PhytoScience - Article

 

When hospitals make us sick

Published: Sunday, April 06, 2008

As 'superbugs' grow tougher and tougher to fight, our efforts to combat them lag behind

Every day, Dr. Fred Roberts goes to work to face the same problem. It never has an easy answer.

A patient shows up in the emergency room to be treated for one illness, but is also suspected of carrying a bacterial "superbug."
Roberts knows unless the patient is isolated, others are put at risk.
"But there are no beds," he says. "So what do you do with them? Do you leave them sitting in emergency? Or do you put them in a unit and put other patients at risk?

"It's not what you want from an infections-control standpoint, but then you get into the conflict of what is best for the treatment of patients."
As the medical director of infections control at Fraser Health, Roberts knows the dilemma arises every day at the 12 hospitals under his watch, from Burnaby to Hope.

It underscores the formidable challenges doctors face in trying to cut the rising rates of hospital-acquired infections that affect 220,000 Canadian patients every year, including 8,000 who die, according to an estimate by the Canadian Nosocomial Infection Surveillance Program (CNIS). The national estimate of 8,000 deaths is not broken down by province, but statistically, the estimate suggests B.C. could have an annual hospital superbug death rate of more than 1,000 people.

But despite much attention to the problem, a new federal report released last month showed the rates of one lethal "superbug" {MRSA} have risen yet again among hospital patients across the country, continuing a 13-year trend.

"We're concerned because despite our best efforts, our rates have continued to climb," said Dr. Andrew Simor, who co-authored the report and is CNIS co-chairman.

Ten year old warnings of an epidemic rise in incidents of hospital MSRA infections unfolding as predicted

The 2006 figures {based on a survey of 48 hospitals in nine provinces, including B.C.} translate into a 17-fold increase of MRSA hospital cases since 1995. Put another way, some 12,000 patients became infected with MRSA in 2006 and another 17,000 became carriers of the bug. Not everyone who becomes a carrier develops an infection.

There's no doubt the issue of hospital-acquired infections is highly complex. But Simor says when countries such as the Netherlands and Denmark are winning the war against germs, there's no question "we can do better." So-called "superbugs" are powerful drug-resistant bacteria. While they can be found anywhere, these infectious agents are notorious for the risk they pose to the sick and frail when found lurking in health-care facilities.

The bane of hospitals for years, they're now a bigger problem than ever due in part to a rise in the rate of superbug infections in the community, which are then brought into hospitals via patients, visitors and an aging population that is particularly vulnerable.
In B.C., resources have not kept pace with the problem.

A critical report released a year ago by acting auditor-general Arn van Iersel found not a single health authority in B.C. had a comprehensive program in place to fight hospital-acquired infections. Though the audit recognized that all six health authorities had taken steps to deal with the problem, it also found basic prevention measures, such as handwashing by health-care workers, were not up to par.

A year later, action is being taken to address the problem, including handwashing campaigns and better public reporting. A progress report due in June is expected to show "a lot of improvement," said assistant auditor-general Morris Sydor. But for patients whose lives continue to be put at risk, they say change isn't happening fast enough.

Tragic death leaves infants without their mother
In February 2008, Debrah Osborn of Burnaby died in Vancouver General Hospital after becoming infected post-surgery with the bacterium C. difficile. The mother left behind eight-month-old twins. Her grieving husband, Don Osborn, suspects his wife contracted the powerful bacterium in hospital. VGH has agreed to review the case and is meeting with Osborn later this month.

Previous government cutbacks in hospital housekeeping salaries may be exposing patients to higher risks
Last month, Terry Dorcas says he witnessed abysmal cleaning standards while visiting his mother at MSA Hospital in Abbotsford, leading him to question how seriously health authorities are taking the issue of hospital superbugs. Dorcas says he often saw cotton balls stained with blood littered on the floor, but what angered him most was the sight of a bedpan placed next to food by his mother's bed last month.
"However you try to justify it, how could you leave a bedpan on someone's food tray?" says Dorcas, 52, of Coquitlam.

Mother suffers ongoig complications from infection after surgery
Then there are patients such as Kim Muir, whose life has been reduced to a daily battle against complications from an infection developed after surgery last June. The Port Coquitlam mother woke up in a pool of blood 10 days after surgery at University of B.C. Hospital. Although there's no definitive proof, she suspects the infection was acquired from the hospital.

"I had the original surgery in order to better my quality of life, and it was the worst thing I could've done," says Muir, 33.
"This has affected my entire family. My mom has had to take tons of time off work in order to take care of my family. My husband exhausted all means of holidays, all means of days off without pay that he could take in order to deal with this. I mean, my children, every time I get a cold, my sons say, 'You're not going to die, are you?' They've been so terribly traumatized."

Taxpayers bear the burden

It's estimated hospital-acquired infections cost Canadian taxpayers $1 billion annually. In B.C., the lack of good surveillance data means it's difficult to know the full cost, but the Vancouver Coastal Health authority estimates it costs $6,000 to treat every case of MRSA or VRE, whether the patient is infected or simply carrying the organism.

But in B.C. and across the country, everyone's playing catch-up to the problem because it languished at the bottom of the health agenda for so many years, says Dr. Elizabeth Bryce, regional medical director for Vancouver Coastal Acute Infections Control.
"If the public understood that about 200,000 Canadians acquire hospital infections each year and about 8,000 die, it would be more of a priority," she says.

Even among doctors, the issue has not been well understood. Something as simple as better hand hygiene among health-care professionals could reduce hospital infection rates by up to 30 per cent, according to a U.S. report.

