HOSPITAL ACQUIRED INFECTIONS IN CANADA AND HOW TO STOP THEM MICHAEL HURLEY & JONAH GINDIN, ONTARIO COUNCIL OF HOSPITAL UNIONS (OCHU)

 Poor collection of Hospital Acquired Infection (HAI) data in Canada  10.5% of admissions result in a HAI (Public Health Agency of Canada)  This means:  330,000 HAIs in Canada each year  12,000-18,000 deaths  3 rd leading cause of death, after cancer and heart disease  Annual cost to Canadian health system: $1—9 Billion

WHY? OVERCROWDING  Academic literature shows that high occupancy rates increase risks of superbug infection  Specifically, occupancy rates below 82% have been associated with significantly decreased levels of infection  Canada has hospital occupancy rate of 89%, higher than any other Organization of Economic Cooperation and Development (OECD) country  Less hospital beds than any other OECD country, after Mexico.

ONTARIO? WORST PROVINCE  Ontario has less hospital beds than any other province, less than Mexico, about the same number as Haiti (the poorest country in the Western Hemisphere).  When 91 patients died at Joseph Brant Memorial Hospital it was regularly operating at 105% capacity

WHY? CUTS TO CLEANING  Academic literature shows that:  Superbugs can survive in hospital environment  Can be transferred from environment to hands  Exposure to contaminated environment is associated with colonization  Environment cleaning can reduce risk of infection  Yet governments and hospitals look to cleaning for cost-savings

“Just because it’s a public healthcare system doesn’t mean that we…should expect to pay more to sweep the floor in a hospital.”

 When there’s an outbreak, hospitals end up hiring more cleaners (after the fact):  Honoré Mercier, QC: 16 deaths. Hospital hired ten additional cleaners to control outbreak  Nanaimo General Regional Hospital, BC: 8 deaths, hospital tried to get out of contract with private cleaning firm Compass due to negligence, but was contractually unable  Niagara Health System, ON: 16 deaths, NHS cut ties with private cleaning firm Aramark after allegations they cut staff and cleaning supplies resulting in outbreak  Burnaby Hospital, BC: 84 deaths, hospital department heads wrote open letter to government demanding enhanced cleaning to stop outbreaks

From 2000 to 2009 the proportion of hospital budgets going to cleaning dropped by 25%

Erratic increases and cuts to cleaning reflect attempts to cut costs, only to have to reinvest after outbreaks or other cleaning needs’ spike.

 B.C. government legislates contracting-out of hospital cleaners in 2003, proportion of cleaning budgets diverted to private contracts has jumped from 3% to 60% since 2003  Privatization nearly halved wages for BC hospital cleaners, rolling them back to pre-1968 levels  Those working for private contractors are now the lowest paid health services support workers in all of Canada, earning 26 per cent below the national average.

 One study of contract cleaners found 75% were understaffed, 1/3 did work without training, were limited to only one pair of gloves per shift  Cleaning is a labour-intensive job: staff account for about 93% of cleaning budgets, so when cleaning budgets are cut it translates directly into fewer cleaning hours  In rates of MRSA doubled in B.C./Alberta  Since 2008, B.C. has highest rate of C.diff in country

 After a 2008 outbreak at Nanaimo General Regional Hospital BC Centre for Disease Control conducted an investigation  They found that private cleaning company Compass Group failed to:  Provide adquate training to cleaners  Sufficient cleaners to meet agreed standards in their contract  Sufficient cleaners to meet needs during outbreak  Poor training and limited cleaning supplies resulted in cleaners over- diluting bleach (1:1000 bleach to water, instead of 1:10), which was determined to have contributed to the outbreak

WHO DOES IT BETTER? NETHERLANDS  “Search & Destroy” strategy involving screening, cohorting and intensive disinfection has kept MRSA infections very low in Netherlands  “Search & Destroy” is also cheaper even though it is labour intensive (because prevented infections save health system $millions)  At only 64%, Netherlands has one of lowest hospital occupancy rates in OECD

WHO DOES IT BETTER? SCOTLAND  Health ministry bringing all hospital cleaning back in-house  Added 1,000 extra cleaners  Have added staff and have involved them in infection-control  Strategy has reduced C.diff 37% in patients over 65, and 42% in those under 65

SO, WHAT IS OCHU DOING ABOUT IT?!