Cleaning Standards Urged for Hospitals

Joan Walters; With Files from Daniel Nolan


A series of outbreaks that have killed one patient -- and caused St. Joseph's Healthcare to investigate three other patient deaths -- is prompting renewed calls for provincial cleaning standards.


The Ontario Council of Hospital Unions says St. Joe's -- which cut back on cleaning before the three outbreaks -- is among many hospitals facing financial and other systemic problems that aggravate the spread of infections.


"At the very least, there should be provincial cleaning standards that a hospital has to meet, and there should be resources provided to the hospital to make sure they can meet the standards," said Michael Hurley, president of the council.


Since early March, in quick succession, St. Joe's has faced outbreaks of the superbug C. difficile, the Norwalk intestinal virus and invasive Group A streptococcus, which can lead to flesh-eating disease and septic shock.


St. Joe's yesterday announced there are nine cases of C. diff at its Charlton campus and it is investigating two more patient deaths for links to the outbreak. C. diff is believed to have contributed to, but not caused, a third patient's death on Friday. The Norwalk outbreak appeared to be easing, with cases down to eight from 14 on Sunday. There were no new cases of Group A streptococcus at its Mountain site on West 5th Street after two confirmed cases, including one death.


Hurley's council -- part of the Canadian Union of Public Employees -- has long campaigned to end the contracting out of cleaning in health institutions.


Hurley said there is an appalling lack of cleaning standards in hospitals, even though epidemiologists believe "we could reduce these (infections) by 40 per cent if we applied ourselves to the problem."


"Yet over the last 15 years, hospitals have cut back the support services -- we think by about 15 percent," he added.


"People are given greater and greater areas to clean, or they're told they can skip some cleaning, or that some cleaning is more important than others."


Kevin Smith, CEO of St. Joe's, says he would have no objection to province-wide standards, but that his hospital focuses on other infection control measures that are proven to work.


"We are really focused on handwashing -- every patient, every time, with or without gloves, handwashing, handwashing, handwashing," Smith said.


The hospital is also closely monitoring antibiotic use -- a known trigger for C. diff -- and "looking at anything else we could be doing differently" in housekeeping.


Smith stressed that St. Joe's has scaled back cleaning only in non-clinical areas, such as public areas and administration offices.


In the aftermath of an outbreak at Joseph Brant Memorial Hospital in Burlington, the worst Ontario C. diff outbreak on record to date, the province imposed mandatory infection reporting for hospitals. But it rejected the idea of mandatory hygiene standards, which have become common in jurisdictions such as the United Kingdom and Europe after the virulence and frequency of hospital infections had risen there in the past few years.


Now, six months after the launch of Ontario's mandatory infectious disease reporting, critics like Hurley say there are still cracks in the system. He says requiring reporting is good, but "they've missed some of the other key elements."


Dr. Michael Baker, the patient safety adviser who spearheaded the Ontario reporting regime, says if there are glitches in the system, he's willing to have a look.


"Absolutely, my intention is ... to make a major review and upgrade and improve it to the extent we can to respond to our learning curve, at least on an annual basis," Baker said.


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