Defend Public Healthcare

Commenting on a Niagara superbug rally Wednesday, the Ontario Hospital Association CEO complained  that unions and politicians were being unhelpful, "basically turning  it into a panic situation".   Hmm -- I don't get a sense of panic -- just a bona-fide concern in the community about the outbreak and the fact that the community wasn't informed about deaths of patients infected with C. Difficile at two sites until long after they occurred. I think the hospitals should accept that is a legitimate feeling in the community and encourage government to require standardized reports.  Short of that, I think there is going to be more hard feelings in other communities.   Consider this: Allison McGeer, director of infection control at Mount Sinai Hospital,  says  a new virulent strain of C. Difficile detected only in the past few years will kill 250 people in Ontario this year — about 10 times as many as a decade ago. The  Globe and Mail   reports  that the

The latest report ( May 2011 ) on the incidence of C. Difficile in Ontario hospitals shows that the disease is more common than any time since September 2008, one month after the province began to publicly report the data. In response to an earlier OCHU campaign demanding action on superbugs, a government cabinet minister claimed  in March that superbug rates were going down.  I'm not sure if they are still claiming that or not... Of course, the public reports of C. Difficile outbreaks skyrocketed in June and July, not May -- so it will be interesting to see the reports for those months.   More on whether we should all just relax and let these superbug problems pass us by tomorrow.  

The   Welland Tribune   reports that the Niagara Health System hospital is "struggling with a lack of patient beds as it tries to isolate patients with the infectious C. Difficile disease."  Nevertheless, t he Niagara Health System has no plans of reopening recently closed  hospital  beds to help deal with its current superbug outbreaks.    Justifying, this position, the NHS interim CEO Sue Matthews said  "We will not be going and knocking on the Ministry (of Health and Long-Term Care's) door asking for more money, more money. We have lots of tough decisions that obviously have been made and need to be made. We will continue to work within our finances that we have." The NHS has closed many  hospital  beds through the implementation of its so-called " hospital  improvement plan". Ontario  Hospitals, under intense funding pressure, closed over 600 beds in 2010. As reported in an earlier note , the British Medical Association has identified high

Tomorrow, a health care rally will be held at 3 pm outside the Greater Niagara General Hospital.  The theme is "Residents have a right to know!"  (Notice for the rally is below.) The rally follows the long delay in the announcement that  patients had died with the infectious superbug C. Difficile, creating what has become a major national new story. The hospital has tried to justify the long delay in telling the community of the deaths at the Welland and Greater Niagara hospitals because an 'outbreak' had not been declared.  But the outbreak issue is beside the point. It is actually quite tricky to determine when an 'outbreak' has occurred.  In any case, superbugs are in our hospitals all the time, ‘outbreak’ declared or not.  Incredibly, this is sometimes used as an excuse NOT to report superbug associated deaths. To my mind, it is in fact all the more reason to report the facts to the public.   Past campaigns by OCHU and others forced government

Bullet News in Niagara reports that  Niagara Health System (NHS) officials kept quiet the deaths of five C. difficile patients at hospitals in Niagara Falls and Welland, even as they struggled to bring under control an official outbreak at St. Catharines General where 10 elderly patients have died in less than four weeks. The Bullet adds that as late as Friday afternoon, NHS officials had made no mention of the deaths of four C. difficile patients at Greater Niagara General hospital and one at Welland County General hospital between May 12 and June 16.  The deaths were revealed later Friday – a full day after official outbreaks were declared at the Welland and Niagara Falls hospitals – by way of a single sentence at the bottom of a notice posted on the health system’s  website . “I just can’t believe it,” said Niagara Falls MPP Kim Craitor, who said he intends to contact Ontario Health Minister Deb Matthews over the weekend to ask her to launch an investigation. “This warrants

Below is an excerpt from the British Medical Association report, Tackling Healthcare Associated Infections Through Effective Policy Actions .  This report was prepared under the auspices of the Board of Science of the British Medical Association.  The circumstances are similar to Ontario in many ways --  except that the bed occupancy is much higher here than it is in Britain, with Ontario bed occupancy rates currently running at about 97.9%.     Bed occupancy  Evidence from various retrospective surveys suggests that bed occupancy level is associated with HCAIs (health care acquired infections), and in particular MRSA. In 2005, the House of Commons Committee of Public Accounts noted that high levels of bed occupancy are not consistent with effective infection control policies.  A high bed occupancy may potentially impact in several ways, including: •increasing the proximity of patients and therefore the risk of direct and indirect patient-to-patient contact •making it more difficult

