Infection control

Canada's hospital-infection watchdog in need of help

TORONTO – Infection control specialists from nearly 50 hospitals across Canada country are considering pulling out of the only national system for collecting data on hospital-acquired infections, according to a report by CTV News. They say the program is crumbling due to lack of interest and investment on the part of the Public Health Agency of Canada.

Agency staff assigned to the program have quit in frustration or sought reassignment, those familiar with the program say.

Data on rates of important superbug infections like C. difficile or methicillin-resistant Staphylococcus aureus flow into the agency to be analyzed and published, but take inexorably long to flow back out – leaving healthcare administrators and the public in the dark about infection levels in the country’s hospitals.

The hospital-based infection control experts who have partnered with the Public Health Agency in the surveillance program were to meet last month in Vancouver to discuss whether they should consider pulling the plug and look for another partner.

“We’re impatient. We’re frustrated. It’s been many years already that we’ve been singing the same message over and over again and we’d like to see tangible evidence of change,” said Dr. Andrew Simor (pictured), head of microbiology at Toronto’s Sunnybrook Health Sciences Centre and co-chair of the Canadian Nosocomial Infections Surveillance Program, or CNISP.

Nosocomial infections are those acquired in hospitals – bacteria like MRSA or Clostridium difficile that can lengthen a patient’s hospital stay and often result in death.

It is estimated that between 8,000 and 12,000 Canadians die every year from bugs they pick up while in hospital for other reasons.

Many of those deaths could be averted through better infection control practices. But the cornerstone of infection control is knowing what you are battling, experts say. And without a co-ordinated surveillance system, it’s virtually impossible to know which hospitals are succeeding, which need work and which way the tide is flowing.

“It’s the only way to measure whether our interventions are working or not,” Dr. Simor said. As the fifth anniversary of Canada’s SARS outbreak approaches, the irony of the surveillance program’s current crisis – his word – is not lost on him.

In the aftermath of SARS – which, in Canada, spread almost exclusively in hospitals – the federal government set up the Public Health Agency of Canada in an attempt to focus greater attention on public health issues like infectious diseases.

“All they’ve done at the public health agency is reorganize. But they have not actually made the substantive changes and increased investments in hospital infections that are required. And I think that’s been a failure over the last five years,” Dr. Simor said.

The new head of the agency’s centre for communicable diseases and infection control said he can’t answer for previous years, but does intend to make hospital infections a priority within his operation in the coming fiscal year, which begins April 1.

“In terms of budget and sort of looking at the priorities for the coming year, this will be one of the areas that will be highlighted,” said Dr. Howard Njoo, who took over as director general of the centre in a shuffle of the agency’s senior management in December.

“My sense is that it’s been accepted by senior management, that this is an important issue to deal with. I think certainly there is a will. And we just need to obviously do the right things to make it happen in the coming year.”

But people in the field are skeptical, having heard similar declarations in the past.

“They keep saying they’re doing things and they’re not,” said Dr. Allison McGeer, head of infection control for Toronto’s Mount Sinai Hospital. “They set their priorities. They decide what they’re spending money on. It’s not a priority.”

Dr. McGeer said she’s baffled as to why the surveillance program seems to be perennially on life-support, given the fact that players at all levels of public health and health care routinely demand data on trends in the spread of C. difficile, rates of community-acquired MRSA and the like.

“It’s a very useful system, small and precarious as it is ... and everybody wants the data. But it isn’t a big-ticket item. It remains a mystery to me precisely why PHAC seems so dedicated to keeping it unstable,” she said, suggesting an investment of $1 million a year would work wonders.

The agency’s side of the program has been operating on a skeleton staff of late after two of its three epidemiologists left. Dr. Njoo suggested the staff may have moved for reasons of career advancement, but others say it was frustration at the lack of funding and commitment to the issue on the part of the agency.

“They’re almost out of staff,” Dr. Simor said.

Dr. Njoo said he is exploring whether the centre’s operations can be reorganized to allow for more flexibility, so that people from other programs might also be able to work on some CNISP projects.

Meanwhile, the agency’s hospital-based partners would be exploring reorganization options of their own at the Vancouver meeting, Dr. Simor said. “If the Public Health Agency is not going to be able to manage, we will at least begin the discussion to look at other options,” he said.

“This isn’t a threat that we’re making to the Public Health Agency, because it’s not the route we want to take. We believe the best way to do this is to continue the partnership between the front-line hospitals that are actually seeing the patients and are actually collecting data, partnering with the expertise at provincial and public health agencies.”

“That’s clearly the best way to do it. But we need appropriate commitment and resources to come from these agencies in order for us to be able to do the work.”