"This is a tragedy and very disturbing. The results clearly show that we need to be doing a lot more to prevent hospital-acquired infections," says Queen's epidemiologist Dr. Dick Zoutman, Director of Infection Control Services at Kingston General Hospital (KGH) and chair of the Ontario SARS Scientific Advisory Committee. "Our hospitals are not safe enough."
"SARS put hospital infection control at the top of everyone's radar screen, and showed how vulnerable our hospitals are to the spread of infectious disease – in this case, one with a high mortality rate," Dr. Zoutman notes. "While the immediate threat of SARS has lessened, this study should be a wake-up call that other hospital-acquired infections (equally devastating to staff and patients) will continue to plague us unless improved infection control measures are put into place," he says.
Statistics gathered by the Community and Hospital Infection Control Association of Canada, of which Dr. Zoutman is Physician Director, indicate that about 250,000 patients a year experience infected surgical wounds, blood infections, and antibiotic-resistant organisms while in hospital – and 8,000 of these patients will die. The annual cost of treating patients who acquire such infections is estimated at a minimum of $1 billion.
The survey, entitled Resources for Infection Control in Hospitals (RICH), was conducted in the fall of 2000 by the Canadian Hospital Epidemiology Committee (CHEC), a group of medical specialists who head infection control programs in about 30 hospitals across the country. It is published in the current issue of the American Journal of Infection Control.
Sponsored by Health Canada's Population and Public Health Branch, the survey involved 238 hospitals in 150 hospital systems. Points were awarded for human and physical resources, as well as for the programs in place to utilize these resources to prevent infections. All Canadian hospitals with more than 80 acute care beds were invited to participate, and 73% accepted.
"That's an extremely high response rate, especially considering the heavy time investment," says Dr. Zoutman. "I think it shows how seriously hospitals regard this problem and wish to find solutions."
The RICH report argues that the intensity of disease in hospitals today requires a higher level of infection control investment by hospitals. Despite this fact, 46.9% of Canadian hospitals fall short of the minimum recommendations for adequate numbers of infection control staff to do the work of preventing infections.
"It's critical that all hospitals have specific human resources, in the form of ICPs (Infection Control Professionals) and support staff, for an effective infection prevention program," says Dr. Zoutman. Such programs must include surveillance (counting infections), control (interventions to prevent them from occurring), and education components.
Particularly in large, complex teaching hospitals, it's important to have multi-disciplinary professional infection control teams, the report states. Yet at 40% of Canadian hospitals there is no dedicated infection control physician to lead the program.
Providing feedback to surgeons on the post-surgery incidence of infection in their patients is also essential, says Dr. Zoutman. At Kingston General Hospital, for example, an infection control nurse visits patients after surgery to check how their wounds are healing, and surgeons receive monthly confidential reports, which Dr. Zoutman reviews.
"As a teaching hospital and the only tertiary care hospital in southeastern Ontario, protecting our SARS-free status was critical to providing specialized care for our patients," says Joe de Mora, President and CEO of Kingston General Hospital, who gives much of the credit to the hospital's infection control team. "Norwalk and SARS put the spotlight on the 'Bug Patrol' at KGH," de Mora adds. "But all hospital-acquired infections are something we need to guard against every day."
"The cost to the system – not just in extra resources and longer waiting lists, but in the misery of patients – is enormous," says Dr. Zoutman. "And in as many as one-third to half the cases, we believe the infections are preventable."
The RICH survey can be accessed on-line at: http://www.apic.org/ajic or call Queen's News & Media Services to receive a faxed PDF version.
Journal
American Journal of Infection Control