‘If I had to put my finger on one thing that would have an impact on healthcare infection it is cleaning,’ says Scottish expert  microbiologist Dr Stephanie Dancer. ‘Comprehensive, targeted cleaning at the high-risk sites around the patient.’   Commenting on the fads that wash over hospital infection control, Dr. Dancer  says the real problem with hospital infections is not long sleeves, long hair or white coats — it’s a lack of regular, thorough cleaning of all ‘touch sites’.  Door handles, drip stands, bedheads and curtains round beds, if not regularly cleaned, become a source of infection — even to clean hands.  Dr Dancer did a trial comparing two wards, one cleaned normally, and one with thorough cleaning of all these bedside objects included.  On the better cleaned ward, the rate of new infection with MRSA dropped by more than a quarter. Unfortunately, as cleaning in hospitals is now often franchised out to for-profit companies in Britain, ward sisters do not usually have contr

A great story today in the Brantford Expositor on the important role played by housekeeping in hospitals. Finally , the media is beginning to recognize the role housekeeping staff play in fighting superbugs and hospital acquired infections.   In the past, hospital housekeeping services were cutback, privatized and treated as "hotel" or "auxillary" services with predictable consequences for the level of care.  Here's some excerpts from the story: The job isn't just housekeeping. These days it is much more technical. Today, they collaborate closely with the  infection prevention  and control department. " Our environmental service aides are  skilled  professionals whose contributions are  critical  to the  success  of preventing the transmission of infectious diseases not only among patients, but also our staff, physicians and volunteers, " Sandra Comand, manager- infection prevention and control said. " They are a highly educated staf

St. Catharines General Hospital has had three more patients with the C. Difficile die.  This brings the total to eight patients who have died. Since the outbreak was declared May 28, there has been 29 patient cases diagnosed, according to the Niagara This Week .    Anne Atkinson, vice-president of patient services for the NHS, said the patients' deaths will be reviewed to determine the role C. Difficile played (or didn't play) in the death: was  it the  cause of death, a contributing factor, or was the death unrelated to C. Difficile .  The regional coroner is also being notified of all deaths as is  the Region's public health department. Well this is interesting.  OCHU calls for the government to require hospitals to report this  information to the public , and in particular deaths of people infected with superbugs.   So far the government refuses.  Judging by the claims made by St. Catharines General, however, this information can be and is collected.   

" I think we are vastly underestimating the number of people colonized by the  C. difficile  bacteria .   The statistics say something like 3% to 5%. I think that is much lower than what is actually out there, "   says the infectious-control director at the Ontario Agency for Health Protection and Promotion, Dr. Doug Sider.    " There are healthy people who are carrying the bacteria and don't know it, " Sider noted.  Those people could unwittingly carry the bacteria into a  hospital  -- and trigger an outbreak.  That is reason enough to take  infection control  measures seriously, he added. The agency advises hospitals on infection and outbreak control.  Some factors, like the physical space and design of a  hospital , are difficult to control.  Older hospitals are cramped, crowded, and have few options to isolate patients, Dr. Sider suggested.  

Too many of our public sector managers and politicians never miss an opportunity to give away work.   That is an unfortunate sign of our conservative times.   Private corporations however aggressively seek ways to expand their business (and their profits) by seizing on emerging health care trends.   Earlier today we discussed how corporations use regionalization to get into the health care business.  Now another example: an enterprising business trying to get in on the growing recognition that clean hospitals are an important part of the solution to hospital superbugs.       Here's  their pitch: According to the  American Journal of Infection Control , high rates of contamination have been recorded in National Health Services organizations, rising from 2% in 1990 to 43% in 2002. This rise in contamination rates may be reduced by implementing disinfection standards. “Everything in a medical environment should be disinfected,” said Dave Huddleston, Econo-Keys operations manager.

