All language subtitles for secret.life.of.the.hospital.2018.1080p.web.h264-failed.[eng]

[Narrator] NHS
hospitals treat over

a quarter of a million
of us every day.

[Doctor] That is an
abnormal pumping of the heart.

[Narrator] Open 24/7,
hospitals help begin life,

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?

[Female] 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?

[Narrator] Exclusive
access to one of Britain's

busiest hospitals...

Royal Devon and Exeter.

[Narrator] 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.

[Narrator] Cleaners
spray poisonous gas

with strange robots.

Infection kills.

I couldn't contemplate
not doing the deep clean.

[Narrator] A topsy turvy
world where engineers

resuscitate dead machines.

If it fails, it's
absolute chaos.

[Narrator] 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.

[Narrator] 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.

[Narrator] It's full on, 24/7.

Medical or trauma.

[Narrator] Incoming
ambulance crews

give 10 minutes warning.

(telephone rings)

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.

[Narrator] The NHS
uses 130,000 pagers,

more than any
organization on Earth.

Blood can be ordered.

X-ray 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.

[Narrator] 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.

[Narrator] As they rush her
to x-ray 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Rachael] I can hear
another pod coming.

[Narrator] 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.

[Narrator] 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.

(upbeat music)

Any calls that come through
the emergency phone line,

we have to get those
notes within an hour

of receiving that request.

[Narrator] 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.

(laughing)

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] The robot
analyzers are super-fast

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.

(tense music)

[Narrator] 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.

[Narrator] While
Margaret is taken to a bed

in intensive care, on the
wards the hospital comes

face to face with
its arch enemy.

(dramatic music)

Infection kills.

I couldn't contemplate
not doing the deep clean.

[Narrator] 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

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.

[Nurse] There we
are, your breakfast.

[Narrator] 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.

[Narrator] 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?

[Narrator] 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.

[Narrator] 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.

[Narrator] So how do
our biggest hospitals

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.

[Narrator] 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.

[Narrator] 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.

(melodic music)

[Narrator] 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?

[Narrator] There's
nowhere porters don't know.

Excuse me please.

[Narrator] No one
they can't collect.

Thank you guys.

[Narrator] Nothing
they can't deliver.

Cheers, thank you.

[Narrator] 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.

[Narrator] 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.

(laughing)

They call me the
Beastmaster sometimes.

[Narrator] This is
a 750 bed hospital.

And I'll grab you some
fresh towels for tomorrow.

Ah, good, thank you very much.

[Narrator] On busy
wards, linen can be changed

many times a day.

To keep up, staff need
10 sets of linen per bed.

[Nurse] Two pillows enough?

[Patient] Yes, quite enough.

Thank you very much.

[Narrator] But how
does the hospital cope

with thousands of dirty sheets?

(upbeat music)

In the hospital laundry
they've mechanized

war against infection.

The laundry's
state-of-the-art 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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

and then we'll make
sure everything's

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Male] You're in
the right job then.

I think so, yeah.

[Narrator] Shirley
inspects 800 sheets an hour.

Eagle-eyed 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] The ward will
soon be back in action.

(dramatic music)

Cheers, thank you.

[Narrator] While upstairs,
another unseen team

keep the operating theaters
running on schedule.

14 year old Sid needs
life-changing surgery

to straighten his spine.

It's quite painful
a lot of the time.

[Narrator] Surgeons
will put in titanium rods

and color-coded screws.

You'll be a bit like
Wolverine won't you?

Yeah.

[Narrator] But the vital
ingredient is a big surprise.

The anesthetist did say
that they use old lady bones.

[Narrator] Recycled bone.

Through the double doors here,

stairs on your left,
lift on your right,

you need to go up one floor.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

(gentle music)

[Narrator] 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
three-dimensional 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.

[Narrator] Sid's
operation is just one

of 80 scheduled today.

Any problems today?

None.

[Narrator] 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 x-ray?

Have you spoken to
them this morning?

[Female] Yeah, that
was already booked.

[Matron] 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 bee-line,

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.

[Narrator] 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 1-8 ish.

[Narrator] 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.

[Narrator] Every single
light bulb is replaced,

working or not.

Everything is double-checked.

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.

