“This is a huge problem and I don’t think it’ll be solved simply,” Dr. Taylor said. “We recognize there’s much more that needs to be done.”
The case for doing more is compelling. If the world were to enter a post-antibiotic era, vast numbers of people could die from infections after routine surgery. Bone marrow transplants and chemotherapy would no longer be a feasible option because patients, whose immune systems are compromised, would be unable to fight infections on their own. Even strep throat could become a fatal disease.
The power of cleaning
The microbiology lab at Sunnybrook Health Sciences Centre is the hospital’s nerve centre for superbug detection and diagnosis. All day long, technologists examine samples collected from patients to diagnose infections and identify antibiotic resistance. Some of the tests can take minutes. Others, days. The work done here is critical to determining a patient’s treatment options and reducing the spread of hospital-acquired infections. If a bacterial swab grows on a culture plate despite the presence of an antibiotic, the doctor knows that patient must be isolated and any antibiotic treatment should be stopped.
Efforts like this, used in hospitals across Canada, are part of the search for new weapons in the war against superbugs.
Scientists are developing new antibiotics that bacteria don’t yet know how to outsmart. Hospitals are redesigning wards to have more single-patient rooms, a proven way of reducing the spread of infections between patients. And a growing number of companies are jumping into the fray, offering new – and often expensive – technologies that promise to wipe out superbug bacteria using ultraviolet light or hydrogen-peroxide vapour.
In a sense, everyone is looking for a quick fix to a highly complex problem, says Dr. Michael Gardam, director of infection prevention and control at Toronto’s University Health Network and one of Canada’s most respected infectious-disease specialists. The irony is that one highly effective tool in the battle against superbugs – hospital housekeepers – is right under our noses.
Cleaners are, in many ways, the front-line gatekeepers against superbugs. But these days, health-care budgets are tight and demands on hospitals are greater than ever. That makes housekeeping, a department that isn’t directly involved in providing patient care, an all-too easy target for cuts, Dr. Gardam says.
“Environmental services is not being recognized as the incredibly important patient safety initiative it is,” he says.
It’s a country-wide problem. British Columbia privatized hospital cleaning more than a decade ago, and more hospitals across Canada have been increasingly outsourcing housekeeping work in recent years. A 2008 report published by the Hospital Employees’ Union in B.C. found that privatization led to high staff turnover and a dramatic reduction in the amount of time cleaners spent at health-care facilities.
Conversely, a study published in the Journal of Hospital Infection found that a stubborn MRSA outbreak at a hospital in Britain was only contained after the number of hours cleaners spent on the ward was doubled from 60 to 120 each week.
With constant pressure for cleaners to perform their duties faster and turn beds over in less time, many experts are questioning whether the importance of housekeepers is being overlooked to the detriment of patients.
“Whether we like it or not, we have a hierarchy in health care,” said Hugh MacLeod, chief executive officer of the Canadian Patient Safety Institute. “[Cleaners] are an important part of a continuum of care. I don’t know if all institutions, to be quite honest with you, view it at that level of importance.”
Back on the fifth floor at Sunnybrook, Ms. Da Costa’s pager buzzes steadily, alerting her when a patient has been discharged. Each time that happens, she knows she has to move quickly to get the empty bed ready for the next patient. She will clean and scrub and disinfect as much as she can, hoping the room has been decontaminated before she moves on to her next assignment.
She knows someone’s life depends on it.