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Patients and family members have settled their lawsuit over a superbug infection at a Quebec hospital. At a coroner's inquiry into the outbreak, the hospital's unionized workers said the outbreak should be blamed on staffing problems that worsened after the institution cut four cleaning jobs. As a result of staffing shortages, patients' rooms were only disinfected during the week and bathrooms in the ER were cleaned just once a day. Dr. Anne Vibien,on staff at the hospital in St-Hyacinthe in 2006 told the inquest that a strict plan drawn up by administrators to increase disinfection procedures was never enacted because of staff shortages.  Rooms were not disinfected often enough, she added. Toilets in the emergency room were cleaned just once a day. Sixteen patients died.  The hospital has admitted there were problems with the cleaning procedure but claimed there were no direct links to the outbreak.   The families of patients who died after contracting C. difficile

"The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services." This is taken from recent  comments  on hospital acquired infections to the the Standing Senate Committee on Social Affairs, Science and Technology by Senior Scientist, Dr. Michael Schull. Dr. Schull was representing the the Institute for Clinical Evaluative Sciences. ICES is an independent non-profit corporation that uses information derived from health administrative records to assess the performance of the Ontario health system. They are, however, funded by the Ministry of Health and LTC. While there has been some signs of reinvestment, it is far from clear what the ongoing trend will actually be.  The government plans to squeeze hospital funding and it would be far from surprising if support services are not sacrificed onc

A leading Welsh doctor has warned of hospital bed cuts. Dr Richard Lewis, Welsh secretary of the British Medical Association, said the bed cuts could put patients at greater risk of catching a serious hospital infection. Dr Lewis told the Daily Post , “we know patients are still waiting on trolleys to find beds; elective surgery is being cancelled because of pressure on beds." Calling the cuts "unacceptable," Dr Lewis added, “There’s a clear link between hospital-acquired infections, the overcrowding of beds and high bed occupancy rates.” According to the most recent government figures , Welsh hospital bed occupancy is 82.5%. The government reports 13,116 hospital beds in Wales,  or one bed for every 229 people in the nation of just over 3 million. That however is far , FAR better than in Ontario, which is running at an astronomical 97.9% bed occupancy (after the elimination of about 18,500 beds, one-third of the total, since 1991). With 30,810 beds and 13,210,600

A $50-million class action lawsuit has been certified over a deadly outbreak of C. Difficile at Joseph Brant Memorial Hospital in Burlington, the Hamilton Spectator  reports. "That's a positive step in the process," said Hamilton lawyer Stanley M. Tick, who represents the claimants with Windsor lawyer Harvey Strosberg. The lawsuit alleges that Joseph Brant Memorial Hospital was not properly cleaned, maintained and disinfected. None of the allegations have been proved in court. The Spectator notes that "in the years since the outbreak, the hospital has significantly changed procedures and cleaning protocols, invested heavily in infection control, and made other changes recommended by experts." The superbug overran the hospital from May 2006 to December 2007. But the full extent of the infection was not known, or made public, until the spring of 2008, after a review by expert outsiders.  The hospital announced that 91 infected people had died. About 225 caught C.

Health Minister Deb Matthews has told the Niagara Falls Review that although the C. Difficile outbreak at the St. Catharines General hospital has (finally) ended, not much is going to change at Niagara's hospitals. Many of the changes introduced to cope with the outbreak -- from restricted visiting hours, increased cleaning and hand washing, and daily staff meetings -- will remain in place. "This is the new normal," Matthews said. Matthews added that it cost the Niagara Health System approximately $1.5 to $2 million to cope with the outbreak.  Maintaining the outbreak measures going forward will cost about $1 million annually, she said. More on the costs of not improving hospital housekeeping tomorrow.

As reported earlier here , the publicly reported incidence of C. Difficile in Ontario hospitals hit a 22 month high in May.   But it was not until June and July that we saw a surge in reports of outbreaks of C. Difficile.   One outbreak was declared at the St. Catharines General Hospital May 28 with twelve cases confirmed.  Another nine  hospitals declared outbreaks in June and July. So it is, perhaps, odd that the rates reported to the public  by hospitals in June and July were lower than in May.  According to the reports from the hospitals, the rate of infection was not much higher than average, even while ten hospitals reported C. Difficile outbreaks. The reported rate went down again in August to 0.32 cases per 1,000 patient days, with 266 cases reported.

