Defend Public Healthcare

A new report from the Chief Medical Officer of Health in England reports that "rates of  C. difficile  have fallen consistently in all English regions in recent years. MRSA has fallen markedly and is now very low in many areas." As noted  in  November, there is no evidence of that in Ontario, as the incidence of both MRSA and C. Difficile is about the same as when public reporting started (i.e. over about the same period as when the rates of MRSA and C. Difficile were falling in England). While England has made good progress on MRSA and C. Difficile, the new report also indicates an alarming increase in other types of bacteria including new strains of  E coli  and  Klebsiella , which causes pneumonia. There are now many more cases of these than MRSA. As many as 5,000 patients die each year in the UK of gram negative sepsis – where the bacterium gets into the bloodstream – and in half the cases the bacterium is resistant to drugs, the Gua...

There has been no progress stopping the spread of superbugs in Ontario hospitals according to government data. Reported C. difficile rates are about the same as they have been, starting this past year at 0.35 cases per thousand patient days and ending it at the same level.    The annual average was also 0.35. Month Rate Oct '11 0.35 Nov 0.32 Dec 0.36 Jan '12 0.35 Feb 0.38 Mar 0.37 Apr 0.31 May 0.32 Jun 0.34 Jul 0.38 Aug 0.32 Sep 0.35 Ave. 0.35 Similarly, C. difficile rates in the first year of public reporting ( Aug 2008-July 2009 ) also averaged 0.35 per thousand patient days: Month Rate Aug-08 0.39 Sep-08 0.44 Oct-08 0.39 Nov-08 0.35 Dec-08 0.35 Jan-09 0.36 ...

Joseph Brant Memorial Hospital has agreed to settle a law-suit by approximately two-hundred victims of a C. difficile outbreak at the hospital for $9,000,000, the Hamilton Spectator reports.  That is an average of about $45,000 per claimant.   The law-suit alleged the Burlington hospital was not properly cleaned, maintained and disinfected.  OCHU has long warned that hospitals would be subject to law-suits because of cuts to housekeeping services.  Since the 1970s hospital support services have been cut back again and again.  Ninety-one patients infected with C. difficile died.   The settlement must still be approved by the courts.  The Spec adds "that lawyers for the plaintiffs will be paid $1.122 million, for partial fees and out-of-pocket disbursements to date, plus 15 per cent of what their clients receive in payments. There is also a sum - capped at $375,000 - to pay a court-appointed administrator to oversee the settlement ...

VRE Some Ontario hospitals are giving up on trying to control the superbug VRE. No doubt the hospitals are responding to the government funding squeeze on hospitals. Below, i nfection control experts offer a tart warning of the consequences of this policy . We've been downs a similar road before: past cuts to hospital cleaning (and hospital beds) helped lead to the explosion in superbug infections in recent years. In the period ahead we will see more and more examples of how hospital cuts will affect patient care.  Local hospitals isolate, others relax about super bug  Hamilton Spectator  Fri Sep 7 2012  Page: A16  Section: Editorial  Byline: Allison McGeer, MD, Kevin Katz, MD, Mary Vearncombe, MD, Toronto  'Big and   dumb' VRE not the worry it was: Local hospitals isolate, others relax about   super   bug (Aug. 30) As directors of  infection prevention  programs at Toronto hospitals, we are always ...

A new report indicates that C. difficile is linked in hospital records to more than 30,000 deaths a year in the United States. That's about twice as many as federal US estimates and rivals the 32,000 killed in traffic accidents in the US. USA Today reports that in March, the Centre for Disease Control indicated that the infection kills 14,000 people a year. "But that estimate is based on death certificates, which often don't list the infection when patients die from complications, such as kidney failure. Hospital billing data collected by the federal Agency for Healthcare Research and Quality shows that more than 9% of C. diff-related hospitalizations end in death — nearly five times the rate for other hospital stays. That adds up to more than 30,000 fatalities among the 347,000 C. diff hospitalizations in 2010." OCHU successfully campaigned for public reporting of hospital acquired infections like C. difficile, but the Ontario government has simply re...

It's often said that success has many fathers but failure is a ...., well, it's an orphan. In this case, however, the campaign by the Ontario Council of Hospital Unions / CUPE on hosptial acquired infections has paid off. OCHU led the campaign for years demanding (among other points) that hospitals be required to report hospital acquired infections. After repeated campaigns by OCHU, the government began to require hospitals to report on three major hospital acquired infections. A new study on one of these diseases, C. difficile, has just come out. It shows that public reporting has led to a significant reduction in the incidence of the disease in hospitals. Below is an editorial from today's Toronto Star commenting on the results of that change in policy and concluding that "Openness isn't just the right thing to do. It saves lives, too.". They suggest about 100 lives per year are being saved Now if only we could get the Star to fight for another a...

C. Difficile and MRSA infections have hit a record low in Scottish hospitals and the government has credited its  £ 50 million investment in new cleaning staff and unannounced inspections. Gil Paterson, member of the Scottish Parliament’s Health and Sport Committee, said: “Hundreds of additional cleaning staff have been brought in and independent, unannounced inspections are carried out to make sure hospitals are as clean as they should be. “Driving down these infection rates has been a key priority and I am delighted that the £50 million that has been invested in this is paying off. “There is of course no room for complacency, but the fact that HAIs are at their lowest level ever recorded should be enormously reassuring to patients and their families across Scotland." The Ontario Health Quality Council has just reported that hospital C. Difficile rates have increased slightly over the last year in Ontario.

