A Vancouver Island hospital is struggling to contain a deadly bug whose spread is tied to poor hygiene, months after health authorities were warned to improve infection controls.
One patient has died and 14 people have been infected at Saanich Peninsula Hospital in the outbreak of Clostridium difficile, a bacteria responsible for five deaths last summer at Nanaimo Regional General Hospital.
A report on the Nanaimo outbreak identified problems that could describe any number of hospitals in B.C.: overcrowding and understaffing in an aging facility where patients must share bed wards and bathrooms.
In such conditions, the formula for combatting the bugs is twofold: meticulous hand hygiene and proper cleaning of equipment and all surfaces. The most effective cleaning solution is a simple mix of bleach and water, but it has to be the right mix.
In a report on the outbreak at Nanaimo Regional, the B.C. Centre for Disease Control found breaches of those cleaning protocols.
"Foremost was the discovery that the bleach solutions used by the cleaning staff were incorrectly constituted, leading to the use of a much-reduced concentration," the report found.
The disinfectant was 100 times weaker than the formula needed to kill C. difficile. "It is unclear how long this had been an issue, but it was at least several months if not longer and was clearly a contributing factor to the propagation of the ... outbreak."
That error was not detected in an independent cleaning audit just months before the outbreak.
The issue of hospital cleaning has been politically charged in B.C. since the province privatized housekeeping services in 2003. To address concerns, an independent cleaning auditor has been brought in to ensure B.C. hospitals are maintaining adequate standards.
Westech Systems Ltd. conducted a housekeeping audit of Vancouver Island hospitals from February to April, 2008, and Nanaimo Regional passed inspection with flying colours.
The outbreak began in June.
Westech's president, Dean Waisman, said in an interview that the audits will detect dirt, but they are not designed to examine whether equipment is properly sterilized.
"Cleanliness is a key ingredient to a safe hospital," he said. "We don't get involved in whether they are using the right bleach."
In its review of the incident, the Centre for Disease Control found bedpans were inappropriately cleaned and there were not enough stations for hospital staff to wash their hands.
But it also concluded: "There were insufficient numbers of cleaning staff to meet the basic daily needs of the facility, and they were not adequately trained in appropriate cleaning procedures for a health-care facility."
The Vancouver Island Health Authority received the report several months ago, but did not make it public until it had a plan to address the cleaning concerns.
Health Minister Kevin Falcon said he can't say if B.C. hospitals have enough cleaning staff today, but he wants all B.C. hospitals to take some lessons from the Nanaimo incident.
He maintained that B.C. has a good infection control record compared to the national average, however, he said he was not pleased the situation in Nanaimo.
Adrian Dix, the NDP health critic, said privatization of cleaning operations in hospitals has led to cuts in services.
"Hospitals are dirtier and the risk is significantly higher than it used to be," he said.
Joe Murphy, VIHA's vice-president for operations, said there are more housekeeping staff on contract at Nanaimo Regional now than when the services were done in-house.