 Poor collection of Hospital Acquired Infection (HAI) data
in Canada
 10.5% of admissions result in a HAI (Public Health
Agency of Canada)
 This means:
330,000 HAIs in Canada each year
12,000-18,000 deaths
3rd leading cause of death, after cancer and heart disease
 Annual cost to Canadian health system: $1—9 Billion
WHY? OVERCROWDING
 Academic literature shows that high occupancy rates increase
risks of superbug infection
 Specifically, occupancy rates below 82% have been associated
with significantly decreased levels of infection
 Canada has hospital occupancy rate of 89%, higher than any
other Organization of Economic Cooperation and Development
(OECD) country
 Less hospital beds than any other OECD country, after Mexico.
ONTARIO? WORST PROVINCE
 Ontario has less hospital beds than any other province, less
than Mexico, about the same number as Haiti (the poorest
country in the Western Hemisphere).
 When 91 patients died at Joseph Brant Memorial Hospital it was
regularly operating at 105% capacity
WHY? CUTS TO CLEANING
 Academic literature shows that:
Superbugs can survive in hospital environment
Can be transferred from environment to hands
Exposure to contaminated environment is associated with colonization
Environment cleaning can reduce risk of infection
 Yet governments and hospitals look to cleaning for cost-savings
“Just because it’s a public
healthcare system doesn’t
mean that we…should expect
to pay more to sweep the floor
in a hospital.”
 When there’s an outbreak, hospitals end up hiring more cleaners (after
the fact):
Honoré Mercier, QC: 16 deaths. Hospital hired ten additional cleaners to
control outbreak
Nanaimo General Regional Hospital, BC: 8 deaths, hospital tried to get out
of contract with private cleaning firm Compass due to negligence, but was
contractually unable
Niagara Health System, ON: 16 deaths, NHS cut ties with private cleaning
firm Aramark after allegations they cut staff and cleaning supplies resulting
in outbreak
Burnaby Hospital, BC: 84 deaths, hospital department heads wrote open
letter to government demanding enhanced cleaning to stop outbreaks
Housekeeping as a proportion of total hospital budget
3.50%
3.00%
2.50%
2.00%
1.50%
1.00%
0.50%
0.00%
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Housekeeping as a proportion of total hospital budget
From 2000 to 2009 the proportion of hospital
budgets going to cleaning dropped by 25%
10.00%
Annual % Increase in Hospital and Houseekeping Funding
5.00%
0.00%
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
-5.00%
-10.00%
-15.00%
Hospital Funding
Housekeeping Funding
Erratic increases and cuts to cleaning
reflect attempts to cut costs, only to have to
reinvest after outbreaks or other cleaning
needs’ spike.
 B.C. government legislates contracting-out of hospital cleaners in 2003,
proportion of cleaning budgets diverted to private contracts has jumped
from 3% to 60% since 2003
 Privatization nearly halved wages for BC hospital cleaners, rolling them
back to pre-1968 levels
 Those working for private contractors are now the lowest paid health
services support workers in all of Canada, earning 26 per cent below the
national average.
 One study of contract cleaners found 75% were understaffed,
1/3 did work without training, were limited to only one pair of
gloves per shift
 Cleaning is a labour-intensive job: staff account for about 93%
of cleaning budgets, so when cleaning budgets are cut it
translates directly into fewer cleaning hours
 In 2004-05 rates of MRSA doubled in B.C./Alberta
 Since 2008, B.C. has highest rate of C.diff in country
 After a 2008 outbreak at Nanaimo General Regional Hospital BC
Centre for Disease Control conducted an investigation
 They found that private cleaning company Compass Group failed to:
Provide adquate training to cleaners
Sufficient cleaners to meet agreed standards in their contract
Sufficient cleaners to meet needs during outbreak
 Poor training and limited cleaning supplies resulted in cleaners overdiluting bleach (1:1000 bleach to water, instead of 1:10), which was
determined to have contributed to the outbreak
WHO DOES IT BETTER? NETHERLANDS
 “Search & Destroy” strategy involving screening,
cohorting and intensive disinfection has kept MRSA
infections very low in Netherlands
 “Search & Destroy” is also cheaper even though it is
labour intensive (because prevented infections save
health system $millions)
 At only 64%, Netherlands has one of lowest hospital
occupancy rates in OECD
WHO DOES IT BETTER? SCOTLAND
 Health ministry bringing all hospital cleaning back in-house
 Added 1,000 extra cleaners
 Have added staff and have involved them in infection-control
 Strategy has reduced C.diff 37% in patients over 65, and 42% in
those under 65
SO, WHAT IS OCHU DOING ABOUT IT?!