Original subtitles

[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)