Privatization in Canada’s Health Care System is Killing People

March 22 2012

Poor hospital cleaning revealed as major problem

‘Some hospitals are a real freaking disaster’

The health of hospitalized Canadians and their visitors is being seriously put at risk by hospitals that have cut corners in cleaning budgets to a Marketplace investigation has revealed.

The program took hidden cameras inside 11 hospitals in Ontario and British Columbia. What they found in many of them were surprisingly inadequate cleaning regimens – in short, dirty hospitals that could make you sick.

In many hospitals, Marketplace staffers applied a harmless gel to places that many people would touch – hand rails, door handles, light switches, elevator buttons.

DIRTY HOSPITALS

The full story, Dirty Hospitals, can be seen on CBC-TV’s Marketplace tonight at 8 p.m., 8:30 in Newfoundland.

The gel glows when seen under an ultra-violet light. But most of the time – and this was true in every hospital where Marketplace carried out gel tests – the gel was still there more than 24 hours later, meaning the surfaces had not been cleaned at all.

The program talked to cleaners, supervisors, nurses, doctors, and hospital administrators to get a handle on what has become a major problem at Canadian health-care facilities – a shocking number of hospital-acquired infections.

While Canadians love to crow about their first-rate health-care system, it also leads in one area that doesn’t get the same glowing reviews.

About 250,000 Canadians come down with life-threatening infections while in hospitals every year. That’s the highest rate in the developed world. As many as 12,000 people a year die.

Denise Ball’s husband Gary became one of those statistics last year.

He was admitted to Niagara General Hospital for treatment of pancreatitis. While there, the 63-year-old retired school teacher contracted C. difficile – a life-threatening superbug that is all too common in Canadian hospitals. It ended up playing a role in his death a few months later.

Denise Ball remembers the cleaning regimen in her husband’s room was less than adequate, saying the cleaners would spend only 10 minutes on a room everyone knew was infected with C. difficile. She says a proper cleaning would have taken much longer.

“This has to stop,” she says. “This is Canada.”

More with less

Time and again, hospital insiders told Marketplace that cleaners were being asked to do more with less. “We used to have one person to one wing of a hospital to clean,” one cleaner said. “Now, we have three floors to clean.”

A cleaning supervisor at one hospital told Marketplace host Erica Johnson that it’s “common practice” for cleaners not to change the cleaning solution in the bucket when mopping up. “They just don’t have the time,” the supervisor said.

‘Some hospitals are a real freaking disaster.’—Infectious disease expert Dr. Michael Gardam

Sometimes there aren’t enough cleaning supplies. A nurse, whose identity Marketplace protected, said she’s seen a cleaner mopping common areas after having mopped the rooms of infected patients because she didn’t have enough mops to change. “She’s just cross-contaminated the whole area, so there’s no area that was actually clean.”

Sometimes, only one cleaner would be on staff in an entire hospital during night shifts. “That kind of day-night difference is very common, and it makes no sense,” says Dr. Michael Gardam, an infectious disease expert at the University Health Network in Toronto.

Gardam has seen enough in his time looking at hospital cleaning practices to know that some hospitals are worse than others – much worse. “Some hospitals are a real freaking disaster,” he told Marketplace.”They’ve been told to actually cut their number of housekeeping staff by outside auditors who are trying to help them balance their budgets.”

In recent years, many hospitals have cut the portion of their budget that is devoted to cleaning. Sometimes, they’ve done that by contracting out cleaners or their management.

C. difficile outbreaks common

It’s not like we haven’t seen the devastating results of hospital-acquired illness. Newscasts and newspapers have been filled with stories of hospitals under quarantine because of C. difficile outbreaks. In the last decade, outbreaks have hit hospitals in most provinces. A huge outbreak in 2003 and 2004 led to as many as 2,000 deaths in Quebec.

Last year, there were outbreaks in at least 10 hospitals across Ontario alone. One of the worst was the Niagara Health System in Ontario. More than 100 cases were diagnosed and the infection was a factor in the deaths of 37 patients, including Gary Ball, the patient mentioned earlier in the story.

The man appointed by the Ontario government to get the Niagara outbreaks under control, Dr. Kevin Smith, denies that hospitals have been cutting back on cleaning. “I think they’re experimenting with new models of cleaning,” he says.

When informed that workers in the Niagara hospital system told Marketplace that they still don’t have the time or resources to do an adequate cleaning job, he says, “I haven’t heard that message,” saying “everybody” feels rushed in health care these days.

The outbreaks are officially over in the Niagara Health System. But when Marketplace showed Smith several areas where researchers had applied test gel in three hospitals he supervises, most of the surfaces showed no evidence of cleaning. The ultra-violet light showed uncleaned hand rails outside an isolation room, uncleaned support rails in a public washroom and uncleaned hand rails in a ward with highly contagious patients.

