Hospital-acquired infections in Canada

A three-year long study by the Canadian Patient Safety Institute (CPSI) revealed in 2012 that 8000 Canadian deaths are a result of infections acquired while receiving treatment in hospitals, with 200 000 more patients leaving healthcare facilities carrying newly acquired infections. It’s a startling statistic for a country generally reputed to have a strong healthcare system- but publicly funded healthcare doesn’t necessarily mean superior quality, as this study indicated.

CPSI was created and funded by Health Canada with the aim of improving the national healthcare system. It does this through evaluation, education, and collaboration between healthcare providers and stakeholders, as well as research on patient care in Canada.

The institute’s 2012 study on hospital-acquired infections found that pathogenic microorganisms are spread by two means: indirect contact or direct contact. Indirect contact refers to the contamination of equipment or the environment through air and waterborne pathogens. On the other hand, direct contact, such as when healthcare workers fail to adhere to strict hand hygiene and equipment sterility procedures, turns doctors and workers into vehicles of infections. This is caused by improper handwashing techniques before changing wound dressings or handling patient central lines that directly feed into major blood vessels, both sites of infection susceptibility.

Just as the form of contagion differs, so too does the danger posed by pathogens. In fact, CPSI found that Staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile) are the two most dangerous infection-causing pathogens at present: both evolve faster than current antibiotics can keep up. Lax hygiene procedures combined with patient non-compliance with antibiotic use (which strips away healthy gut bacteria without fully eradicating pathogens, leading the way for antibiotic-resistance pathogens to replicate) have led experts to call MRSA and C. difficile “superbugs”. As superbugs, these pathogens do not easily respond to antibiotics designed to treat them.

For instance, C. difficile was first identified in the 1930’s. Since then, it has evolved to become more fatal. From 1997 to 2010 alone, mortality rates attributed to it more than tripled from 1.5% to 5.4%. Similarly, MRSA, a genetically unique strain of a bacteria naturally found in the gut, has long been known to be resistant to drugs and antibiotics .

As the Canadian Union of Public Employees reports to their health care workers, Canada spends an estimated $1 billion annually to treat these kinds of infections. At any time, 10% of adults and 8% of children have acquired an infection in Canadian hospitals, with more than 50% of these infections having been caused by antibiotic-resistant bacteria. Undoubtedly, contracting infections when in hospitals undermines patient confidence in health care settings and in the providers overseeing management. This was supported by a 2016 Canadian Healthcare Worry Index, that reported that seven out of ten Canadians fear that they could be harmed, or even die, as a result of hospital-acquired infections.

It seems inevitable that hospitals are hotbeds of infections; they are where infection-carrying and immunocompromised people congregate and are linked together by their healthcare providers. And while human error is part of the hospital infection problem, so too is resource allocation and patient-task prioritization. With finite funds, hospitals outsource non-medical services like laundry, cooking, and cleaning to private companies whose first priority is not patient-care. This can mean the difference between a sterilized, recently cleared out patient room and a seemingly clean one still inhabited by pathogenic residue.

In addition, it’s easy to forget stringent handwashing procedures during exhausting or high-stress situations. If hand washing procedures aren’t easily integrated into daily patient-care routines, other urgent tasks take precedence during time-sensitive situations.

However, the increasing adaptability of hospital-residing pathogens and the high financial cost of treating it means that more effort must be placed on infection prevention rather than treatment. With over 80% of hospital acquired infections spread through workers, visitors and patients, the onus is on hospitals to reform and enforce hygiene-related policies. It only takes a few negligent cases to spread infections. An increase in hand hygiene adherence by 20% has been shown to reduce hospital infection rates by 40%. So making hygiene a seamless part of providing treatment in hospitals, instead of an addendum, will make it easier to follow. But reducing infection rates also extends to facilities management too, as this indirectly affects patient care.

Reporting and tracking hospital-acquired infections have proven to be an effective way in preventing their spread. In fact, MRSA infection rates fell by more than 50% over one year when Toronto’s University Health Network (UHN) began tracking the success of its infection-prevention methods. It might be years before superbug rates drop, but waiting any longer to work towards reducing infection rates will only rack up the cost, and further erode public trust in health care facilities.

By Hagr Saad and Aishah Cader 

Please note that opinions expressed are the author’s own. They do not necessarily reflect the views and values of The Blank Page.