The U.S. based Association for Professionals in Infection Control and Epidemiology (APIC) and the Association for the Healthcare Environment (AHE) are partnering to strengthen the relationship between infection prevention (IP) and environmental services (EVS) to reduce infections. A joint educational campaign, "Clean Spaces, Healthy Patients: Leaders in Infection Prevention and Environmental Services Working Together for Better Patient Outcomes," will incorporate educational resources, training materials and other solutions to help IP and EVS professionals combat the spread of healthcare-associated infections (HAIs). Cooperation between IP and EVS staff is an excellent idea. However, the privatization of environmental services will undermine this cooperation. From our experience, for-profit cleaning corporations prefer to keep direct control of EVS staff to maintain profits. IP and nursing staff may have to make requests to the corporate hierarchy rather than

An earlier report indicated potential problems with health care uniforms contaminated by superbugs.  Now, it's privacy curtains.   Researchers in Chicago reported this week that privacy curtains in hospitals are often contaminated with potentially dangerous bacteria. "There is growing recognition that the hospital environment plays an important role in the transmission of infections in the health care setting and it's clear that these (privacy curtains) are potentially important sites of contamination because they are frequently touched by patients and providers," Dr. Michael Ohl told Reuters Health . Tests detected MRSA and VRE.  The study found significant contamination that occurred very rapidly after new curtains were placed. "The vast majority of curtains showed contamination with potentially significant bacteria within a week of first being hung, and many were hanging for longer than three or four weeks," Dr. Ohl noted. "We need to think a

Medical errors and other adverse events occur in one-third of hospital admissions according to authors of  a new study . This is much, much higher than the number of incidences voluntarily reported.    The study reviewed 795 patient records: voluntary reporting detected 4 events , while a "Global Trigger Tool" detected 354 events , 88 times higher than voluntary reporting.  The authors note:   " Reliance on voluntary reporting ... could produce misleading conclusions about the current safety of care in the US health care system and misdirect efforts to improve patient safety." OCHU has raised concerns that hospital self-reporting of superbug infections may underestimate the extent of the problems.

More than 60% of doctor and nurse uniforms tested positive for potentially dangerous bacteria, according to a new study, Science Daily report s.  Researchers collected swab samples from the sleeve-ends and pockets of the uniforms of 75 registered nurses and 60 doctors at the Shaare Zedek  Medical Center in Jerusalem. They found 65% of nurse uniforms and 60% of doctor uniforms contained multi-drug-resistant pathogens (e.g. MRSA). The authors noted that more hand washing could help control uniform bacteria counts, as well as wearing a clean uniform every day, adequate laundering, using plastic aprons when necessary and even discarding white coats. "It is important to put these study results into perspective," said Russell Olmsted, president of the Association for Professionals in Infection Control and Epidemiology. "Any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of infection prevention remains the use of hand hygien

Here are some of the comments at a Health Coalition town hall meeting earlier this week about the problems at the Niagara Health System hospitals (as reported by the Welland Tribune ): John Degazio, a former housekeeping staff member at Welland hospital, recalled trying to draw attention to problems with the cleaning of hospital rooms after staffing levels were severely cut in the early 2000s. He said he recalled seeing bed linens that were supposed to be clean, with blood and feces stains on them. "At the end of it all, I was forced to leave (my job) for bringing up stuff that was contrary to people's health," he said. Retired nurse Nancy Gladman said more than a decade ago, before cuts, there were enough beds to isolate patients with potentially contagious diseases. "It's just a mess," Gladman said. "Really, I wouldn't advise anyone to use any hospital in Niagara run by the NHS." Registered nurse Cindy Forster, a Welland region

Sue Matthews, the interim CEO of Niagara Health System is doggedly sticking  to her earlier statement that she will not to ask the province for more cash to deal with the superbug problem at the hospital. No doubt this approach  is appreciated by the government.  But it doesn't sit well.   Scores of patients have been infected with C. Difficile (or other superbugs).   A significant number of those patients have died.   The expert report on the C. Difficile outbreaks at NHS recommended the  "i ncreases in housekeeping resources put into place during the outbreak should be maintained permanently." And now the St. Catharines Standard reports t he "outbreaks have come with pointed criticisms, including a report from the Ministry of Labour, over insufficient training of NHS staff coping with the infectious bacteria."

As noted a few days ago, a new World Health Organization (WHO) report has identified Canada as having a high rate of hospital acquired infections.  Among reporting countries, the Canadian rate of 11.6% was second only to New Zealand's rate of 12%.  (New Zealand, like Canada, has very few hospital beds). Now, thanks to a Postmedia report , we know that the Public Health Canada (the main federal government agency responsible for public health) doesn't dispute the figures.   At 11.6 per cent, Canada's rate contrasts poorly with the U.S. rate of 4.5 per cent and Europe's rate of 7.1 per cent, according to data in WHO's Report on the Burden of Endemic Health Care-Associated Infection Worldwide 2011. R esponding to a Postmedia News inquiry, the Public Health Agency of Canada (PHAC) did not dispute WHO's finding - and indeed WHO typically bases its reports on data provided by the respective countries.... ``The data was taken from surveys and the objective was to

The Ontario Ministry of Health and Long Term Care tweeted yesterday that if you have time to tweet you have time to wash your hands. Probably pretty good advice, even if it does harp on the government's long time focus on this aspect of infection control. But when I looked at the MOHLTC site linked to the tweet, I noticed they praised the use of alcohol gels and rubs and did not raise the issue of whether these are suitable for dealing with C. Difficile.  And, from what I've seen, at least some hospitals recommend using alcohol gels to help prevent the spread of C. Difficile. Yet many  experts dealing with C. Difficile in health care settings report that alcohol gel s are ineffective when dealing with C. Difficile. This is important as the alcohol gels are widely used in health care settings - hospitals have spent a lot of money putting dispensers around their facilities. So why the discrepancy in advice?

