Canada's largest research hospital is about to launch a massive screening program that will test every overnight patient for two virulent superbugs that kill thousands in their path.
For the 30,000 people admitted annually at the University Health Network in Toronto – whether for a broken hip or brain surgery – the nation's most ambitious bug-fighting plan in history will subject their noses, underarms, groins and anuses to swab-wielding staff.
The network's three facilities – Princess Margaret, Toronto General and Toronto Western hospitals – will start screening as early as next month, taking aim at methicillen-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The two intruders, along with other superbugs, are among the hospital-acquired infections that kill more than 8,000 people a year, roughly the same number who die of breast cancer and car accidents combined.
Those found to be infected with MRSA – even carriers with no symptoms – will undergo a week's worth of antiseptic baths in chlorhexidine and receive a nasal ointment. They will also be put in isolation: Anyone visiting or treating them must take special precautions by donning a surgical mask, gown and gloves.
“MRSA is particularly bad because it's easily transmissible and it really likes the hospital setting,” said Michael Gardam, the University Health Network's director of infection prevention and control, who is spearheading the screening, estimated to cost about $1.5-million annually.
The program, Dr. Gardam said, is designed to produce a “sustained, very significant decrease of hospital-acquired MRSA and VRE. I would like it halved or more. And I think that's achievable.”
An estimated 220,000 patients suffer from hospital-acquired infections each year, according to the Canadian Nosocomial Infection Surveillance Program. Another study by that same group found one of 10 patients admitted to hospital leaves with the unintended consequence of an infection. The annual death toll dwarfs that of the 2003 SARS outbreak, which killed 44 people nationwide.
And the numbers are growing: For MRSA alone, Canadian hospitals have seen a 10-fold increase in the rate of those colonized and infected over the past decade. Some of the highest rates have been noted in Quebec and Ontario, according to the Canadian Nosocomial Infection Surveillance Program study, which looked at MRSA in 38 hospitals in nine provinces.
Ontario is something of an MRSA hot spot: 13,458 patients were found to be colonized or infected with it last year. That's slightly larger than the population of Gravenhurst, Ont., and the highest number the province has ever recorded, according to figures from Ontario's Quality Management Program – Laboratory Services.
Behind the scary statistics is the overprescribing of antibiotics, which has helped create a horrid array of resistant bugs. Old, overcrowded hospitals are a factor as well, as is a sad reality: a simple act too infrequently performed.
“The problem is that 40 per cent [of health-care workers] don't wash their hands properly,” said Phil Hassen, chief executive officer of the Canadian Patient Safety Institute.
That is the case even though half of infections could be prevented with proper hand hygiene, according to Susan Brien, the Canadian Patient Safety Institute's director of operations for Quebec, Eastern Canada and Nunavut.
“For MRSA,” said Dr. Brien, a neurosurgeon, “proper hand hygiene, implemented in health-care settings, can have a significant impact at lowering the rates of these types of infections.”
Blindsided by infections
MRSA is a sneaky enemy: It can hide inside a nostril, sit on a hand or lurk in a piece of soiled clothing. It may show up as a blotch of reddened skin, or as a painful, swollen pimple. The damage it inflicts can be minor and treated with a topical antibiotic, or it can be swift and furious, causing blood poisoning, decayed lungs, pneumonia and infected heart valves.
Patients are often blindsided by infections after a seemingly innocuous hospital visit.