In 2010, a   study   published in the famous academic journal   The Lancet Infectious Diseases   flagged the emergence of NDM-1, an enzyme that  confers high levels of resistance of gut bacteria to almost all antibiotics, leading to potentially life-threatening pneumonia and urinary tract infections   The study concluded,  "The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed." At that time, NDM-1 was widespread in India.   But Canada now has it's first domestically acquired case of NDM-1 -- in an Ontario hospital, according to a new  study  in the Canadian Medical Association Journal .   A man admitted to a Toronto hospital with a stroke later tested positive for NDM-1. He hadn't travelled outside of southwestern Ontario for the past 10 years; none of his family members or friends had travelled to India.  Fortunately, t he man remained asymptomatic and did not spread the organism to othe

Derek Spalding of the Nanaimo Daily News  has won the local reporting award at the National Newspaper Awards for his  investigation  into the spread of Clostridium difficile at Nanaimo Regional General Hospital.  Repeated  freedom -of-information requests finally revealed that the Vancouver Island  Health Authority  intentionally withheld information in order to downplay the  bad  news about  C. difficile  to the public.   The Nanaimo Daily News reported that according to documents  it obtained a  deadly 11-month outbreak of Clostridium difficile at the hospital in 2008 was largely blamed on inadequate housekeeping.  Subsequently, the Island Authority tried to end its contract with the private corporation that cleans the hospital ( without success -- click here for more).  The story shows how important public access to hospital information is.  OCHU/CUPE has been fighting for access to hospital superbug information for years, with some, limited success: most notably helping t

I kid you not -- this is a genuine B.C. news report on privatizing hospital support services.  The Vancouver Island Health Authority tried to dump its housekeeping contractor last month, but Compass Group Canada hung on to its $50-million, five-year deal with the health authority after buying Marquise Group, the company chosen to take over cleaning at several Island facilities. VIHA turfed its agreement with Compass because of the company's poor service. Under its watch, hospitals had regular infection outbreaks, failed housekeeping audits and damaging WorkSafe B.C. Inspections. Health authority officials say they did not know about the purchase when they selected Marquise to take over. ... "It's always a bit disconcerting when you set a contract with one company and another company buys them," said Joe Murphy, vice-president of operations. That frustration grows when the buyer is the company VIHA has tried to get away from after six years.

Scottish hospitals have reduced C. Difficile superbug infections by 37% over the past year.   Cases of MRSA were also down, with 82 new infections recorded between October and December 2009, down from 119 cases in the same period of 2009. Scottish Health Secretary Nicola Sturgeon  said : "The Government has put 1,000 additional cleaners in our hospitals, brought an end to the privatization of hospital cleaning contracts and introduced a tough new inspection regime by the Healthcare Environment Inspectorate. "With the extra efforts, extra investment and contribution of people across the NHS we have made Scotland's hospitals cleaner and hospital treatment better and safer." dallan@cupe.ca

A new study  in the academic journal Archives of Internal Medicin e from researchers at the University of California indicates that the risk of MRSA superbug infection in intensive care units (ICUs) was sharply reduced through enhanced cleaning practices. The study notes: "Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40% increased risk of acquisition, presumably through environmental contamination. Subsequently, a cleaning intervention was shown to reduce MRSA and VRE room contamination." The study evaluated "the effect of this intervention on the risk of acquiring MRSA and VRE from prior room occupants." With the enhanced cleaning intervention, MRSA infection was lowered from 3.0% to 1.5%, and VRE infection from 3.0% to 2.2%.  dallan@cupe.ca

IN  response to a CUPE media conference on superbugs, Nipissing Liberal MPP Monique Smith pointed out that hospitals are now required to report superbug infections. She said  improved   tracking of infection rates has produced the lowest infection rates in years, with the rates of infection going down all the time. Which is an odd claim because the government only instituted superbug reporting (after CUPE had spent years campaigning for it) in August 2008 – a mere two and a half years ago.  And it’s odder still because the government’s own data proves no such claim.  The  MRSA rate is where it was when the government started reporting;  the C. Difficile rate for January 2010 through January 2011 (0.301)  is very slightly lower than the 2009 average (0.305) , but the January 2011 rate is actually higher (0.34).  The VRE rate continues to be reported as 0.00, with few cases reported (only 8 in all hospitals from October to December 2010).  But, as reported here earlier , the Ott