A specialized team that would scour hospital rooms in the event of an outbreak of infectious disease is part of a new housekeeping contract for some Vancouver Island health-care sites.
The contract also boosts the target score on a provincial cleanliness audit from 85 to 90 per cent and features an additional "thoroughness" audit to test if rooms that look clean actually are.
For that test, an ultraviolet solution - invisible to the naked eye - would be applied to 10 "high-contact" points in a patient room and those surfaces later checked with an ultraviolet light to determine if they have been wiped down.
"These are things that everybody touches," Joe Murphy, vice-president of operations and support services with the Vancouver Island Health Authority, said in a recent interview. "And after a room has been terminally cleaned or discharged clean, our expectation is that all those things would have been cleaned."
Currently, audits required by the province and conducted by Westech Systems do not include UV markers, but that could change as more facilities add the tests to their infection-fighting routine.
"Health authorities continue to meet with [Westech]to improve this audit, which may include using UV marker technology in the future," provincial Health Ministry spokesman Ryan Jabs said.
The current audit, used since the province began contracting out housekeeping services in 2003, involves visual checks that emphasize high-touch areas such as doorknobs and bed rails.
VIHA announced on April 1 that it has signed a contract with Vancouver-based Marquise Group for food and housekeeping services at seven sites currently served by Mississauga-based Compass Group.
Marquise will start taking over facilities under the five-year, $10.5-million contract on October 1 in a changeover expected to take several weeks. Compass has been given six months' notice, as required under its contract with VIHA.
Cleaning and its potential role in disease control was thrust into the spotlight on Vancouver Island in 2008 and 2009, when an outbreak of Clostridium difficile swept Nanaimo Regional General Hospital. The outbreak involved 94 cases, including five deaths.
A 2009 B.C. Centre for Disease Control report cited numerous factors in the outbreak, including shared wards, too few sinks for hand-washing and "insufficient numbers of cleaning staff to meet the daily needs of the facility."
The review also found cleaning staff were using bleach solutions at the wrong concentration, making it ineffective as a disinfectant.
A related report by VIHA's chief medical health officer Richard Stanwick zeroed in on training gaps and high turnover in housekeeping staff, as well as shortcomings in VIHA's housekeeping contract for Nanaimo hospital.
"By today's standards and the expert review of current [infection control practitioners] the standards cited in the contract are inadequate," Dr. Stanwick said in his report. " As well, other variables have changed - the population VIHA is serving is older, the patients in hospitals and in long-term care are even more complex and of increased acuity, and the organisms being dealt with are nastier. During the term of the contract, standards for housekeeping have gone up provincially."
In an update in 2009, VIHA said it had either completed or was in the process of meeting recommendations of both reports. Last year, it issued several requests for proposals for housekeeping and food services, saying it "recognized there is room for improvement in service provision and standards."
Mr. Murphy said the decision to switch contractors was not driven by the C. difficile outbreak but by other factors - including Marquise's superior food offerings, which involve fresh food at each facility rather than a central commissary, and enhanced housekeeping services that include the specialized infection control team.
The switch from Compass to Marquise could mean layoffs for as many as 350 workers, although Marquise has said it will interview any workers that want to keep their jobs.
Marquise, which provides services to 17 facilities in the province, is privately held and a predominantly non-union employer.
Marquise routinely interviews staff when it takes on a service contract, said Rocky Ozaki, Marquise's human resources director.
"Why wouldn't we hire back the best people?" Mr. Ozaki said, adding that Marquise has previously hired back from 20 to 90 per cent of employees at other sites for which they have won contracts. "They [Compass]have some great people there and we intend to keep as many as possible."
The Hospital Employees' Union, which currently represents Compass workers, says such reassurances are no guarantee.
"VIHA should make it a condition of these contracts that they hire the existing workforce," HEU spokeswoman Judy Darcy said. "These are experienced people, some of them have put in several years working in health care, some of them are workers who lost their jobs when the work was originally contracted out."