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The Big Picture: Housekeeping's role has never been more important

Globe photographer Kevin Van Paassen has spent countless hours at Sunnybrook Health Sciences Centre since September capturing the drama and the routine of the institution. This gallery features images of Sunnybrook Environmental Services workers whose role at the hospital has never been more important. Read the related story The new germ warfare  by Health Reporter Carly Weeks and explore the rest of The Hospital series.

Debra Owusu is an Environmental Services employee at Sunnybrook Health Sciences Centre in Toronto, photographer on November 21, 2013.

Any vacated hospital room must be completely disinfected and scrubbed from top to bottom by MS. Owusu before the next patient is allowed in.

Cleaners such as Ms. Owusu are often the last line of defence. A missed surface could trigger an outbreak that can close the room for days, cripple a department and even kill vulnerable patients.

For many patients, hospital housekeepers are one of the only things standing between them and destructive antibiotic-resistant bacteria

Hospitals face a challenge, though: demands on budgets are higher than ever before and hospitals are faced with having to chose where to spend, on full-time staff such as Beverley Anderson or elsewhere.

A department such as Ms. Anderson's housekeeping, which is not directly involved in providing patient care, is an all-too easy target for cuts, critics say.

More and more, hospitals across Canada have been outsourcing the type of job Ms. Anderson does at Sunnybrook. British Columbia, for example, privatized hospital cleaning more than a decade ago.

A 2008 report found that privatization in B.C. led to high staff turnover and a reduction in the amount of time cleaners spent at health-care facilities. The number of patients infected with superbugs also rose during that time.

With constant pressure for cleaners such as Leontina Da Costa to perform their duties faster and turn beds over in less time, many experts are questioning whether the importance of housekeepers is being overlooked.

Ms. Da Costa’s pager buzzes steadily, alerting her each time a patient has been discharged.

Each time that happens, Ms. Da Costa knows she has to move quickly to get the empty bed ready for the next patient.

Infection control experts who are watching the spread of hospital-acquired superbugs across the country say not nearly enough is being done to control this deadly problem. 

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

On average, hospital-acquired infections kill 22 Canadians every day.  That's a death rate similar to the total number of Canadians who die annually from all car accidents, drowning, falls, burns and poisoning combined. 

Overuse of antibiotics over a number of years allowed bacteria to develop resistance and outsmart the attempts to kill it. Andrew Simor, chief of microbiology and infectious diseases at Sunnybrook is one of Canada’s leading experts in this area.

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