Skip to main content

Niagara superbug report makes important recommendations

The new expert report from an Infection Control Resource Team (ICRT) on the C. Difficile outbreak at the Niagara Health System (NHS) makes a number of significant recommendations, including 11 concerning environmental cleaning at the NHS.  


Housekeeping
The report notes that additional "housekeeping resources" have been brought in during the outbreak to increase the frequency of cleaning and that unit aides have been brought in to assist with environmental cleaning.  It adds: "These aides, in addition to increased and dedicated housekeeping staff, play a fundamental role in maintaining environmental cleanliness and both of these enhanced resources should be maintained over the long term." 


The report makes three recommendations on housekeeping staffing:

  • Increases in housekeeping resources put into place during the outbreak should be maintained permanently so that high risk units can maintain twice daily cleaning and dedicated housekeeping staff. 
  • Additional unit aides put into place on the medicine units during the outbreak should be retained permanently. 
  • One additional FTE housekeeper should be recruited for the night shift at the SCG site, so that the emergency department can retain a dedicated nighttime housekeeper and to ensure that there are sufficient resources to address environmental cleaning issues overnight.
The report notes: "C. difficile is a particularly difficult hospital-acquired infection to deal with as C. difficile spores readily contaminate the patient environment and are very difficult to remove and destroy. In managing a CDI outbreak, particularly one of the magnitude experienced by the NHS, it is imperative to use a sporicidal agent broadly as it can be assumed in a facility wide outbreak that gross spore contamination has occurred."

The report also notes the importance of a proactive approach:

"Given that environmental contamination is an important underlying cause of nosocomial transmission of antibiotic resistant organisms, and that environmental contamination can occur whenever there is an isolation burden on a given unit or in a facility, an important concept to keep in mind is that housekeeping and environmental cleaning should be proactive rather than reactive to maximize its benefit in preventing outbreaks."


The report recommends that "Outbreak measures such as enhanced cleaning can be implemented in advance of declaring a formal outbreak and when nosocomial activity is noted to be increasing. This should be considered as part of a proactive approach to outbreak avoidance."

The report recognizes that "housekeeping staff exhibited good cleaning techniques and applied excellent infection control practices."

Overcrowding
The report also reflects on the infection control challenges created by a hospital operating over-capacity and overcrowded:

"As is the case for many Ontario hospitals, the NHS is frequently over census and therefore has issues of overcrowding and overstretched staff. In addition, most sites at the NHS have a chronically high isolation burden, due to high regional rates of antibiotic-resistant organisms. There are no hand hygiene sinks present in many clinical areas and certain facilities do not have patient bathrooms in every room. The ICRT acknowledges that these factors create a challenging patient care environment.

"The ICRT understands that at times the NHS would cohort suspect and confirmed CDI patients together. This practice should be discontinued immediately.... 

"Prior to declaration of the outbreak, it appears that transfer of both patients and patient care equipment between units was common. Increased movement of patients with actual or possible CDI increases the risk of spreading C. difficile and its spores, through environmental contamination and unwashed hands. During the outbreak, these transfers were minimized and this practice should be continued as part of outbreak management and prevention."

Infection Prevention and Control Staff
The report also makes important recommendations on increases in physician and managerial infection control and prevention staff. 




This report is a step forward in the battle against superbugs.  

Labels:

Comments

Post a Comment

Popular posts from this blog

Ford government fails to respond to 72% increase in COVID inpatient days, deepening the capacity crisis

COVID infections continue to drive up hospital costs and inpatient hospitalizations in Ontario. For the most recent fiscal year (April 1, 2022- March 31, 2023) hospital stays related to COVID cost $1.221 billion, according to new CIHI data.   This is about 4% of total hospital spending, creating a very significant new cost pressure beyond the usual pressures of population growth, aging, inflation, and rising utilization.   Costs for COVID related hospitalizations increased 22.2% in Ontario in 2022/23 from the previous fiscal year, rising from $999 million to $1.221 billion.  That rise is particularly notable as the OMICRON spike of late 2021 and early 2022 had passed by the the 2022/23 fiscal year.   The $222 million increase in COVID hospitalization costs came in the same year as the Ford government cut special COVID funding and, in fact, cut total hospital funding by $156 million.     In total, there were 60,653 COVID hospitalizations in Ontario in 2022/3, up from 47,543 in 2021/2. 
Post a Comment
Read more

More spending on new hospitals and new beds? Nope

Hospital funding:  There is something off about the provincial government's Budget claims on hospital capital funding (funding to build and renovate hospital beds and facilities).    For what it is worth (which is not that much, given the long time frame the government cites), the province claims it will increase hospital capital spending over the next 10 years from $11 billion to $20 billion – or on average to about $2 billion per year.   But, this is just a notional increase from the previous announcement of future hospital capital spending.  Moreover, even if we did take this as a serious promise and not just a wisp of smoke, the government's own reports shows they have actually funded hospital infrastructure about $3 billion a year over the 2011/12-2015/16 period. So this “increase” is really a decrease from past actual spending. Even last year's (2016-17) hospital capital funding increase was reported in this Budget at $2.3 billion - i.e. about 15% more th
Post a Comment
Read more

The hospital crisis: No capacity, no plan, no end

While Canada has achieved universal public healthcare coverage, that does not mean conservative forces have given up trying to erode that coverage and expand corporate care where it does not currently exist. The battle has become particularly intense in Ontario under the Ford Progressive Conservative government, which is implementing serious cuts to the level of care and moving to bring in for-profit mini-hospitals. Inadequate Staffing.   Less and less of hospital spending is on staff.   Employee compensation as a share of hospital expenditures has consistently shrunk in Ontario. This is not some immutable law of hospital development.  It is in stark contrast with the rest of Canada, where compensation has become a larger share and now accounts for 67.1%. Hospitals in provinces other than Ontario now have 18 percent more staff per capita than hospitals in Ontario. Overall, if Ontario had the same staffing capacity as the other provinces and territories, there would be another 33,778 full t
Post a Comment
Read more