… superbug outbreak abates, but enemy still lurks

Posted on July 14, 2011 in Health Delivery System

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TheGlobeandMail.com – life/health/new-health – Southern Ontario hospitals’ superbug outbreak abates, but enemy still lurks
Published Wednesday, Jul. 13, 2011. Last updated Thursday, Jul. 14, 2011.    André Picard

With a body count that has not even reached two dozen, the “superbug outbreak” in Southern Ontario hospitals is all but over.

Doctors and nurses have been sternly reminded to wash their hands. Fingers have been pointed: The “crisis” is due to a) the contracting-out of cleaning services; b) wrong-headed priorities of the dreaded local health-integration networks; or c) provincial cuts to health spending.

Take your pick and then we can all go back to sleep.

That’s how crisis journalism works, especially in the age of Twitter. We focus intensely on an event like a spike in deaths from Clostridium difficile in hospitals in the Niagara Region. We extract some earnest concern and vague promises from political leaders, and move on.

If only pathogens were as easily mollified.

The challenge of C. difficile cannot be explained in 140 characters or less, or by focusing on a handful of hospitals.

The deaths in Niagara Region are, unfortunately, commonplace.

Nosocomial (hospital-acquired) infections kill about 12,000 people a year, the Community and Hospital Infection Control Association of Canada says. Nasty bugs like C. difficile, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus(VRE) sicken another 250,000 or so.

This is a state of normalcy we ignore.

Some of this mortality and morbidity is avoidable. In fact, what was most glaringly lacking in the daily Niagara hospitals body count was information on who was dying.

Some hospital patients are gravely ill and particularly susceptible to infection. Not so long ago, the terminally ill routinely got bacterial pneumonia, nicknamed the “old man’s friend” because it causes a rather peaceful death.

C. difficile causes violent diarrhea and gruelling intestinal pain. When it is not fatal, it can cause life-long disability. In other words, it is extremely costly.

Equally worrying is when young, healthy people – including health workers – start contracting nosocomial infections, or when they migrate into the community.

Studies have shown that about one in 20 hospital patients will contract an infection.

The average hospital stay is five days, but that jumps to 22 if a patient gets an infection. One U.S. study estimated that nosocomial infections cost $35-billion a year – which translates to about $3.5-billion in Canada.

So what is to be done?

Yes, handwashing is necessary for health-care workers, patients and visitors. But in Canada, we too often skimp on support staff like janitors. It’s not enough, however, to throw bodies with mops into the equation: In health care, everything should be evidence-based, including room cleaning. Some excellent research indicates that hydrogen peroxide kills C. difficile.

Patients with pathogens like C. difficile should also be placed in a private room, and traffic should be minimized. More broadly, shouldn’t private rooms be the norm in modern hospitals? In Canada, a patient can have as many as 46 roommates during a hospital stay, and emergency departments routinely have hallway medicine – ideal conditions for spreading disease.

Just as important as preventing the spread of pathogens is minimizing patient susceptibility. C. difficilepounces when the path is cleared of other bacteria, making patients on antibiotics vulnerable.

There is a lot of evidence that antibiotics are overused, particularly in elderly patients and in hospitals. Figuring out whether to treat a bacterial infection or let it run its course is crucial. And patients have to understand that these miracle drugs can have unintended consequences.

Research also shows that patients taking proton pump inhibitors (which can upset the balance of flora in the gut) for gastrointestinal woes are far more susceptible to C. difficile infection.

There is decent evidence that cheap, over-the-counter probiotics can lessen the symptoms of C. difficile.

But more than anything, to come to grips with the challenge of hospital-acquired infections, a change of attitude is needed.

We need to empower patients and their families with basic information. For example, infection rates should be routinely published, not just when there is a deadly outbreak). And physicians need to discuss the pros and cons of antibiotics and PPIs openly.

Above all, we need a culture of safety in our health system, with an obligation – nay, an obsession – to pursue innovation and improvement. We need to make minimizing hospital-acquired infections a point of pride.

For too long, providers and administrators have washed their hands of this issue, with deadly consequences.

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