Which would you say causes more deaths: diabetes, Alzheimer’s or hospitals?

According to a survey published in the current issue of the American Journal of Infection Control, the answer is hospitals. The research suggests that every year, about 250,000 Canadian patients suffer blood infections, infected surgical wounds and catch antibiotic resistant organisms while in hospital. Between 8,000 and 12,000 of those patients die. (American Journal of Infection Control, August 2003.)

What makes the hospital environment one of Canada’s biggest killers?

While some medical errors will always occur, the report argues that 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 in July 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 behavioural 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 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 only bottom line that benefits from better hand-washing techniques is not measured in dollars, but rather in lives.

The data is starting to come in about what happens when “business-minded” governments focus on profit-making opportunities and short-term efficiency in our medical system. And the SARS outbreak is one illustration of how money is much better spent on public health promotion.

The contrast between Toronto’s situation and Vancouver, where contact with China is as strong, may be telling. In B.C. last February, public health officials sent memos to hospitals warning them to be aware of atypical pneumonia. Immediately thereafter, emergency room physicians were on the lookout for this type of pneumonia (later known as SARS). With effective infection-control programs in place, people with these symptoms were moved from the general hospital. In Ontario, where Tory cutbacks to public health have been more severe, it appears no memo was sent.

Post-SARS, governments should have learned that the minimal savings from hospital cutbacks are simply not worth their possible health effects. Ironically, while the B.C. public health and infection-control systems should be praised and strengthened, it seems that instead the Liberal provincial government is poised to do serious damage to an integral part of the infection control system. An ideologically-driven government, bent on adding a few more profit-making opportunities for its friends, has begun to contract out hospital cleaning services — even though, according to Taiwan’s Centre for Disease Control the contracting-out of hospital laundry, cleaning and nursing aide services contributed to the devastating outbreak of SARS in that country. Meanwhile, evidence from Britain also strongly suggests that this will result in a significant deterioration of cleaning standards.

An over-reliance on the profit motive also causes infection-control problems outside the hospital door.

After medication errors, nosocomial infections (health-care acquired infections) are the second most common cause of adverse events befalling hospitalized patients. Recent American data, reported in New Scientist in July, 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.

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, kowtowing to the animal industry, has 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

Dubbed “Canada’s version of Noam Chomsky” (Georgia Straight), “one of the most important voices on the Canadian Left” (Briarpatch), “in the mould of I. F. Stone” (Globe and Mail), “part...