By Linda McKellar
From time to time there have been and shall continue to be outbreaks of virulent disease in both the public setting and in health care facilities. One such case is colstridium difficile.
Colstridium difficile (known more commonly as C. difficile) is a gram-positive bacteria that causes severe diarrhea and other gastric complications that can result in death. This pathogen can take over when the “normal flora”, the intestinal bacteria found in everyone, is destroyed by antibiotics. Overuse of antibiotics by the public who often demand them even when inappropriate is one cause of the rise of these “super bugs”.
One of the dangers in this scenario is that many institutionalized individuals require antibiotic therapy, which makes them susceptible. These individuals are often hospitalized due to severe acute or chronic health conditions or are elderly thus making them even more likely to become ill from C diff. People go to the hospital with the intent of getting well and going home, not dying.
Unfortunately, some NHS patients have recently died who otherwise should not have done so.
The c diff spores are very hard to eradicate with routine cleaning methods and are likely always present in the institutional environment to some degree so strict cleaning and isolation protocols are required. Health care facilities should be prepared and equipped to handle such outbreaks.
While no one can predict or stop these outbreaks of virulent pathogens easily, I believe cutbacks do have some effect on the ability to control them.
One problem is lack of suitable beds due to closures. Strict isolation in appropriate units is required. Currently, one is fortunate to have a bed at all let alone a designated isolation room. With the ER wait, infected individuals may be stuck in a hall sharing bathroom facilities until, after a several hour wait, they are seen, diagnosed and sufficiently isolated. By this time c diff has made a new home for itself.
Another factor exacerbating the problem is a cutback in cleaning staff. The resultant decrease in cleanliness is most certainly a factor. One housekeeping staff may be required to work in several departments as diverse as obstetrics, the OR and the ER during a single shift. A great way to spread pathogens. In addition, under hectic circumstances when staff are demanding beds be available in a hurry, cleaning quality may suffer.
When nursing or other staff is hurried or working with inappropriate isolation rooms, for example linen bags in a hall instead of an anteroom, slip-ups will occur. How often when you are harried and in a hurry to do something do you forget to use a turn signal or not come to a full stop? The same happens when these individuals are rushed at work. Innocent, unconscious oversights with complications.
Transfers between facilities have increased due to closures. This can also increase the spread of pathogens.
While no one can hope to completely prevent such outbreaks, current cutbacks in the health care system can and do influence the possibility of their recurrence and severity. This is just one more consequence of our provincial “hospital improvements”.
Linda McKellar is a Fort Erie, Ontario resident and a retired nurse.
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Excellent expert information Linda. Lack of beds and frontline staff…congestion, cramped quarters, long wait times, overworked staff and poor morale. I think what it all boils down to is the HIP has exacerbated the problem of infectious antibiotic resistant diseases to an unmanageable monster in our hospital system….the NHS. We often thought the system would implode on itself and that is what is happening.
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Linda
Your descriptive letter written through the eyes of one who has had extensive knowledge in the field of hospital hygiene and cleanliness come at a time when people are dying from what seems to a great extent the lack of those critical ingredients.
The NHS Administration in their efforts to cut costs seems to have cut the very foundations of a somewhat sterile space. When they eliminate the Hospital Cleaning staffs (Who took pride in their work ethics) and replaced them with Private contractor who pay minimum wages, thus they get what they pay for minimum service. I confess I am not a vocal advocate of the NHS and could never be because of the almost complete lack of sophistication when it comes to the field of endeavors they somehow got themselves involved in plus the fact that I doubt whether they could organize a “Two Car Funeral” Too many administrative chiefs and too few workers taxes the system and they do not know what to do with it so they muddle along. getting their annual remuneration increases while the diseased hospitals become a morgue.
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What I find most outrageous in this whole business is the fact that the NHS continues to be protected, not only by the HNHB LHIN, but by the Ontario government, through the Ministry of Health and Long Term Care.
I quite agree that the NHS Board should go — but what person of integrity is going to want to serve on a new Board, when the hospital still has to operate within the jurisdiction of this LHIN and this Ministry? The NHS operates under orders from above. Perhaps the NHS Board is exceptionally incompetent, but the MOHLTC has steadfastly refused to acknowledge any problems, despite all the evidence.
