Poor hospital cleaning revealed
as major problem
'Some hospitals are a real freaking disaster'
Posted: Mar 22, 2012 9:29 PM ET
Last Updated: Mar 23, 2012 8:23 AM ET
The health of
hospitalized Canadians and their visitors is being seriously put at risk by
hospitals that have cut corners in cleaning budgets to save money, a
Marketplace investigation has revealed.
The program
took hidden cameras inside 11 hospitals in Ontario and British Columbia. What
they found in many of them were surprisingly inadequate cleaning regimens – in
short, dirty hospitals that could make you sick.
In many
hospitals, Marketplace staffers applied a harmless gel to places that
many people would touch – hand rails, door handles, light switches, elevator
buttons.
DIRTY HOSPITALS
The full story,
Dirty
Hospitals, can be seen on CBC-TV's Marketplace tonight at 8 p.m.,
8:30 in Newfoundland.
The gel glows
when seen under an ultra-violet light. But most of the time – and this was true
in every hospital where Marketplace carried out gel tests – the gel was
still there more than 24 hours later, meaning the surfaces had not been cleaned
at all.
The program
talked to cleaners, supervisors, nurses, doctors, and hospital administrators
to get a handle on what has become a major problem at Canadian health-care
facilities – a shocking number of hospital-acquired infections.
While Canadians
love to crow about their first-rate health-care system, it also leads in one
area that doesn't get the same glowing reviews.
About 250,000
Canadians come down with life-threatening infections while in hospitals every
year. That’s the highest rate in the developed world. As many as 12,000 people
a year die.
Denise Ball's
husband Gary became one of those statistics last year.
He was admitted
to Niagara General Hospital for treatment of pancreatitis. While there, the 63-year-old
retired school teacher contracted C. difficile – a life-threatening illness
that is all too common in Canadian hospitals. It ended up playing a role in his
death a few months later.
Denise Ball
remembers the cleaning regimen in her husband's room was less than adequate,
saying the cleaners would spend only 10 minutes on a room everyone knew was
infected with C. difficile. She says a proper cleaning would have taken much
longer.
"This has
to stop," she says. "This is Canada."
More with less
Time and again,
hospital insiders told Marketplace that cleaners were being asked to do
more with less. "We used to have one person to one wing of a hospital to
clean," one cleaner said. "Now, we have three floors to clean."
A cleaning
supervisor at one hospital told Marketplace host Erica Johnson that it's
"common practice" for cleaners not to change the cleaning solution in
the bucket when mopping up. "They just don't have the time," the
supervisor said.
Sometimes there
aren't enough cleaning supplies. A nurse, whose identity Marketplace
protected, said she's seen a cleaner mopping common areas after having mopped
the rooms of infected patients because she didn't have enough mops to change.
"She's just cross-contaminated the whole area, so there's no area that was
actually clean."
Sometimes, only
one cleaner would be on staff in an entire hospital during night shifts.
"That kind of day-night difference is very common, and it makes no
sense," says Dr. Michael Gardam, an infectious disease expert at the
University Health Network in Toronto.
Gardam has seen
enough in his time looking at hospital cleaning practices to know that some
hospitals are worse than others – much worse. "Some hospitals are a real
freaking disaster," he told Marketplace."They've been told to
actually cut their number of housekeeping staff by outside auditors who are
trying to help them balance their budgets."
In recent
years, many hospitals have cut the portion of their budget that is devoted to
cleaning. Sometimes, they've done that by contracting out cleaners or their
management.
C. difficile outbreaks common
It's not like
we haven't seen the devastating results of hospital-acquired illness. Newscasts
and newspapers have been filled with stories of hospitals under quarantine
because of C. difficile outbreaks. In the last decade, outbreaks have hit
hospitals in most provinces. A huge outbreak in 2003 and 2004 led to as many as
2,000 deaths in Quebec.
Last year,
there were outbreaks in at least 10 hospitals across Ontario alone. One of the
worst was the Niagara Health System in Ontario. More than 100 cases were
diagnosed and the infection was a factor in the deaths of 37 patients, including
Gary Ball, the patient mentioned earlier in the story.
