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Ottawa targets hospital superbugs
Health agency acts as infection rate soars
LISA PRIEST From Monday's Globe and MailFebruary 4, 2008 at 4:08 AM ESTThe federal government is launching a national effort targeting the superbug methicillin-resistant Staphylococcus aureus in its bid to reduce the number of hospital-acquired infections that kill thousands of Canadians each year.An estimated 220,000 Canadians develop hospital-acquired infections each year, of which MRSA is one type, according to Canadian Nosocomial Infection Surveillance Program figures. About 8,000 people die of them annually. Until now, efforts to reduce the prevalence of superbug infections have been largely left to individual hospitals, which resulted in inconsistent policies and outcomes. The annual death toll of hospital-acquired infections dwarfs that of the 2003 SARS outbreak, which killed 44 people nationwide.By targeting MRSA, Howard Njoo of the Public Health Agency of Canada said it is making patient safety in this country's hospitals a priority. Superbugs are of such concern that almost all acute-care Canadian hospitals and nursing homes now applying for accreditation will have to provide their rates of MRSA or Clostridium difficile. The new requirement of the Canadian Council on Health Services Accreditation, effective as of last month, will compel those organizations to track the rate of those two types of bacteria as part of the accreditation process. And although accreditation is voluntary, 99 per cent of Canada's acute-care hospitals participate, as do many nursing homes, some community health centres, home-care organizations and other health-care facilities. "We recognize that both in the community and in the health-care setting, trying to decrease the transmission of infections is very important," Dr. Njoo, director-general of the agency's Centre for Communicable Diseases and Infection Control, said.Hand washing and appropriate use of antibiotics are two measures that help reduce various forms of hospital-acquired infections, including MRSA, Dr. Njoo said.While hand hygiene is a crucial and obvious step to reducing infections, prodding those who provide care to scrub up has been maddeningly difficult: only 40 per cent of Canadian health-care workers properly wash their hands. Others measures proven to help reduce MRSA include screening patients for the superbug upon admission to hospital, isolating hospital patients who have it, proper cleaning of hospital rooms, and ensuring hospital visitors and health-care workers who come into contact with those who have MRSA don gloves, gowns and masks. The federal effort - the largest national effort to date - comes after it said in September that it would develop a plan by January on how to reduce the staggering number of infections occurring in the nation's hospitals. At the time, it was considering three superbugs: MRSA, vancoymycin-resistant enterococci and C. difficile. In the end, MRSA was selected, in part, because it is highly responsive to proper hand hygiene.Phil Hassen, chief executive officer of the Canadian Patient Safety Institute, said MRSA is causing a lot of grief in Canadian hospitals, adding that "this is a safety issue; this is about preventing harm to people."The federal government has not yet set a target on how many MRSA infections it would like to reduce. Joanne Laalo, past president of the Community and Hospital Infection Control Association of Canada, the group co-leading the superbug initiative with the government, stressed that a figure still has to be determined, but a "reduction by 50 per cent would be wonderful."MRSA can hide inside a nostril, on a hand or in soiled clothing. Symptoms can vary from a blotch of reddened skin treatable with a topical antibiotic to a merciless attack that causes blood poisoning, decayed lungs, pneumonia and infected heart valves.The superbug has made significant inroads in Canada, where the rate of those colonized and infected over the past decade has increased tenfold. 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, for example, is something of an MRSA hot spot: 13,458 patients were found to be colonized or infected with it in 2006, the highest number the province has ever recorded, according to the most recent figures from Ontario's Quality Management Program - Laboratory Services.The scourge of hospital-acquired infections have been the subject of marketing campaigns, buttons and posters, most of them aimed at encouraging health-care workers, patients and visitors to hospitals to wash their hands.MRSAWhat is MRSA? Methicillin-resistant Staphylococcus aureus is a bacterial infection resistant to the antibiotic methicillin.Who is at risk? Hospital patients, the elderly, the very ill and frequent or long-term users of antibiotics run a greater risk of acquiring it.How is MRSA spread? It is usually spread through hand contact. The hands of health-care workers can become contaminated by contact with patients, or the bug may cling to surfaces in hospitals and medical devices.What are the symptoms? MRSA generally starts as small red bumps that resemble pimples, boils or spider bites. These can quick turn into deep, painful abscesses that require surgical draining. Sometimes the bacteria remain confined to the skin but they can also burrow deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.Other superbugsVancomycin-resistant enterococci: Enterococci are bacteria that live in the bowels of most people. VRE is a strain that has developed resistance to many commonly used antibiotics, specifically vancomycin.C. difficile: Clostridium difficile is a bacterium that causes severe diarrhea.
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