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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)

Superbugs can live on surfaces for weeks – even months. To illustrate how difficult these bacteria are to contain, one study by U.S. researchers published in Infection Control and Hospital Epidemiology found that when hospital staff enter the room of a patient with MRSA, nearly half of them will leave with the superbug bacteria on their gloves or gowns – even if they don’t touch the patient.

Last month, health authorities in the U.S. disclosed that the source of a CRE outbreak in Illinois last year that eventually spread to dozens of people was a single endoscopy scope (a device that is inserted down patients’ throats). The hospital had followed accepted cleaning practices, but the germ still spread.

Brian Young, a former member of the legislative assembly and cabinet minister in Nova Scotia’s government, doesn’t know how his mother, Julia, contracted C. difficile three times during a hospital stay in Cape Breton to recover from a stroke. But since she was bedridden for the duration of her eight-month stay, he suspects the infection was brought to her by a health-care worker whose hands were contaminated with the bacteria.

His mother, a vibrant 88-year-old who painted and went for long walks in her spare time, eventually succumbed to her third bout with the superbug in January 2012. Mr. Young still has trouble comprehending what unfolded.

“You don’t go to the hospital to be made sick or sicker,” he said during a recent interview. “You go to be made better and they failed miserably with mom.”

‘It’s just not nearly enough’

Despite growing worldwide concern over the prevalence of hospital-acquired infections and the threat of antibiotic resistance, many infection-control experts say Canada isn’t treating this global threat with the urgency it deserves.

Other countries have taken deliberate steps to alert the public about the dangerous reality of superbugs and the looming prospect of a post-antibiotic era. The U.S. Centers for Disease Control and Prevention warned in a landmark report last September that, without urgent measures, antibiotic resistance will have “potentially catastrophic consequences.” England’s chief medical officer has said antibiotic resistance is as big a threat to the nation as terrorism. Dr. Margaret Chan, director-general of the World Health Organization, has warned that medicine could take a step back into the 19th century.

But Canada’s federal government has been silent, declining to post current information about superbugs online or warn the Canadian public about the true extent of the problem, according to critics. The Association of Medical Microbiology and Infectious Disease Canada, a group of respected infectious disease specialists, last fall openly accused Ottawa of hiding the data it collects about instances of hospital-acquired infections. The association got a hold of the data and released it in order to inform the public (see sidebar).

Even then, the information is fragmented and incomplete. Dr. Andrew Simor, chief of microbiology and infectious diseases at Sunnybrook and one of Canada’s leading experts in this area, said national surveillance of hospital superbugs in Canada is “rudimentary to say the best” and badly under-resourced. The Canadian Nosocomial Infection Surveillance Program, which tracks microbes in just 54 Canadian hospitals (out of more than 600), is currently the best surveillance program available. It only provides a fraction of the vital information scientists and health-care providers need about sources of outbreaks, which bugs are most prevalent and where the biggest problems are, Dr. Simor said.

Dr. Gregory Taylor, Canada’s deputy chief public health officer, said in an interview the federal government is in contact with provincial and territorial counterparts on this issue, conducts regular surveillence and is looking for a number of solutions. “Certainly there’s been lots going on behind the scenes,” Dr. Taylor said.

But because health is a provincial responsibility in Canada, it has led to an uncoordinated response to the superbug problem. For instance, while some provinces, such as Ontario, have adopted mandatory public reporting of hospital-acquired infections, others don’t proactively disclose to the public when an outbreak has occurred or how many superbug cases there are. And hospitals are left on their own to develop antimicrobial stewardship programs, which focus on reducing inappropriate or unnecessary antibiotic use across institutions.

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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.

The Conversation

Do you think the current model of hospital-based care is working in Canada?



Yes, it’s fine as it is




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