“I’m obviously very disappointed to see that. That is a less than optimal cleaning opportunity. We need to fix it,” Smith said.

There’s something else that some observers think is helping to drive the pressure to skimp on cleaning. In Ontario and British Columbia, for example, hospitals are given bonuses for turning over beds quickly – hundreds of extra dollars each time a hospital gets a patient out of a room before a certain time. More money is dangled for quickly transferring a patient from the emergency ward to a room. Hospital CEOs, already well-paid, receive bonuses that depend, in part, on reducing wait times.

While the goal of such rewards may be admirable, critics say the actual effect has been to speed up cleaning to an unhealthy degree.

“They just don’t get it,” says Denise Ball. “And maybe until one of their loved ones that went in healthy and … a few months later … they’re going to their grave. Maybe that’s what will wake them up.” There is a video at the Source

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8 tips to ensure you won’t get a hospital-acquired infection

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Opportunistic superbug present in most hospitals

Since the cleaning services have been privatized, the problems began.

The ones now doing the cleaning are not trained well. Poorly paid and over worked. They have to much to do and not enough time.

It is actually costing Canada more to use private companies.

A lesson leaned the hard way. Remember:

About 250,000 Canadians come down with life-threatening infections while in hospitals every year. That’s the highest rate in the developed world. As many as 12,000 people a year die.
The Ontario Ombudsman is the only provincial watchdog in Canada restricted from investigating and resolving issues/complaints in hospitals, long-term care, children’s aid. And there are serious issues that are not being resolved. Please check out how Ontario compares to the rest of Canada:

http://www.ombudsman.on.ca/About-Us/The-Ombudsman-s-Office/Who-We-Oversee/MUSH-Sector.aspx

Please download a copy of this petition and speak to your MPP about expanding the mandate of the Ombudsman to ensure the public is protected and issues of mistreatment, abuse, poor care are addressed properly in these institutions.

http://ontariocfa.com/documents/ombudsman_petition.pdf

http://ontariocfa.com/

Pass this on to all your Canadians friends.

Don’t let Harper privatize any more in Health Care and the privatization that has taken place, must be reversed to save lives. The life you save may be your own.

Update March 27 2012

CBC’s ‘dirty hospital’ report sparks changes

Niagara health authority ends relationship with private U.S. cleaning company Aramark

March 26, 2012

A CBC investigation into unsanitary conditions at the nation’s hospitals has sparked a change in policy by Canada’s biggest health authority and a flood of email messages from concerned viewers.

With hidden cameras, including Canada’s first hidden camera glow-gel test, the consumer show Marketplace visited several hospitals in Ontario and British Columbia, secretly applying a harmless gel to high-touch surfaces, then returning 24 hours later to see whether the gel had been removed, which would indicate the surface had been cleaned.

The program revealed many instances where cleaning had not been carried out, and that sparked a response from the Niagara Health System (NHS), the biggest in the country, whose hospitals have suffered a recent Clostridium difficile outbreak. It has decided to end its relationship with the private U.S. cleaning company Aramark.

NHS authorities wouldn’t specify why they made the move, but did tell CBC News they will be adding “the equivalent of 18 new full-time cleaning positions.” It has been suggested that Aramark was at least partly to blame for the C. difficile outbreaks.

“They made decisions around staffing levels,” Eoin Callan of the Service Employees International Union told CBC News. “They made decisions around what was cleaned, what was not cleaned — how frequently things were cleaned. And they also had an incentive to use cheaper diluted cleaning chemicals that were not as effective because it allowed them to pad their profit margins.”

Ontario Minister of Health Deb Matthews wouldn’t talk on camera, but told Marketplace: “We expect our hospitals to make the best decisions to protect patient safety in their communities.”

The NHS decision may be good news for those awaiting a hospital stay, but cold comfort to people such as Ken Hough, who returned home three weeks ago after a stay at St. Thomas Elgin General Hospital in St. Thomas, Ont.

“You really wouldn’t believe it, unless you’ve seen it,” Hough told Marketplace reporter Erica Johnson, describing rooms where he says dirty bandages and plastic needle covers littered the floor.

The bathroom was the worst, he said.

“Feces on the back of the toilet,” he recalled. “You’d go in to use it, and you’d pivot. I put on rubber gloves to use the toilet seat and just thought, no, I’m not doing this.”

Emails from across the country echoed Hough’s observations.

“The waste baskets in the bathroom were overflowing,” an email from Vancouver read. It took “three days to clean up vomit,” a Calgary viewer wrote. And an email from Winnipeg described “feces left on the floor” for days.