A new World Health Organization (WHO) study ( Report on the Burden of Endemic Health Care Associated Infection Worldwide: Clean Care is Safer Care )    indicates that Canada has a high rate of Health Care Acquired Infections (HCAIs) compared to other developed countries.   The study reports that Canada’s HAI incidence is 11.6%.  O f the world’s economically advanced economies, only New Zealand reported a higher rate at 12% . (Notably, New Zealand also has very few hospital beds per capita.)  While Canada has a rate of 11.6% the HCAI prevalence in high income countries is 7.6%:   “According to published national or multicentre studies, pooled HCAI prevalence in mixed patient populations was 7.6% in high-income countries ...The estimated HCAI incidence rate in the USA was 4.5% in 2002, corresponding to 9 3 infections per 1000 patient-days and 1 7 million affected patients”   The Canadian rate is more than 50% higher than the rate reported for high income countries.   While HCAI rates

Dr Michael Phillips, hospital epidemiologist at New York University Langone Medical Center tells Infection Control Today about the role of environmental contamination in the transmission of hospital acquired infections.   To respond to this issue,  he stresses the importance of "incorporating environmental services into the patient care unit team. ... This type of collaboration enhances problem solving – and reduces infections."   He adds that environmental services "are a critical member of the team" and sets out a number of ways that collaboration and communication between infection control specialists and environmental services can be enhanced.  This sounds like common sense.  But can you hope to achieve this if hospital housekeeping services are contracted out?   A separate for-profit business will not want to let its staff receive direction from the hospital or its staff -- they will want to retain control to control costs (and keep their profit

Some comments from Dr. Allison McGeer, infectious disease expert at Mount Sinai Hospital in Toronto, for the St. Catharines Standard :   "Prevention isn't inexpensive" ....There is also a deeper philosophical problem with public health care spending policies... It's possible to hire more cleaners, more supervisors and build better hospitals that will reduce infection rates and prevent outbreaks. But that doesn't give politicians anything tangible to grasp. The question will inevitably be asked: "Why are we spending so much money on prevention if infection rates are low?" " Yet we know outbreaks cost us more than prevention ," McGeer said. "But we have to be willing to make the investment." Brantford General Hospital estimates  "it can cost the hospital from $30,000 to $50,000 to treat a case of C. difficile, what with the protocols kicking into gear, heightened cleaning and patient transfers." Dr. Doug Sider,

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 hou

A great letter in the Niagara newspapers from Pat Scholfield, a community health care activist in Welland.  On Sunday, July 10 I watched and listened to the news as once again we were told about the  C. difficile  problems in hospitals across Ontario and they told us the latest death toll across the entire province to date was 24. Our local papers report 20 people have died in Niagara Health System (NHS) hospitals in cases linked to  C. difficile . The NHS has definitely more than its share of  C. difficile  deaths. Then Ontario Minister of Health Deb Matthews came on the screen and with a sweet smile told us to wash our hands. Come on Minister Matthews, Niagara has a much more serious problem with  C. difficile  than washing our hands. Is there a relationship between the serious  C. difficile  outbreak across Niagara and the implementation of the HIP ( hospital  improvement plan) by the NHS where huge cuts have been made to beds, frontline staff, cleaning staff, depart

The total number of Niagara hospital beds (excluding West Lincoln hospital) was 1,315 in 1995-96 (this includes 149 at the former Hotel Dieu general hospital and 124 at the Shaver which became the Dieu).   Facility Acute Psychiatry Rehabilitation Chronic 1995/96 1997/98 1995/96 1997/98 1995/96 1997/98 1995/96 1997/98 Niagara-on-the-Lake 18 9 - - - - 20 11 Douglas Memorial 50 39 - - - - 25 25 Port Colborne General 50 36 - - - - 30 24 Shaver - - - - 22 22 102 102 West Lincoln Memorial 62 45 - - - - 16 16 Welland County General 159 141 16 16 - - 139 77 Greater Niagara General 173 173 29 29 - - 48 48 H ô tel Dieu 149 119 - - - - St. Catharines General 223 201 26 26 - - 36 36 Total 884 763 71 71 22 22 416 339 Now, there  are  only 926 beds: 787 at Niagara Healt