the TPN is in the bag, the
bag that's sealed from light,
so we do protect it from light,
and that comes down the orange line here
and then directly into her vein.
Cause that's the way that
she's getting her nutrition,
so she isn't gonna grow without it.
At the heart of
aseptics is a sterile room.
It's ringed with defenses
like a medieval fortress,
designed to be impregnable to bugs.
To get to work in there, staff
must negotiate five zones.
First, a gowning room.
Each zone is at a higher
air pressure than the last.
Bacteria are simply blown away.
We're having a cascade
of precious as well,
to ensure that the bacterias,
which is more or less our enemy,
doesn't come into our cleanest room.
But the fortress
has one terrible weakness.
The staff.
Although they scrub up like surgeons,
and even check that
their hands are bug free,
they just can't help bringing
in dirt against the flow.
The skin of humans is one
of our biggest problems.
Unfortunately the skin is shedding,
so particles are always
getting into the environment
which could be a risk of
contamination of any product.
So the staff going inside the facilities
are only gowned up to a maximum
so the exposure of skin
is kept to a minimum.
Anyone with dandruff
or dry skin problems can't go in.
Makeup is not allowed.
And even in surgical
clogs, feet are a curse.
So shoes are one of our
biggest enemies as well,
cause there's lots of dirt you could bring
through your footwear.
The countermeasure
is hightech tacky mats,
designed to snatch any
particles of dirt from shoes.
Regularly cleaned and
serviced, their tough,
specially formulated
polymers last for 25 years.
If it all seems a bit OTT,
remember, bacteria have no mercy.
We do not want to bring
even a smallest bacteria
into the room because we
could contaminate the product,
and then we could infect a patient.
The technicians
are only halfway through
their super clean journey to work.
Before they can make any
lifesaving intravenous fluids,
there is yet another gowning
room, at even higher pressure,
where they must add an extra
layer of sterile clothing
and an extra pair of sterile
gloves, just to be sure.
At last, the inner sanctum.
The preparation cabinet
is completely sterile,
and has a third pair of
gloves as a final barrier.
In there is the highest pressure of all,
and even a nicked glove
will trigger an alarm.
There has been shown
worldwide that products
have been contaminated during preparations
and then maybe infused into
patient and patient died
following contamination of the product,
or patient maybe died on overdose,
such as cause maybe the products
were not diluted appropriately.
The worst has
happened, but never here.
Check please.
Okay.
TPN.
Baby TPN.
Solivito.
Each preparation has a team
of at least three people.
Had to trace 2.5.
One making...
And water for injections, five mils.
One double
checking fluid volumes.
Correct.
Thank you.
And another triple
checking the whole process.
If there's any doubt, it gets rejected
and we have to restart again.
So there's never anywhere that we're not
a hundred percent happy with the product.
No, no, this
is the half hour one.
Oh, brilliant.
And then you have
the big long one after that.
Cameron's treatment
today will take some time.
Yeah, I've got a seven
hour one that's coming up.
So it's like a one hour infusion,
but then they need a six hour flush.
So that's what's keeping
us in for most of the day.
So you've got a starter,
main course and dessert today,
haven't you?
Yeah.
Cameron's chemotherapy fluid
flows in through a semipermanent catheter
or PICC line to a major vein by his heart.
I'm big on football and tables tennis,
but with the PICC line,
it's a bit of a struggle.
So I'm not allowed to play in goal,
which is where I played.
And I'm not allowed to
play table tennis, but...
Hey.
Temporary.
Temporary
It's temporary.
Yeah, exactly.
We go to
hospital to get better,
but it's a fact of life that
some of us will not go home.
Hello, it's John speaking,
how can I help you?
For the Royal
Devon and Exeter hospital,
it's a daily event.
Deceased patient.
All booked for you.
Bye.
We rely on our hospitals
for treatment throughout our lives.
Specialist departments are there for us
at the start of life, and at the end.
Hello, Greg?
Okay go ahead.
Can you take you and young Ryan with you
and do a Rosie please, down on ERT?
Okay, will do.
Got a patient to go to the Rose Cottage,
which is the mortuary.
It's the first one today.
It sounds better over
the radio, Rose Cottage,
than taking someone to the mortuary.
Does that happen a lot?
Yeah.
If it's in a ward, they make sure that
all the curtains are closed
around all the other patients,
check all patient's details,
patient is in a bag,
make sure they've got no jewelry
and stuff like that on them.
You transfer the bag onto the trolley
and then put a blue cover on.
Nobody sees you do it.
And then they go down to the mortuary.
Placed in a secluded corner,
the mortuary is one of the
most sensitive departments
in the hospital.
The staff receive 1,700 deceased people
from the hospital every year.
Well, anyone that
comes to our department
is still a patient.
They're still in the care of the hospital.
And by saying patient,
it really reinforces
the fact that that is still a person
that someone has lost and still loves.
Inside this closed off world,
there are 79 refrigerated spaces,
concealed from visiting relatives.
They see their loved
ones specially laid out
in the viewing room.
Our role is really to
look after those people.
There's a lot of different
things that we need to do
to make sure that that journey
is as smooth as possible
for bereaved people.
Just simple things like making sure that
their hair's shampooed and blow dried
so that their relatives
can see them again.
That's what makes our jobs worthwhile.
Hyper aware that
even the smallest mistake
could be devastating, staff
double check everything
by using very important fridge magnets.
We, first of all, will
check that we don't have
any patients with the same or similar name
in the department.
If we do, we'll make sure
that there's an alert in place
so that we always are
showing the right patient
to the right family.
We don't get second chances.
We're one of the few areas of medicine
where you can't put something right.
If we make a mistake, it's wrong.
And it'll be wrong for the family
for the rest of their lives.
Advanced medical technology
is used throughout the hospital.
So the mortuary staff
must be aware of devices
like heart pacemakers or defibrillators.
These must be removed,
as batteries explode during cremation.
And there's an added danger.
With the internal defibrillator,
they will still continue to shock,
so they're like the big
paddles that you'd see in A&E.
They'll still continue
to shock after death.
So, if we were doing a
postmortem examination,
we'd need to know that
patient has a defibrillator in
and that it's switched off so
that we don't get that shock.
If it's enough to start a heart,
it's enough to stop a heart.
The adults you get used to,
but the babies you never do.
You never get over taking
babies to the mortuary.
I've been doing it for 25 years
and it never gets any easier really.
Yeah, it's difficult.
Difficult.
Our hospitals
are so familiar to us
we think we know them intimately.
But we don't.
There are hundreds of
backstage departments
and thousands of people
working behind the scenes,
keeping the hospital show on the road.
Every minute of every hour of every day,
they are living the secret
life of the hospital.