It was shocking to read that in 18 months 100 people died from the Clostridium difficile superbug at one Sherbrooke, Quebec, hospital. Even more worrying is that between 8,000 and 12,000 Canadian patients die of hospital acquired blood infections, infected surgical wounds and antibiotic resistant organisms every year. And a report by Health Grades Inc., released 2 weeks ago, concludes that there were an astounding 575,000 preventable deaths in U.S. hospitals between 2000 and 2002, many from hospital-acquired infections.
But shock, worry and amazement won’t help answer the question; what makes the hospital environment one of North America’s biggest killers?
While some medical errors will always occur, according to a Canadian survey published in the September issue of the American Journal of Infection Control, up to half of all hospital-acquired infections are preventable. But hospital infection control procedures are inadequate. The survey reports that fewer than 25 per cent of Canadian hospitals have adequate measures in place to properly prevent the spread of infection. And nearly half of all hospitals fall short of the minimum recommendations for the number of infection-control staff.
An American study reported in the Chicago Tribune concluded that up to 75 per cent of deadly infections caught at hospitals could be avoided by doctors and nurses using better washing techniques.
Nevertheless, it is wrong to simply blame front-line medical workers for these unnecessary infections. Data shows that successful behavioral change is contingent upon vigilant supervisors who put in place adequate preventive measures and demand proper cleaning practices. As well, understanding management, a culture of respect, proper staffing levels, ongoing education programs and proper shift scheduling have all been shown to improve the health and safety of hospitals—for both patients and workers.
The biggest barrier to improvement, however, is our economic system, which focuses on cures and technology because that's where the biggest, quickest profits can be found. Billions of dollars are spent annually on the development of new drugs and medical technologies, but little is spent on basic hospital infection control—even though this would save a greater number of lives—because there has been little economic incentive to do so. Some company makes a profit when a new MRI machine is purchased, but the bottom line that benefits from better hand-washing techniques is only measured in lives.
An over-reliance on the profit motive outside the hospital door also causes infection-control problems. Recent American data, reported in New Scientist July 2003, shows that more than 70 per cent of hospital-acquired infections are resistant to at least one common antibiotic. Infections resistant to antibiotics significantly increase the chance of death.
This increase in deadly multi-resistant viruses is, in large part, attributable to our overuse of antibiotics, which is connected to drug companies' bottom lines. Doctors, faced with patients demanding quick cures, and encouraged by a pharmaceutical industry that spends billions on advertising, have over-prescribed antibiotics. This over-prescription increases the growth of multi-resistant organisms. In the case of Clostridium difficile, antibiotics perturb the bacterial flora in the intestine, which opens the door to the superbug.
Moreover, half of all antibiotics sold each year are used on animals, according to New Scientist. Industrial farmers give their animals constant low doses of these drugs to treat infection but also as a growth hormone. The administration of low doses is especially problematic since it becomes a feeding ground for organisms to mutate. Data shows a strong correlation between increased use of antibiotics on animals and the emergence of resistant strains in the animal population with mirrored increases amongst people.
To end this practice, governments in Sweden and Denmark have already banned antibiotic growth promoters while the European Union's ban will become total in 2006. Ottawa and Washington, kowtowing to the animal industry, have done little.
Hospitals can be much safer and healthier places. Thousands of lives can be saved if real health outcomes can be given priority over profit-making opportunities.
Yves Engler lives in Montreal and writes regularly on health policy. He is author of the forthcoming book Playing Left Wing from Hockey to Politics: The Making of a Student Activist. He can be reached at: email@example.com.
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