Years ago, I spent a summer working at St. Mary's Hospital in Montreal. My job was to type the surgeons' handwritten reports and deliver them to an office where they would be filed. One sentence kept appearing on all the reports: “The patient returned to the ward in good condition.” Apparently, all the operations went perfectly well and, if someone were to die afterward, it wasn't going to be the surgeon's fault.
In any case, this sentence often returns to my mind these days, as I hear more and more distressing reports of people getting terribly sick after an operation deemed successful. The culprit is always the same: an infection while the patient was in hospital.
Downtown Montreal hospitals offer an especially fertile terrain for nosocomial (hospital-acquired) diseases because they were built more than 50 years ago; some, such as the Hôtel-Dieu and the Royal Victoria, are more than a hundred years old. The buildings are always in need of repair, they have very few private rooms and most patients share bathrooms - increasing the risk of contamination. (This is why hospitals of the future will have only private rooms: It's the best way to prevent contamination.)
Part of the answer to this problem that claims thousands of lives every year is to focus on cleanliness. Hospital employees should wash their hands regularly with antiseptic solutions, and liberally use gloves. Doctors should wash their hands after seeing each patient. Patients with infectious diseases should be separated from the others. And needless to say, hospital rooms and toilets should be thoroughly disinfected every day.
And now, as if there aren't enough problems in our hospitals, comes the “green” factor.
Like many other well-meaning institutions, most hospitals are increasingly using “green” products, which are not as efficient as the traditional ones in combatting bacteria and viruses. The problem has reached such proportions - 70 per cent of Quebec's hospitals now use ecological cleaning products - that the province's Ministry of Health recently felt obliged to issue a warning calling for extra vigilance about the kind of products hospitals use. Typically, those labelled “ecological” are often milder - and thus less prone to kill infectious agents.
“This trend toward green products is not without risk,” says Richard Marchand, a microbiologist and member of a government committee that monitors hygiene and safety standards in Quebec's hospitals. He says that, since the industry escapes regulation, some products are diluted by the manufacturer and, once delivered to hospitals, diluted again by infection-control staff eager to save money - just as cheap beauty salons do with hair shampoo. The difference is, while a low-quality shampoo has no other consequence than a bad hairdo, overdiluted cleaning products in hospitals are inactive and can lead to an increase in nosocomial infections such as Clostridium difficile , a superbug that can kill older and weaker patients and attack the immune systems of younger and healthier patients.
Dr. Marchand is seeking more stringent guidelines and regulations on the antiseptic products used in hospitals. Health Canada is aware of the problem and plans to act, but governments being slow animals, the new rules probably will not be issued before next year, and maybe even later.
There was once a time when a person felt safe in a hospital. Wasn't it supposed to be the place where one would be taken care of and cured? We used to laugh at the elderly folks who would stubbornly refuse to go to hospital because they said hospitals made you sick. The spread of nosocomial infections, as well as the sloppy maintenance that is visible in too many institutions, have changed everything. Now, hospitals are beginning to look like the worst place to be if you're sick or fragile. Maybe the old superstitious folks were right after all.
