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The Hospital

Dispatches from inside one of Canada's busiest health care institutions

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The Hospital

How hospitals are on the front lines in a new era of germ warfare Add to ...

Cleaning like your life depended on it: A day with a Sunnybrook housekeeper (The Globe and Mail)

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Leontina Da Costa and Millicent Linton pick up the lightweight hospital mattress in a room on the orthopedic and neurosurgical unit at Sunnybrook Health Sciences Centre and scrub it with vigour normally reserved for the removal of red wine from white upholstery. The swishing sound of their microfibre cloths repeatedly assaulting the green waterproof cover provides a hypnotic soundtrack to their work.

After the mattress is clean, the two housekeepers still have to scrub the bathroom, disinfect all of the surfaces in the room and mop the floor before the next patient is allowed in. If one bed rail isn’t properly wiped down, if every millimetre of a toilet seat isn’t disinfected, if a TV remote control isn’t cleaned with industrial-strength chemicals, the result can be a catastrophic outbreak of antibiotic-resistant bacteria that can cripple an entire department and kill the vulnerable patients in its path.

This is the new reality of hospitals in the 21st century. The admission last week by B.C.’s Fraser Health Authority that it has confirmed 41 cases of Carbapenem-resistant Enterobacteriaceae (CRE) – a superbug that is resistant to nearly all drugs and was thought not to have gained a foothold in Canada – is a startling reminder of the dangers antibiotic-resistant bacteria pose.

Every year, more than 220,000 Canadians develop infections during a hospital stay. On average, these infections kill 22 patients every day – about the same as the number of Canadians who will die from breast cancer and leukemia combined. The cost of caring for these patients ranges from $2,000 to $20,000 each. It’s a massive burden on health care in Canada, and it’s getting worse.

If drastic measures aren’t taken quickly, experts say the world could enter a post-antibiotic era, where children die from scraped knees and something as simple as surgery to implant a pacemaker is too risky to undertake. What is most frightening, say infection-control experts who are watching the spread of hospital-acquired superbugs across the country, is that Canada is not doing nearly enough to control this deadly problem.

New threats on the horizon

Right now, one out of every 12 patients in a Canadian hospital is colonized or infected by Clostridium difficile, Methicillin-resistant Staphylococcus aureus (MRSA) or Vancomycin-resistant Enterococcus, the superbugs that currently pose the biggest challenges to health institutions.

C. difficileMRSAVRECRE
Total cases: 3,479Total cases: 1,788Total cases: 482Number of cases: 81

Rate per 1,000 patient admissions: 4.81%

Rate per 1,000 patient admissions: 2.14%

Rate per 1,000 patient admissions: 0.57

Number of deaths: 6

CRE, the latest threat, are a family of bacteria that are resistant to all of the standard classes of antibiotics normally used to treat serious infections. Once introduced into a health-care facility, CRE can transfer their resistance to other bacteria, making once-manageable superbugs impossible to treat. So far, the number of cases in Canada has been relatively small, but the unfolding situation in Fraser Valley has many infection control experts gravely concerned.

Superbugs are created when a bacterium develops resistance to the antibiotic designed to kill it. When antibiotics are used inappropriately, they kill susceptible bacteria and create the perfect environment for resistant strains to grow, multiply, mutate and spread. Hospitals, where antibiotic use is high and invasive medical procedures are performed on patients with weakened defences, provide an ideal breeding ground for these virulent, insidious bacteria to thrive. Alcohol-based hand sanitizers and handwashing can help prevent the spread between hospital workers, visitors and patients. But they can’t stop a patient from being infected by an improperly cleaned table tray or blood-pressure cuff.

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The Globe and Mail partners with Sunnybrook hospital to explore the challenges on the ground at Sunnybrook hospital and what patients, doctors, nurses and other vital staffers think needs to be done to improve the hospital experience.

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