In the 18 months from January 2003 to June 2004, some 100 people died from the clostridium difficile superbug at Sherbrooke Hospital in Quebec. In the UK almost 10 per cent of patients pick up a hospital infection, including MRSA, and at least 5,000 people die as a result each year. Between 8,000 and 12,000 Canadian patients die because of hospital-acquired blood infections, infected surgical wounds and antibiotic-resistant organisms every year. And 103,000 Americans died from hospital-acquired infections in 2000. What makes the hospital environment such a major killer?
Some medical errors will always occur, but last September the American Journal of Infection Control (AJIC) reported the findings of a Canadian survey that claimed that half of all hospital-acquired infections are preventable. The problem is, hospital infection-control procedures are inadequate. The survey quoted in the AJIC found that less than 25 per cent of Canadian hospitals had adequate measures in place to properly prevent the spread of infection, and that nearly half of all hospitals in Canada fell short of the minimum recommendations for the number of infection-control staff.
Similarly, the UK’s National Patient Safety Agency found that there was a 60 per cent shortfall in the number of hand-hygiene procedures performed in British hospitals. And an American study concluded that up to 75 per cent of deadly infections caught at hospitals in the US could be avoided by doctors and nurses using better washing techniques.
Nevertheless, it is wrong to simply blame frontline medical staff for these infections. Data shows that successful behavioural change is contingent upon vigilant supervisors putting in place adequate preventive measures and demanding proper cleaning practices. Moreover, sympathetic management, a culture of respect, proper staffing levels, ongoing education programmes 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 the latter would save a greater number of lives. Now the data is starting to come in about what happens when ‘business-minded’ governments focus on profit-making opportunities and short-term efficiency in medicine. Last year’s Sars outbreak in Canada and Asia is just one illustration of how money would be much better spent on public-health promotion.
One of the factors that Taiwan’s Centre for Disease Control singled out as contributing to the devastating outbreak of Sars in that country was the contracting-out of hospital laundry, cleaning and nursing-aide services. You would hope that the Taiwanese experience might prove salutary for Britain, where the dirtiest hospitals in the NHS all have contract cleaners.
Another cause of infection-control problems is an over-reliance on the profit motive outside the hospital door. Recent American data, reported in the magazine the New Scientist, shows that more than 70 per cent of hospital-acquired infections are resistant to at least one common antibiotic. This increase in deadly multi-resistant viruses is, in large part, attributable to our overuse of antibiotics in wider society. Doctors, faced with patients demanding quick cures, and encouraged by a pharmaceuticals industry that spends billions on advertising, over-prescribe antibiotics, which are losing their efficacy and encouraging the growth of multi-resistant organisms as a result.
Furthermore, half of all antibiotics sold each year are used on animals. Antibiotic use in agriculture has increased 15-fold over the past 30 years in the UK. Industrial farmers give their animals constant low doses of these drugs to treat infection and to encourage growth. The administration of low doses is especially problematic, because instead of killing bacteria off, such doses provide a feeding ground in which organisms can mutate. Governments in Sweden and Denmark have already banned antibiotic growth-promoters, while an EU-wide ban is supposed to become total in 2006. British poultry farmers, however, continue to use antibiotic growth-promoters. And North American governments, kowtowing to the livestock-farming industry, have done little or nothing.
Hospitals can be much safer and healthier places, thousands of lives could be saved, if only real health outcomes were given priority over profit-making opportunities.
Yves Engler is a freelance journalist
This article first appeared in the Ecologist February 2009