We should think twice, therefore, before putting all the blame on NHS Board, because, as we saw with the firing of Sevenpifer, we then create a convenient scapegoat that lets the LHIN and the MOHLTC off the hook. The buck stops at the top: Niagara should be calling for Deb Matthews’ head. There can be no significant change at the local level without a change throughout the system. Anything else will simply be a stop-gap measure, a rearrangement of the deckchairs on the Titanic.
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There are actually Hospital Board of Directors in this Province who are advocating on behalf of their Hospitals and their patients,
When unreasonable demands for budget or program cuts are made by the LHIN Boards they question, they resist and they negotiate on behalf of proper patient care,
With the hand picked process for replacing Board members and the recycling of the old Board chair we will continue to see a dysfuctional Board that will continue to acquies to all LHIN mandates,,,,dare I say with all too much gusto and perceived enthusiasm.
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Corporate tax cuts seems to be the order of the tenure for Liberal and Conservative (Corporate) Governments Federally as well as Provincially and it has been proven over and over again that this appeasement never works because these cuts erode the social safety net put in place by our grand parents following years of depression and wars.
Making Corporate Millionaires into Greedy Corporate BILLIONAIRES drains the pool of the resources needed to allow all citizens the rights supposedly guaranteed in the constitution American and/or Canadian and this seems to be the hard line being taken in the USA as well as Canada by Republican and Conservative governments bent on having the tax breaks for the more monetary affluent carved in stone while the so called middle class sinks into a morass of fear, debt and isolation. A rotten apple in a barrel surely spreads the rot throughout and if one looks to our supposed representatives we see a rot that is eating away at the very fabric of our nations..God HELP us for they surely know what they ARE DOING
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I agree with Joseph. What’s worse is that we don’t elect these corporations. Part of the problem with communication in this hospital debacle is the corporate influence. Corporate interests are not aligned with the public good in this matter, and democracy is diminished. Canadians are swallowing the “tax cut” nonsense to their detriment. Like Mr. Kah said, for most of us, (and that means our sons and daughters too,) it’s a race to the bottom, and there aren’t any ribbons or medals when we get there.
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The chickens have been voting for Colonel Saunders – A stolen line but true. We’re going back to the days of haves and have-nots and we’re letting it happen, in fact causing it to happen, by believing our politicians’ lies while their pockets are being lined by corporate interests.
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I definitely agree that cutbacks are at least in part responsible for these super bugs, as well as over use of anti biotics. We have to watch for the Conservatives, who tend to only think of further cuts as opposed to management. I can’t understand why people who are suffering in economic hard times tend to look for politicians who will make it worse. We need leaders who are capable of leading, focusing on customer/ consumer services and ensuring excellence in the delivery for the end user. All I’ve seen from successive Liberal and Conservative governments is more and more top heavy establishments and cutbacks at the lower end. As Somers suggested, cleaning and sterilization policies have been replaced by minimum wage cleaners. Can you see where that is getting us?
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Here is a ‘memo’ sent long ago to Niagara doctors. It speaks for itself:
MD core group, October 12, 2009: Not much is happening with us – but a lot is going on all around us. NHS is consolidating (and gloating over) its ‘win’ in Niagara’s southern tier (Port & Fort). Fortunately, time-critical emergencies from Fort Erie will be taken by ambulance from home directly to Buffalo’s ECMC. Of course, that will be a paramedical decision with no FE family doctors involved. Sad that they opted themselves out. LHIN is also pushing ahead with its CHC model of primary ‘health’ care. Again, bureaucrats only, not doctors, involved in the decision-making – at least locally. Farther afield, OMA is making windy pronouncements, taking no action. Again locally, it does seem that a group of 15 family doctors in NF is taking care of its own perceived needs (and threats to it), making patients stick to their contracts, etc., but, unfortunately, other doctor-run walk-in clinics, instead of the lay-bureaucrats, are their selected nemesis – a target to boycott. We, a potentially unique core MD group, have a chance of doing constructive things, but, few takers. Recruitment is stalled. Perhaps we should invite the other two sides of the medical professional trio, selected nurses and pharmacists, to join us. Would appreciate your thoughts on it. /Best regards, Bill
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