Michael Gardam, medical director of infection prevention and control at the University Health Network, is photographed on the general surgery ward at the Toronto General Hospital on Jan. 10, 2011.FRED LUM/The Globe and Mail
The omnipresent hand-sanitization stations in the entrances of Canadian hospitals probably may strike you as a sensible option for the prudent visitor, or as an oasis for hypochondriacs. The truth is, they are neither. Those squirts of isopropyl alcohol are a critical part of an existential battle against the steady rises of antibiotic-resistant bacteria and hospital-acquired infections in this country. Canadians have yet to fully grasp how serious the problem is, and the federal government needs to do more to bring them up to speed – and to track where the war is, and is not, being won.
The Chief Public Health Officer reports that more than 200,000 Canadians acquire infections in hospital every year, and that more than 8,000 die from them. That is a startling rate of 22 deaths each day. It's more alarming when you realize that the dead did not bring the disease that killed them to the hospital; it was there waiting for them on another patient, on the hands of a nurse or doctor, or on an improperly cleaned door handle.
More than half of these fatal infections involve a growing number of antibiotic-resistant bacteria, such as Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE) and Clostridium difficile (C. difficile). Last month, a hospital in British Columbia revealed it had had an outbreak of Carbapenem-resistant Enterobacteriaceae (CRE) – a new superbug that is invulnerable to existing drugs and fatal in most cases.
Health officials around the world worry that the steady rise of superbugs could lead us back to a "post-antibiotic" era, in which conventional surgeries and treatments would be impossible. The cancer treatment chemotherapy, for instance, drastically reduces the immune systems of patients, who then require antibiotics to fight infections. But if the infections are immune to the antibiotics, then the side effects of chemotherapy could render it too dangerous to be a useful treatment.
The Health Officer reports says the number of hospital-acquired infections involving drug-resistant bacteria is on the rise, but also admits that "definitive numbers are not available." The Association of Medical Microbiology and Infectious Disease Canada, which represents doctors, microbiologists and researchers, has been critical of Ottawa for its refusal to make public the infection rates in Canada. But even if the federal government wanted to be more forthcoming, its data are limited. There is no systematic reporting of cases, because health is a provincial jurisdiction and reporting rules vary from province to province.
This simple lack of data makes it hard to get an accurate picture of the level of antibiotic-resistant bacteria and hospital-acquired infections, and the facilities with the best and worst records. The federal government is best situated to fix that. It needs to lead the charge to create a system for gathering common, national information. This could be handled by organizations such as AMMI or the Canadian Institute for Health Information. The stakes are high, and solutions involve more than just clean hands.