theglobeandmail.com
Top hospital to screen all patients for superbugs
LISA PRIEST
From Saturday's Globe and Mail
September 8, 2007 at 12:48 AM EDT
TORONTO — Canada's largest research hospital is about to launch a massive screening program that will test every overnight patient for two virulent superbugs that kill thousands in their path.
For the 30,000 people admitted annually at the University Health Network in Toronto – whether for a broken hip or brain surgery – the nation's most ambitious bug-fighting plan in history will subject their noses, underarms, groins and anuses to swab-wielding staff.
The network's three facilities – Princess Margaret, Toronto General and Toronto Western hospitals – will start screening as early as next month, taking aim at methicillen-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The two intruders, along with other superbugs, are among the hospital-acquired infections that kill more than 8,000 people a year, roughly the same number who die of breast cancer and car accidents combined.
Those found to be infected with MRSA – even carriers with no symptoms – will undergo a week's worth of antiseptic baths in chlorhexidine and receive a nasal ointment. They will also be put in isolation: Anyone visiting or treating them must take special precautions by donning a surgical mask, gown and gloves.
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“MRSA is particularly bad because it's easily transmissible and it really likes the hospital setting,” said Michael Gardam, the University Health Network's director of infection prevention and control, who is spearheading the screening, estimated to cost about $1.5-million annually.
The program, Dr. Gardam said, is designed to produce a “sustained, very significant decrease of hospital-acquired MRSA and VRE. I would like it halved or more. And I think that's achievable.”
An estimated 220,000 patients suffer from hospital-acquired infections each year, according to the Canadian Nosocomial Infection Surveillance Program. Another study by that same group found one of 10 patients admitted to hospital leaves with the unintended consequence of an infection. The annual death toll dwarfs that of the 2003 SARS outbreak, which killed 44 people nationwide.
And the numbers are growing: For MRSA alone, Canadian hospitals have seen a 10-fold increase in the rate of those colonized and infected over the past decade. Some of the highest rates have been noted in Quebec and Ontario, according to the Canadian Nosocomial Infection Surveillance Program study, which looked at MRSA in 38 hospitals in nine provinces.
Ontario is something of an MRSA hot spot: 13,458 patients were found to be colonized or infected with it last year. That's slightly larger than the population of Gravenhurst, Ont., and the highest number the province has ever recorded, according to figures from Ontario's Quality Management Program – Laboratory Services.
Behind the scary statistics is the overprescribing of antibiotics, which has helped create a horrid array of resistant bugs. Old, overcrowded hospitals are a factor as well, as is a sad reality: a simple act too infrequently performed.
“The problem is that 40 per cent [of health-care workers] don't wash their hands properly,” said Phil Hassen, chief executive officer of the Canadian Patient Safety Institute.
That is the case even though half of infections could be prevented with proper hand hygiene, according to Susan Brien, the Canadian Patient Safety Institute's director of operations for Quebec, Eastern Canada and Nunavut.
“For MRSA,” said Dr. Brien, a neurosurgeon, “proper hand hygiene, implemented in health-care settings, can have a significant impact at lowering the rates of these types of infections.”
Blindsided by infections
MRSA is a sneaky enemy: It can hide inside a nostril, sit on a hand or lurk in a piece of soiled clothing. It may show up as a blotch of reddened skin, or as a painful, swollen pimple. The damage it inflicts can be minor and treated with a topical antibiotic, or it can be swift and furious, causing blood poisoning, decayed lungs, pneumonia and infected heart valves.
Patients are often blindsided by infections after a seemingly innocuous hospital visit.
In August, 2001, an inline skating accident sent Claude Dumaine to a Montreal-area hospital to get a plate and screws for a fractured shin bone. Six years and 21 operations later, he has become resistant to virtually all antibiotics for his MRSA, is in constant pain, unable to work.
Marie-Marthe Becigneul of Orford, Que., thought she had gone through the worst of it when she was treated for flesh-eating disease, but a greater health-care hell awaited her: an MRSA infection of the spinal cord that left her a paraplegic in 2006.
Ronald Devito entered a Montreal-area hospital to have a kidney cyst removed. At the hospital, he contracted Clostridium difficile (C. difficile), a superbug infection that turns patients into toxic, diarrhea-making machines. As a result, 1.5 metres of colon had to be surgically removed.
Then there is Sheri Moos, who is baffled that it took three emergency visits to two Edmonton hospitals in July, 2007, before she was definitively diagnosed with a type of MRSA acquired not in the hospital but in the community.
Of particular concern is MRSA's ability to hook up in hospital with VRE, the other superbug that the University Health Network is targeting with its mass screening. VRE has developed resistance to many of the antibiotics normally used to treat it.
The concern is that MRSA and VRE will mingle, share some genes and become an even more pernicious strain of superbug that is “truly drug-resistant,” said Shirley Paton, director of the Public Health Agency of Canada's health-care acquired infection division. Ms. Paton said she has been watching MRSA and VRE for the past decade, and “we've been looking for that superbug to emerge.”
Those specializing in infection control have struggled to prod health-care workers to properly wash their hands. Catchy slogans have appeared on buttons and posters.
But Dr. Gardam of the University Health Network aims to go further. He is poised, as part of the superbug screening program, to send out a posse of hygiene workers to roam hospital corridors and monitor hand-washing compliance.
“People's hand-washing compliance is abysmal,” said Dr. Gardam. “And it's particularly bad with certain groups, such as physicians.”
Instead of punishing offenders, he believes the best way to change behaviour is to use more carrot than stick. So Dr. Gardam is toying with the idea of giveaways: Hospital staff caught in the act of “cleaning up” might be handed a card from Starbucks or maybe Tim Hortons.
“If we're all washing our hands, it's [MRSA] not going anywhere,” Dr. Gardam said. “You can spend millions on surveillance and millions on rapid testing, but if you're not washing your hands, it probably doesn't matter that much.”
Indeed, other hospitals may end up following the lead of the University Health Network.
Dany Larivée, infection control manager at the Montfort Hospital in Ottawa, which screens about 80 per cent of its in-patients for MRSA, is considering expanding it further.
And there is The Ottawa Hospital, which began a pilot project in July to determine whether to screen all patients, not just the ones at four medical wards as is currently the case. As part of that project, the hospital is using the rapid MRSA test, which can provide an answer in as little as two hours. Only a dozen or so Canadian hospitals use the more costly test; other MRSA tests take roughly two to three days.
“The biggest risk is that these organisms could move from one patient to another, either by the hands of people or equipment, or contaminated objects,” said Virginia Roth, director of infection prevention and control program for The Ottawa Hospital.
The pilot program is finding that “these organisms are circulating in the community so the patients we would have never suspected are carrying it,” Dr. Roth said. “And we don't want to miss them.” |
