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Germs Winning in BC's Hospitals

Nasty infections are up steeply. Health workers, NDP blame Liberals.

By Crawford Kilian 21 Apr 2009 | TheTyee.ca

Crawford Kilian is a contributing editor of The Tyee.

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NDP candidate Mo Norton: 'Patients get sicker'.

A routine bureaucratic report points to an issue that many health workers, their unions, and at least one NDP candidate would like to make a major issue in the B.C. election campaign: the state of our hospitals after eight years of Liberal rule.

The report, from WorkSafeBC, found that Nanaimo Regional General Hospital had, for the second time, failed to maintain adequate cleaning and safety standards. A standard cleaning product was causing health problems in staff. Other chemicals were being diluted or mixed. Hazard investigations were superficial, and the workers' supervisor "has not been educated on health and safety."

Since the privatization of cleaning services in B.C.'s hospitals, healthcare workers say they've seen a sharp increase in "healthcare-associated infections" -- diseases contracted by patients and staff within the hospitals themselves.

The infections are serious: Methicillin-resistant Staph aureus (MRSA). Norovirus. Vancomycin-resistant Enterococcus (VRE). Clostridium difficile. Once established in a hospital, they're tough to get rid of. Established in a patient, they can be fatal.

According to a CUPE background paper, these infections have been growing. The incidence of MRSA in Canadian hospitals increased by a factor of 17 between 1995 and 2006. Between 1991 and 2003, the number of patients coming down with "C diff" quintupled. One hospital patient in nine gets a healthcare-associated infection, for a total of 220,000 infections every year. Between 8,500 and 12,000 Canadians die yearly of such infections.

'Always room for improvement': Health authority

Hospitals are keenly aware of the problem, though they don't always agree with healthcare workers' analysis of the problem. The Vancouver Island Health Authority, which oversees Nanaimo Regional General Hospital, noted in the minutes of a 2006 board meeting that "VIHA's infection rates are within acceptable standards, but there is always room for improvement."

VIHA didn't say what "acceptable" meant, though last year it reported seven cases of Clostridium difficile at NRGH, resulting in three patient deaths. VIHA made a point of saying "...this is not primarily due to housekeeping practices and/or clinical infection control."

A VIHA report on infection control implies that it still doesn't have data for surgical site infections at acute-care sites outside Victoria: "Denominator data (number of procedures performed) is not easily available, so infection rates cannot be calculated...Enhanced surveillance was initiated following a concern expressed by Cardiac Surgical Services that there was a perceived increase in its infection rates."

Prescription for disaster?

CUPE blames political decisions to cut spending on cleaning and infection control: "Hospital spending on support services in Canada fell from 26 per cent of total budgets in 1976 to 16 per cent in 2002. Most of those cuts applied to staffing, with cleaning departments taking a major hit. Clinical studies and audits have linked healthcare associated infection outbreaks with understaffing, increased workload, high turnover, and inadequate training."

Mo Norton, currently running as the NDP candidate in North Vancouver-Seymour, is chief steward for the North Shore chapter of the Health Sciences Association. She handles the paperwork for outpatients in the community, and says she and her colleagues are seeing a "huge" increase in post-operative infections.

"Most charts come through me," Norton says. "We're seeing increases in staph infections and MRSA positives." The deterioration, she adds, has come over the last five or six years. Without enough staff to keep hospitals clean, "Patients sometimes walk out sicker than when they walked in."

One client told Norton about her father, a stroke victim, who had to use a broken hospital toilet for a week. Only then did someone come to fix the toilet and flush it.

Evolution of superbugs

The superbugs like MRSA have evolved to resist antibiotics and antivirals, and the effort to clean up hospitals has led to problems like those at NRGH: chemicals that can also be hazardous when used carelessly or without proper training. As the Health Employees Union said in a news release about the Nanaimo inspection, "In an era of superbugs, these poor health and safety practices put everyone who uses our hospitals at risk."

It's not just a problem in Vancouver Island hospitals. Last year, after a three-year freedom of information suit, HEU learned that privatized cleaning had also meant less cleaning: Vancouver Coastal Health signed a deal with ARAMARK in 2003 that included a reduction of over 153,000 cleaning hours annually.

In its most recent yearly report (2007-2008), Vancouver Coastal Health reported 778 new MRSA cases, three-quarters of them acquired "in-house" or in another healthcare facility. Out of 472 VRE cases, 95 percent were "in-house" or acquired in another facility.

Dying of diarrhea

Clostridium difficile-associated diarrhea (CDAD) has a hypervirulent strain that kills two per cent of patients over age 60. The VCH report noted that mortality attributable to CDAD has quadrupled in Canada since 1997. Vancouver Coastal Health reported 456 cases of it in 2007-2008, 70 percent acquired in-house.

Bacteremic infections (involving bacteria in the bloodstream) have increased in recent years, the report said. At Vancouver General Hospital, 501 cases in 2005-06 rose to 673 in 2007-08. According to the VCH report, "This data suggests that either the patient population is more susceptible for bacteremia infection or that policy/practice issues resulting in a second or third bacteremic event are not being effectively addressed."

As long ago as 2004, the BC Nurses' Union and HEU co-authored a detailed report, "Falling Standards, Rising Risks," warning about the health hazards implicit in privatized housekeeping. Among its findings: "Employees of a private contractor are no longer integrated into a facility's infection control system and are no longer identified with the health care team itself. Responsibility for orienting and training cleaners is no longer under the hospital's control, which opens up questions about skill development and training standards...Evidence also points to the fact that privatizing hospital cleaning contributes to falling standards of cleanliness."

Cleaning is key: HEU's Darcy

Judy Darcy, secretary-business manager of the HEU, concurs: "It's essential to have cleaning staff who are part of the healthcare team. The health authorities have put their stock in hand-washing. It's important but it's only part of the solution. It's negligent and wrong to ignore the connection between cleaning and the spread of these superbug infections."

Darcy sees three steps to begin solving the problem: "First, we've been pressing for functional health and safety committee to ensure good training and identification of issues. Second, we want to stabilize the workforce, and ensure ongoing training. Third is workload reduction -- we know that our members have impossible workloads plus inadequate training.

"All three involve investment in people, and recognition that cleaning staff are a vital link in preventing the spread of superbugs."

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