The man
appointed by the Ontario government to get the Niagara outbreaks under control,
Dr. Kevin Smith, denies that hospitals have been cutting back on cleaning.
"I think they're experimenting with new models of cleaning," he says.
When informed
that workers in the Niagara hospital system told Marketplace that they
still don't have the time or resources to do an adequate cleaning job, he says,
"I haven't heard that message," saying "everybody" feels
rushed in health care these days.
The outbreaks
are officially over in the Niagara Health System. But when Marketplace
showed Smith several areas where researchers had applied test gel in three
hospitals he supervises, most of the surfaces showed no evidence of cleaning.
The ultra-violet light showed uncleaned hand rails outside an isolation room,
uncleaned support rails in a public washroom and uncleaned hand rails in a ward
with highly contagious patients.
"I'm
obviously very disappointed to see that. That is a less than optimal cleaning
opportunity. We need to fix it," Smith said.
There's
something else that some observers think is helping to drive the pressure to
skimp on cleaning. In Ontario and British Columbia, for example, hospitals are
given bonuses for turning over beds quickly – hundreds of extra dollars each
time a hospital gets a patient out of a room before a certain time. More money
is dangled for quickly transferring a patient from the emergency ward to a
room. Hospital CEOs, already well-paid, receive bonuses that depend, in part,
on reducing wait times.
While the goal
of such rewards may be admirable, critics say the actual effect has been to
speed up cleaning to an unhealthy degree.
"They just
don't get it," says Denise Ball. "And maybe until one of their loved
ones that went in healthy and … a few months later ... they're going to their
grave. Maybe that's what will wake them up."
Reflections
1. What
is the link to Crisis Management?
The story identifies problems with the cleaning and
disinfecting practices of hospitals in Ontario and British Columbia. The
investigative report reveals that many hospitals are not cleaning common areas
properly and this may contribute to more people being infected with diseases
that could have been avoided if the hospitals were appropriately resourced.
2. What
stage of Crisis Management does the system appear to be at?
This is a risk for the healthcare
industry and especially hospitals. This could lead to stricter guidelines on
hospitals and more audits on their cleaning practices. This is also a risk for
hospital senior leadership such as CEOs because the article talks about their
high salaries and hints at the fact that they are cutting corners and putting patients
in harm’s way to benefit from pay outs that they get for discharging patients
faster.
3. How
well does the system appear to be handling the situation?
The healthcare industry is
already aware of the issue of infection control. Hospitals need to use this
report to make them more aware of issues in their organization and need to ensure
that they are putting systems in place in order to manage the risks. They also
need to make the public and their patients aware of the infection control systems
they have in place for reputation management. That way, if they do have an
outbreak such as C. Diff., they have built up enough reputation capital before
the crisis so that their reputation, brand and public trust can be built up
again after the crisis ends.
4. What level of crisis preparedness does the system appear
to have?
Most hospitals have risk management and
quality departments that monitor signals of crisis such as infection outbreaks.
However, the article mentions that Dr. Kevin Smith who has been appointment by
the Ontario government to get the Niagara outbreaks under control denied that
hospitals have been cutting back on cleaning and that he thinks they are
experimenting with new models of cleaning. This is an indication that hospital
leadership has not accepted this as a risk and this could become a crisis if an
outbreak were to occur again and could further damage the Niagara Health System’s
reputation and their public trust.
5. What
personal reactions/feelings does the description trigger in you?
6. What
advice would you offer to those involved?
I would tell the hospital industry to do an internal
audit of their housekeeping staff and their infection control practices so that
they can identify areas of risk in the pre-crisis phase. This will protect them
from a public loss of trust such as the one that has taken place in the Niagara
Health System. This will also protect the senior leadership of the hospital (CEO
and Board of Directors) from facing consequences such as losing their jobs if
an outbreak does happen.
The Ministry of Health and Long Term Care of Ontario is already
aware of this issue and has required hospitals to publically report their
hospital acquired infection rates through the Excellent Care for All Act which was
put in place in April 2011. The ministry may want to give hospitals more funding
or incentives to spend more on infection control practices.
Patients or their families need to be informed of this
issue and the health risks associated with it and need to remind their
healthcare providers to follow the proper infection control procedures to
ensure that they are not exposed to infections unnecessarily.
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