[Narrator] Sid is
called into theater

only when everyone and
everything is ready for him.

[Doctor] 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...

[Narrator] 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?

[Narrator] And racks
and racks of screws.

They are color-coded
for diameter,

but each must be carefully
double-checked 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.

[Narrator] 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.

[Surgeon] Right, shall we
do an x-ray now of the screws?

[Narrator] An
x-ray 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] The
old femoral heads

can be donated for recycling.

For all the high-tech
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.

Five-six-eight-two.

[Narrator] 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.

[Narrator] 30 femoral heads
are donated every month,

making the hospital
self-sufficient in

And even better, it's free.

It's a win-win
situation really.

People like it cause
it's upcycling.

[Narrator] 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.

[Narrator] 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

[Narrator] 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.

[Female] Three, four,
five, six, seven, eight.

[Narrator] But
the contaminated

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.

[Narrator] 500 sets
a day are sent through

these powerful
industrial dishwashers.

Just make sure it starts.

[Narrator] 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.

[Male] What's your favorite?

Hip.

Really interesting how
they throw your leg around

to get to the hip.

(laughing)

[Narrator] 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.

[Narrator] 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.

(groaning)

[Female] Yeah, just do a
little bit, don't force it.

[Narrator] 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.

[Female] 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.

(laughing)

[Narrator] 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.

[Female] Ready, steady, slide.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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 x-ray 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Mike] Nice
tropical environment.

[Jess] Yeah.

[Narrator] 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?

[Narrator] 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.

[Narrator] 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.

[Narrator] 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 x-ray 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.

(chuckles)

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.

(slow melodic music)

Good afternoon,
Royal Devon and Exeter.

Yes, certainly.

[Narrator] Everyday
the switchboard staff

double check the emergency
team's pagers are working

before they're needed.

(pager beeping)

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.

[Narrator] 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.

[Narrator] 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 life-threatening illness.

Then we need to be on top
of it as soon as possible.

[Narrator] 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.

[Narrator] 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
three-way 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.

[Narrator] 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.

[Male] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] Next,
they encouraged them

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.

[Male] How serious is that?

It could be very serious.

Very serious.

[Male] 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
life-threatening situation.

[Narrator] 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.

[Narrator] 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.

[Narrator] Fortunately,
for this patient,

there's also a clear winner.

This antibiotic
here has created a big

And so the organism will
be killed in the patient

if they were on this antibiotic.

[Narrator] 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.

[Narrator] 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.

[Narrator] 15 year old
Cameron is halfway through

a 16 week course
of chemotherapy.

All right?

Thank you.

Fabulous.

Well done.

Cheers.

[Narrator] 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.

[Narrator] 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.

[Male] 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.

[Narrator] 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 germ-free zone.

We can't have one
bacteria inside the product,

cause it could cause
death to the patient.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] The countermeasure
is high-tech 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,

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.

[Narrator] The technicians
are only halfway through

their super clean
journey to work.

Before they can make any
life-saving 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.

[Narrator] The worst has
happened, but never here.

Check please.

Okay.

TPN.

Baby TPN.

Solivito.

[Narrator] Each
preparation has a team

of at least three people.

Had to trace 2.5.

[Narrator] One making...

And water for
injections, five mils.

[Narrator] One double
checking fluid volumes.

Correct.

Thank you.

[Narrator] 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.

[Nurse] No, no, this
is the half hour one.

[Patient] Oh, brilliant.

[Nurse] And then you have
the big long one after that.

[Narrator] 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.

[Narrator] 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.

[Mother] Temporary.

Temporary

It's temporary.

Yeah, exactly.

[Narrator] We go to
hospital to get better,

but it's a fact of life that
some of us will not go home.

(telephone ringing)

Hello, it's John speaking,
how can I help you?

[Narrator] For the Royal
Devon and Exeter hospital,

it's a daily event.

Deceased patient.

All booked for you.

Bye.

(gentle music)

[Narrator] 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?

[Greg] Okay go ahead.

Can you take you and
young Ryan with you

and do a Rosie
please, down on ERT?

[Greg] 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.

[Male] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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.

[Narrator] 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
post-mortem 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.

(gentle music)

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.

(intense dramatic music)

[Narrator] 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.

(dramatic music continues)