Hospital initiative aims to stamp out superbugs

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They are nasty drug-resistant bacteria that haunt hospital hallways, infecting thousands and killing an estimated 12,000 Canadians annually, and now a new initiative aims to put the squeeze on superbugs.

What started as a pilot project at five hospitals about two years ago expanded Monday to another 30. The bug-fighting approach places the onus on front-line staff, not infection-control doctors, to come up with practical strategies for their particular floors to reduce the spread of hospital-acquired infections.

"We've been trying to control these things for 40 years now, and the rates keep going up. It will just keep getting worse and worse," said Michael Gardam, who leads the initiative and is the medical director of infection prevention and control at the University Health Network. "[With this program,]they own it now. They're doing it."

Over the next few months, and perhaps even a year, the 30 hospitals that have signed on to the superbug initiative will develop tactics for specific wards that take aim at Clostridium difficile (C. difficile), methicillin-resistant Staphylococcus aureus (MRSA) and a host of other superbugs that kill at least as many people in Canada annually as breast cancer and car accidents combined.

More than 200,000 patients suffer from hospital-acquired infections each year, a consequence of three factors: overprescribing of antibiotics that have helped create drug-resistant bugs; old and overcrowded hospitals; and health-care workers not following basic hand hygiene. An outbreak of C. difficile at Joseph Brant Memorial Hospital in Burlington, Ont., in 2006 and 2007 led to the deaths of 91 people.

Infection-control experts in hospitals find that messages around controlling infection rarely stick with front-line staff. Dr. Gardam said his thoughts on prevention used to involve placing more gel dispensers in wards or educating health-care workers about hygiene. But the pilot project involving three Ontario hospitals and two in British Columbia opened his eyes to the changes that happen by empowering hospital workers.

Those working on the superbug project at Toronto East General Hospital, for example, put green tags on IV poles to indicate they've been disinfected (they're analyzing the effectiveness of that initiative). At Vancouver General Hospital, staff on a particular floor carry hand sanitizer to clean patients' hands before they receive meal trays. And at the long-term continuing care unit at Trillium Health Centre's west Toronto site, don't be surprised if you hear one staff member calling another Nurse Jackson - a code word used to address poor infection control.

Project leaders say they've noticed the number of superbug infections decrease as a direct result of nurses and hospital staff being involved. "They all of a sudden realize that their units are in a mess, that they're chaotic, they're disorganized," said Katie Procter, quality leader at the BC Patient Safety and Quality Council. "So, then they start looking and seeing things that are right in front of their eyes that they can change."

Patients are often taken aback by infections after what may seem like a routine hospital visit. In a conference call involving the 30 hospitals Monday, patient Mavis Churchill described how she developed a postoperative MRSA infection at a Toronto-area hospital. "I never want to put people through that pain again," she said.

Dr. Gardam cautions that the hospital-specific strategies will not halt the spread of superbugs, but hopefully reduce the number of cases. "Right now, in most of our facilities, the spread of these things is kind of a free-for-all," he said. "We can do way better than what we're doing."

New approaches

Disinfection tags: At Toronto General Hospital, green tags indicate which IV poles have been disinfected.

Coat hooks: In the general surgery unit at Toronto General Hospital, hooks were put so doctors could hang up their white coats and don and doff protective gear when visiting patients in isolation - and patients' families now have a place to hang their coats and bags so they don't spread infection.