About one-third of hospitals in Ontario outsource their janitorial services, CBC News has learned, and that figure is higher in British Columbia and some other provinces. With files from the CBC’s Erica Johnson Source

That is good news for a change. Now if they could get all the hospitals cleaned up.

With the number of deaths and those who got sick, because of the filth, there were no savings.

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3,000 dead from cholera in Zimbabwe

November 26 2008

By Basildon Peta

A man pushes his relative in a wheelbarrow to a Cholera Polyclinic, where victims of cholera are being treated in Harare, Zimbabwe

Getty

A man pushes his relative in a wheelbarrow to a Cholera Polyclinic,

where victims of cholera are being treated in Harare, Zimbabwe

Robert Mugabe, Zimbabwe’s President, is trying to hide the real extent of the cholera epidemic sweeping across his nation by silencing health workers and restricting access to the huge number of death certificates that give the same cause of death.

A senior official in the health ministry told The Independent yesterday that more than 3,000 people have died from the water-borne disease in the past two weeks, 10 times the widely-reported death toll of just over 300. “But even this higher figure is still an understatement because very few bother to register the deaths of their relatives these days,” said the official, who requested anonymity.

He said the health ministry, which once presided over a medical system that was the envy of Africa, had been banned from issuing accurate statistics about the deaths, and that certificates for the fraction of deaths that had been registered were being closely guarded by the home affairs ministry.

Yet the evidence of how this plague is hurting the people of Zimbabwe is there for all to see at the burial grounds in this collapsing country. “When you encounter such long queues in other countries, they are of people going to the cinema or a football match; certainly not into cemeteries to bury loved ones as we have here,” said Munyaradzi Mudzingwa, who lives in Chitungwiza, a town just outside Harare, where the epidemic is believed to have started.

When Mr Mudzingwa buried his 27-year-old brother, who succumbed to cholera last week, he said he had counted at least 40 other families lining up to bury loved ones. He said: “That’s sadly the depth of the misery into which Mugabe has sunk us.”

Unit O, his suburb, has been without running water for 13 months. The only borehole in the area, built with the help of aid agencies, attracted so many people day and night that it was rarely possible to access its water. Residents were forced to dig their own wells, which became contaminated with sewage. The water residents haul up is a breeding ground for all sorts of bacteria, including Vibrio cholerae, which causes severe vomiting and diarrohea and can kill within hours if not treated.

The way to prevent death is, for the Zimbabwean people, agonisingly simple: antibiotics and rehydration. But this is a country with a broken sewerage system and soap is hard to come by. Harare’s Central Hospital officially closed last week, doctors and nurses are scarce and even those clinics offering a semblance of service do not have access to safe, clean drinking water and ask patients to bring their own.

As the ordinary people suffer Mr Mugabe is locked in a bitter power struggle with the opposition leader Morgan Tsvangirai over who should control which ministries in a unity government. The President has threatened to name a cabinet without the approval of the Movement for Democratic Change, which could see the whole peace deal unravel.

Talks were continuing between the two parties in Johannesburg yesterday with little sign of a breakthrough, but pressure is growing from around the region and beyond to strike a deal as the humanitarian crisis deepens. Hundreds of Zimbabweans have streamed into South Africa, desperate for medical care. Officials in the South African border town of Musina say their local hospital has treated more than 150 cholera patients so far. “[The outbreak] is a clear indication that ordinary Zimbabweans are the true victims of their leaders’ lack of political will,” the South African government’s chief spokesman Themba Maseko said.

Yesterday Oxfam warned that a million of Zimbabwe’s 13 million population were at risk from the cholera epidemic, and predicted that the crisis would worsen significantly in December, when heavy rains start. “The government of Zimbabwe must acknowledge the extent of the crisis and take immediate steps to mobilise all available resources,” said Charles Abani, the head of the agency’s southern Africa team. “Delay is not an option.”

The Zimbabwean Association of Doctors for Human Rights has accused the government of dramatically under- reporting the spread of the disease. Doctors and nurses – whose salaries can just buy a loaf of bread thanks to hyperinflation – tried to protest last week against the health crisis, but riot police moved in swiftly.

It is not just cholera victims who are suffering. Willard Mangaira, also from Chitungwiza, described how his 18-year-old pregnant sister died at home after being turned away at the main hospital because there were no staff and no equipment to perform the emergency Caesarean operation she needed. Yet he added that if the situation in Chitungwiza was deplorable, what he had left behind in his village of Chivhu, 100 miles away, was beyond description. Adults and children alike were now living off a wild fruit, hacha, and livestock owners are barred from letting their animals into the bush to graze until the people have fed first.

Bought foodstuffs are beyond reach. The official inflation figure is 231 million per cent and the real level is higher: some estimates say basic goods double in price every day. Few can afford to give their deceased relatives a proper funeral. Death used to be a sacred time, with families taking a week to celebrate the life of the deceased before burial. Now the dead are buried instantly.