Yet in Canada, only 40 to 45 per cent of doctors, nurses and health-care workers properly wash their hands. At the Fraser Health authority, an audit done around 2005 shockingly revealed that just 11 per cent of health-care workers were fully compliant with handwashing standards. A campaign was launched two years ago to change that rate {which is improving} but these campaigns are costly, and Roberts worries what will happen when they stop.

"You may get a short-term change, but it's very hard to change people's behaviour permanently. It's going to be an ongoing problem. This is well-documented in the literature," he says.

The resources required to maintain change {such as an educational infections trainer, high on Roberts' wish list} simply isn't there.
"You can take very good recommendations and guidelines and put them in place; but how do you carry it out if you don't have the resources?" he asks. Money alone, however, would not solve everything.

Across B.C., there's a massive shortage of infections specialists. Which means despite a recommendation from last year's audit to hire more staff, it will not be happening any time soon.
"They're a scarce commodity," says Roberts. "We could do with a lot of them out here, which makes for a real problem. I mean, as far as I know, there's no infectious-disease specialist in the Fraser Valley."

Dr. Marc Romney, medical director of infection prevention and control at Providence Health Care, which oversees St. Paul's Hospital in Vancouver, says until recently there weren't many formal training programs in infections control.
"That's changing more and more," says Romney. "But [previously] most nurses learned by experience and doctors had limited training."

B.C. Health Minister George Abbott says he has taken the auditor-general's criticism seriously and has made fighting hospital superbugs a priority. Initiatives include forming a patient-safety task force, creating a pilot project to study how to better control C. difficile and funding PICNet, the provincial infection control network created in 2005 with a mandate of collecting and monitoring infection data.
Abbott concedes that some remedies will take time. Getting more isolation units, for example, will only take place when reconstruction or retrofitting of a hospital is planned.

Roberts is hardly surprised. He's been working in the area of infectious disease since 1965, long enough to count every single catastrophe that boosted funding his way. Most recently, it was the 2003 SARS outbreak in Ontario that killed 44 people.
"SARS was a wake-up call," says Roberts. "As far as government was concerned, it suddenly dawned on them that they were not prepared to handle a major problem. The resources weren't there. Now I suspect we're going to lose that impetus, unfortunately, unless we have another SARS."

Solutions for battling the hospital bugs

Dr. Elizabeth Bryce's solutions to cutting hospital-acquired infections:

  1. Sustained hand-hygiene programs.
  2. Clean hospitals.
  3. Appropriate isolation procedures, including providing health-care staff with appropriate protective equipment.
  4. Surveillance of infection rates, which must be reported to health-care workers so they can take ownership of the problem.
  5. Engage everybody from health professionals to patients to visitors on awareness.
  6. Infection-control practitioners must fulfill the role of education.
  7. Have the resources to do all of the above.

Reduce your risk

  • If you're having surgery, ask about the rate of infection for the procedure you're having. And be as healthy as possible before and after surgery by eating well and not smoking.

  • All doctors and medical staff should wash their hands before treating you. If you don't see staff washing or sanitizing their hands, ask if they have and request that they do so. This goes for visitors, too.

  • Avoid a urinary catheter if you can, as it is a common cause of urinary-tract infection. Ask if you can use a bedpan or diaper instead.
    Worst of the bugs


Top three drug-resistant bugs under close watch by hospitals:

  • MRSA (methicillin-resistant Staphylococcus aureus): Staphylococcus is a family of common bacteria that many people carry naturally. MRSA is a strain that is resistant to multiple antibiotics. In hospitals, MRSA infections most frequently occur among patients with weakened immune systems.

  • VRE (vancomycin-resistant enterococci): VRE refers to certain strains of enterococci that are resistant to many antibiotics, especially vancomycin, which makes infections difficult to treat. VRE can be spread from casual contact between people or through contaminated objects.

  • C. difficile (Clostridium difficile): One of the most common infections acquired in hospitals. It may result in diarrhea and has the potential to cause more serious complications. It is not easily treated with antibiotics.

Complementary and alternative medicine

Some people with bacterial infections turn to complementary and alternative medicine treatments to help manage symptoms, improve mood and reduce stress. These treatments may include prayer or spiritual healing, meditation, and vitamin and herbal supplements.

A range of dietary supplements and herbal medicines claim to offer new ways to prevent or treat diseases in general. Some supplements show promise and are slowly gaining acceptance in mainstream medicine. But the benefits and risks of many products and practices remain unproved in human clinical trials.

Although some complementary treatments can be a good addition to your regular treatment, take some precautions first:

  • Don't stop taking your prescribed medications or skip therapy sessions. Complementary medicine is not a substitute for regular medical care.

  • Be honest with your doctors and health providers. Tell them exactly which complementary treatments you practice or would like to explore. There have been many cases {based on test results} where doctors have reduced or stopped medications due to the benificial effects from natural health products.

  • Be aware that some complementary treatments can interfere with your regular treatment. Even over-the-counter or so-called natural supplements may interfere with your prescribed medications. When purchasing a health product; read the label carefully. Look for information that may be found in small print that would indicate drug interactions or product warnings.

  • Mangosteen juice from the whole fruit puree is one of the latest discoveries to be uncovered and it may be the most promising to date.
    Xanthones, which are unique to the mangosteen, as a class of phytonutrients are polyphenolic bioflavonoids. Over 60 research papers show antitumor, antiproliferative, antibacterial, antimicrobial, antihistamine, antiflammatory, antioxidant and gastrointestinal protective effects. Mangosteen has been used successfully for these conditions for centuries throughout Southeast Asia. It also possesses many additional benefits over other natural products. Mangosteen Science

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Source: U.S. Center for Disease Control and Prevention