Part of the official response when we raise the problem of hospital acquired infections (HAIs) is to suggest that the people afflicted by HAIs are old and sick anyway. (Which, even on the face of it, is an unsettling response.) Earlier, I reported a  study which indicated that  the very young (between one month and 23 months old) were the most likely to acquire an infection (8.2%), followed by patients aged 65 to 74 (7.2%) -- at least in British hospitals.  Well, another researcher has now directed me to a study published in the American Journal of Infection Control by Gravel et. al. in 2007, which also found that 8% of children in Canadian hospitals acquired an infection The Canadian study also found that i nfants (1 month to 2 years of age) had a higher  prevalence of HAI  -- 12%.

A new British study of 55,000 hospital patients finds that one in twelve babies and toddlers pick up an infection while in hospital. In fact the very young (between one month and 23 months old) were the most likely to acquire an infection (8.2%), followed by patients aged 65 to 74 (7.2%). Government adviser and  University of Leeds  m edical microbiology Professor  Mark Wilcox told the  Daily Telegraph  that the 'majority' of these cases were not justified. Of the bugs identified, one in eight was resistant to common antibiotics.  

A new study published in the American Journal of Infection Control reports that over 90% of hospital curtains examined six times over a three week period at a US hospital were contaminated at least once with Staphylococcus aureus, MRSA, VRE, or aerobic gram-negative rods. "Forty-one of 43 curtains (95%) demonstrated contamination on at least 1 occasion, including 21% with MRSA and 42% with VRE. Eight curtains yielded VRE at multiple time points: 3 with persistence of a single isolate type and 5 with different types, suggesting frequent recontamination." Hospital curtains are frequently touched by hospital patients, staff, and visitors. The study concludes that "privacy curtains are rapidly contaminated with potentially pathogenic bacteria. Further studies should investigate the role of privacy curtains in pathogen transmission and provide interventions to reduce curtain contamination."

A new report from the CDC ( the U.S. Centres for Disease Control and Prevention) states that the    incidence, mortality, and medical care costs for C. difficile infections have reached historic highs. From 2000 to 2009, the number of hospitalized patients with any C. difficile diagnoses more than doubled, from approximately 139,000 to 336,600, and the number with a primary C. difficile diagnosis more than tripled, from 33,000 to 111,000 . The estimated number of deaths attributed to C. difficile increased from 3,000 deaths per year during 1999–2000 to 14,000 during 2006–2007 . Ontario still refuses to report hospital deaths associated with C. difficile or other superbugs.   If the number is proportionate to the US figure, about 600 deaths would be attributed to C. difficile per year.  The CDC estimates "e xcess health-care costs" of hospital-onset C. difficile at $5,042–$7,179 per case with a national annual estimated excess health-care cost of $897 million t...

The Health Authority that runs the Burnaby General Hospital is now claiming that the C. difficile outbreak had been a contributing factor in only about 30 deaths.   As noted yesterday, top doctors at the hospital had noted  that 84 patients with C. difficile had died and cited an Ontario report that suggested in outbreaks about 80% of infected patient deaths were attributable to the disease. That's quite a discrepancy.  But without reporting requirements about C. difficile deaths, who really knows for sure how many died?  That's why we need reporting requirements here in Ontario (as well as BC).    The Hospital Employees Union released a statement today saying  that B.C.'s annual hospital housekeeping audits fail to provide health care decision-makers and the public with a complete picture of the state of hospital cleanliness in the province.   HEU says that the audits fail to investigate other issues critical to hospital cleanliness and ...

Eight senior doctors at Burnaby General Hospital have raised concerns about infection control at the hospital, after 473 patients were seriously infected with C. difficile. Eighty-four of those patients died. The eight doctors (including 6 department heads) wrote that " current CDAD [C. difficile]  infection control  management at Burnaby  Hospital... is a serious hazard to the patient population. ... Such is the degree of the CDAD  problem  and the ineffectual response to it, that we believe it could objectively be considered medical negligence. " The doctors made 16 recommendations to resolve the problem, including the immediate institution of enhanced cleaning within  hospital  units.  The doctors point to a lack of enhanced cleaning of high C.difficile medical units despite a recommendation from the infection control  committee following the late-2011 outbreaks. Hospital Employees Union spokesperson Margi Blamey said  a foc...

Dr Charles Saunders, deputy chair of the British Medical Association Scotland, recognizes that Scotland has made progress fighting hospital acquired infections, but flags the threat rising bed occupancy now poses : "There is pretty good evidence that once you get high bed occupancy rates then it is very difficult to stop a lot of HAI. Part of that is because you don't have time to get things properly cleaned and partly it is because once you get to those high rates, you tend to move people around hospitals a lot. So they get admitted to one ward and maybe go through three or four different wards in the next few days. If they have anything when they come in, they have an opportunity to spread it quite widely and they also obviously increase the opportunity they have to pick up stuff by being in different wards." Yet, Scotland has more than twice as many hospital beds per capita compared with Ontario.  -- Ontario has one of the highest hospital bed occupancies in the d...

The Ontario Auditor General did a follow up to his 2009 report on health care acquired infections (HAIs) in long term care homes.  The good news is that all three of the homes he examined are now doing the twice daily cleanings of rooms for residents with C. Difficile infections. The bad news is that there is little movement on public reporting of HAIs in LTC. (OCHU helped win this in the hospital sector several years ago.)  Here is the AG's comment: The Ministry indicated that it had examined whether long-term-care homes should be required to publicly report patient-safety indicators such as HAI rates, as hospitals do. The Ministry noted that it had consulted with the long-term-care homes and other stakeholders and that there was a high level of satisfaction with the current extent of voluntary public reporting through Health Quality Ontario. Although Health Quality Ontario  does not provide public information on cases ...