Lovemore Churi buried his father within an hour of his being confirmed dead. “I did not have the money to let mourners assemble and then start to feed them,” he said. “If mourners hear that someone is already buried, they don’t bother coming and one does not have to worry about how to feed them. That is the way we now live.”

The disease: Deadly, but preventable

* Cholera is caused when a toxin-producing bacterium, Vibrio Cholerae, infects the gut. It is carried in water containing human faeces.

* In its most severe form, and without treatment of antibiotics and rehydration, it causes acute diarrhoea and dehydration, and can kill within hours of symptoms showing.

* John Snow, a doctor in 19th-century London, was the first to link it with contaminated water when he studied an outbreak in Soho in 1854, which had killed more than 600 in a few weeks.

* Until then, it was thought to be spread by a mysterious “miasma” in the atmosphere. Snow showed the outbreak came from a single contaminated well in Broad Street. He had the handle of the well removed, and the epidemic stopped almost overnight.

* Preventing cholera relies on proper sewage treatment, sanitation and water purification.

Source

Half of the Zimbabwe population faces starvation

In Zimbabwe Doctors and Nurses beaten by police during peaceful protest

Sanctions=Zimbabwe kids ‘eating rats’

Cholera Grips Zimbabwe’s Capital
MSF teams react to cholera outbreak in Harare

November 14, 2008

In Zimbabwe’s capital Harare, Doctors Without Borders/Médecins Sans Frontières (MSF) is responding to a major outbreak of cholera, which the local Ministry of Health has declared “the biggest ever in Harare.” MSF has set up cholera treatment centers (CTC) in Budiriro Polyclinic and Harare Infectious Diseases Hospital, where 500 patients have been treated to date and, on average, 38 new patients are admitted every day. About 78 percent of the patients come from two densely populated suburbs in the southwest of Harare— Budiriro and Glen View—which have a combined population of approximately 300,000 people. The outbreak has also affected people from the neighboring suburbs of Mbare, Kambuzuma, Kwanzana, and Glen Norah. Up to 1.4 million people are endangered if the outbreak continues to spread.

Since they were asked to assist with the outbreak in Harare, MSF has been providing human, medical, and logistic resources at both CTCs. MSF’s growing team is comprised of over 40 national staff nurses, logisticians, chlorinators, and environmental health workers. The latter perform an important role in reducing the spread of cholera in the community, by disinfecting the homes of those affected, following up with contacts of patients, and supervising funerals, where the traditional practice of body washing, followed by food preparation and eating without proper hand washing, is a recognized factor in the spread of cholera.

Medical Teams are Overwhelmed

MSF water and sanitation officer, Precious Matarutse, comments on the situation: “At Budiriro CTC things are getting out of hand. There are so many patients that the nurses are overwhelmed. In the observation area, one girl died sitting on a bench. The staff is utilizing each and every available room and still in the observation area patients are lying on the floor. A man came to the clinic yesterday for treatment. His wife had just died at home and that is what made his relatives realize this is serious, and they brought the man to the clinic. They wanted to know what to do with the wife’s body. People are concerned about catching cholera from others. Health education must be intensified to inform the population.”

The challenges MSF teams face in the CTCs are manifold. Vittorio Varisco, MSF logistician, describes the struggle: “It is a constant challenge to keep up with increasing patient numbers. We are running out of ward space and beds for the patients. Today patients at the Infectious Diseases Hospital are lying outside on the grass and we are setting up tents with additional beds as an overflow for the wards.” MSF doctor Bauma Ngoya explained how vital human resources are in order to effectively treat patients and contain the outbreak: “Patients need constant supervision to ensure adequate hydration, without which they will die. As patient numbers continue to increase we must continue to recruit and train nursing staff.”

A New Urgency

Cholera is no new phenomenon in crisis-shaken Zimbabwe. In some of the rural areas of the country cholera is endemic and occurs every year. However, until recent years cholera was relatively rare in urban areas of the country where treated, piped water and flush toilets exist in most homes. With the ongoing economic crisis and the constantly deteriorating living conditions these urban areas are increasingly affected. The disease is water-borne and transmitted by the oral-fecal route; hence it thrives in unsanitary conditions. Run-down infrastructure, burst sewage pipes and water cuts are mainly responsible for the outbreak, as they force people to dig unprotected wells and to defecate in open spaces. During the rainy season from November to March, heavy rains effectively flush standing sewage into unprotected wells. The fact that the recent outbreaks of cholera have commenced before the rains, is a clear indication of the deteriorating sanitary conditions and shortage of clean water, and a worrying precursor to the rainy season.

Source