Hospitals need to get back to basics

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After much thought and consideration I have decided to do it – I am going to use my column this month to address the elephant in the room – CBC’s Marketplace Investigation on the cleanliness of hospitals.

For those of you who haven’t seen it – Marketplace staff went undercover and applied a harmless gel (visible only with UV light)to various places many would touch through-out 11 hospitals in Ontario and British Columbia. They went back 24 hours later – and most of the time, in every single hospital – the gel was still there – meaning the surfaces had not received any cleaning at all.

Sadly, I am not surprised. I wouldn’t’ have thought we needed an undercover report to tell us that our hospitals are not as clean as they should be. One only has to look at the number of hospital-acquired infections (HAI) in this country to know there is a problem, and it’s wide-spread.

Hospital acquired infections are nothing new. As an infant I was ill and brought to the hospital – it was discovered I had a milk allergy. While in hospital for treatment I contracted something much worse – whooping cough. So instead of spending a couple of days in hospital, I ended up there for nearly two months. Ironic that the place I went to get better ended up making me a great deal sicker.

We have come a long way since then – clearly not far enough. Canada has the highest rate of HAIs in the developed world with nearly 250,000 of us contracting one every year. It is estimated that as many as 12,000 Canadians die every year as a result of them. That makes HAIs the fourth leading killer in this country. It’s high time we did something about it.

Instead of pointing the finger at hospital staff, management and cleaners we need to find a solution, and fast. This isn’t the result of lazy cleaning staff or clueless management. It’s a systemic problem, and one that requires the attention of provincial and federal governments alike.

Our health care system performs miracles every day. The technological advances and treatments and cures for disease are astounding.  So how is that we can’t get something as simple as cleanliness right? It seems like a no-brainer to me.

Yes, there are huge financial pressures on the health care system, yes hospitals are being asked to do more with less – but that is no excuse. I often find myself defending our health care system, and do so with pride. I have no defense or excuses for this latest blow.

The solution is simple – hospitals need to be cleaned thoroughly and frequently. There can be no short cuts or excuses.

CBC’s Marketplace was told time and again by hospital insiders that hospitals just don’t have the resources – cleaning staff has been cut, and the cleaners just don’t have time. The old adage is that if we increase spending on cleaning, it will result in cuts to areas of patient care. I don’t buy it and I won’t accept that reasoning. Canadians deserve timely patient care in a clean and safe environment. We shouldn’t have to choose one or the other.

There is a lot of talk about how to make our public system sustainable. I can say with 100 per cent confidence the solution is not in cutting costs by scaling back maintenance and housekeeping. Hospital acquired infections cost the system from one to four billion dollars annually (estimates are wide-ranging).

Re-investing in cleaning services seems the next logical step. The money spent would be retuned with a reduction in HAIs. I would go so far as to say that infection prevention may be the most sound investment hospitals through-out Canada can make.

As we (at least in Ontario) move to a patient based payment system for hospitals – why can’t we also include cleanliness? Sure we have hand-washing audits and hospitals have to report their numbers publicly, but that is not enough.

Provincial governments could develop a program where cleaning audits are performed regularly by independent third parties. A mandatory amount of each hospital’s budget should be designated to cleaning costs and follow-up should be conducted to ensure that is where the money was spent.

Incentives need to be provided for maintaining a clean and safe environment just as they are for other areas of patient care. Hospital CEO bonuses should be based partly on how clean their hospital is – that would at least provide some impetus to find other efficiencies before cutting cleaning costs.

It’s not a simple issue – but the solution is – hospitals need to be clean. It’s time to get back to basics and clean our hospitals to ensure they are places of healing, rather than places we go to get sicker.