Hospital infections: Are you at risk?
Each year some seven percent of hospital admissions’an estimated 222,000 Canadians’pick up an infection while in hospital. About 8,000 of them die. Are our hospitals doing enough to ensure patient safety?
Source: Best Health Magazine, November/December 2008
Two weeks after Lisa and Jason Kerr came home from the hospital with their newborn daughter Macy, the Richmond, B.C., couple realized they had more than a bundle of joy. Their daughter was carrying an antibiotic-resistant superbug.
Macy, born in January 2008, was infected with MRSA (methicillin-resistant Staphylococcus aureus), a virulent bacteria. While it isn’t clear how she got it, she was one of a cluster of babies born at Richmond General Hospital who became infected with MRSA that winter. (The hospital swabbed all equipment in the maternity ward, finding no evidence of the bug, and cleaned extensively and found no breach of infection-control procedures. It is continuing to investigate the source.)
Two weeks after Macy’s birth, her left breast swelled to the size of a golf ball, then ruptured into an ulcer of pus and blood.
‘It looked like a gunshot wound,’ says Lisa, whose daughter spent five days in a Vancouver hospital, most of it in isolation, being treated with IV antibiotics. After another five days on oral medication at home, the infection cleared.
Hospital-acquired infections in the U.S. and Canada
Each year some seven percent of hospital admissions’an estimated 222,000 Canadians’pick up an infection while in hospital. About 8,000 of them die; that’s almost 3,000 more a year than those who die from breast cancer. Infection rates from MRSA alone have increased 10-fold since 1995, and hospital-acquired infections, called nosocomial infections, are among the most serious and costly patient-safety issues facing Canada’s healthcare system.
In the U.S., which until recently had a much more severe problem with hospital-acquired infections, 24 states have enacted legislation to make the public reporting of them mandatory. As of October of this year, the U.S. government’s health insurance program for elderly and disabled Americans, called Medicare, will no longer cover the cost of hospitalization for these infections, making hospitals responsible instead.
In Canada, most patients going to hospital have no idea what their risk of contracting an infection might be. Only 49 ‘sentinel’ hospitals in nine provinces report infection rates to a national surveillance program.
Ontario takes the lead
In a bold move to halt hospital-acquired infections, Ontario recently announced that by April 2009, its hospitals and long-term care institutions will be required to publicly report on eight specific infection-related indicators. The information will be available to the public on a government website.
‘The law will be shining a spotlight on these issues and it is going to force hospitals to pay attention,’ says Dr. Michael Gardam, director of infection control at Toronto’s University Health Network, which has been a national leader in the battle against nosocomial infections.
Why do infections thrive in hospitals?
The issue is not new. For as long as there have been hospitals, there have been hospital-acquired infections. It’s simply because hospitals put disease-causing organisms and sick people in one place. Throw in the overuse of antibiotics over the last four decades, multi-bed wards, overworked staff and too few sinks for handwashing, and increased transmission and infection are inevitable, notes Gardam, who’s the leader of a program run by the Canadian Patient Safety Institute to reduce the spread of MRSA.
Healthy people with strong immune systems aren’t often at risk. And some strains, even for the ill, are relatively easy to treat. But some infections can be deadly. The virulent intestinal organism C. difficile (Clostridium difficile) causes a severe diarrhea that is especially lethal in the elderly. The bacteria VRE (vancomycin-resistant Enterococcus), while less virulent than MRSA, is hard to treat because of its resistance to antibiotics. It can colonize surgical wounds, IV sites, heart valves and the bloodstream. MRSA is particularly worrisome because it is easily transmissible from silent or symptomatic carriers as well as contaminated surfaces, and it can infect any part of the body.
An effort to decrease the spread of infections
Quebec and Manitoba have made the reporting of C. difficile mandatory since 2004. Healthcare facilities across the country can become members of Accreditation Canada once they adhere to the rigorous standards of infection prevention and control set by this body. But Ontario is the first province to make its hospitals report monthly on eight separate infection indicators, including rates of MRSA, VRE, C. difficile, surgical-site infections and even staff handwashing compliance.
Will other provinces adopt reporting requirements as extensive as Ontario’s? Though officials see that as the trend, each province has jurisdiction over its own health care, so such measures can’t be nationally imposed, notes Dr. Howard Njoo of the Public Health Agency of Canada. PHAC invites hospitals to voluntarily submit their data to a national surveillance program.
Other measures can reduce infection rates, too. Toronto’s University Health Network saw its MRSA infection rate fall by more than 50 percent over a one-year period thanks to the tracking and reporting of infection rates by each unit in the hospital, and screening everyone for the bug when they are admitted. Any patient found to be positive for MRSA was isolated and treated.
But most of all, handwashing for healthcare workers is crucial. ‘That’s one of the biggest issues,’ says Gardam. ‘If you can get healthcare workers to routinely wash their hands, you can have a dramatic impact.’