Reporting Infectious Disease-Clostridium difficile and others
With the heat turned up on the superbug toll, Mr. Smitherman promises to report C. difficile cases in hospitals along with two other diseases, Methicillin Resistant Staph Aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE), by the end of September 2008.
It seems these days that Ontario's provincial health minister is busy cleaning up dirty "health spills" with great zeal but most often once the issue hits the media--health policy setting by the seat of one's pants, or should that be "diaper"....
In any case, with the reporting of these three infectious diseases...errr.."patient safety indicators", what will be done? More handwashing squads to supervise medical and nursing staff to ensure proper handwashing techniques are adhered to? More prompted reminders from blackberries or cellphones? More squeegee hand sanitizers in the corridors?
Although I support the KISS principle, I must admit that I think the increasing emergence of C. difficile, MRSA and VRE have more to do with much deeper rooted issues than just hand washing practices and if the overcrowding and understaffing in hospitals is not addressed can we truly hope to make inroads in curtailing the growing number of nasty germs poised to humble medical science?
Even a new U.S. study reports that other factors come in to play in the rise of C. difficile cases including a larger number of patients who are older and sicker. Dr. Marya Zilberberg, a University of Massachusetts researcher and lead author of the study examining C. difficile in the US indicates that the number of people hospitalized with the dangerous superbug is growing by more than 10,000 cases a year. In Canada, it is blamed for 260 deaths at seven Ontario hospitals recently and for 2,000 deaths in Quebec since 2002. The virulent strain of C. difficile was rarely seen before 2000.
"The nature of the infection is changing. It's more servere," said Dr. L. Clifford McDonald, an expert at the U.S. CDC, as reported in the Associated Press.
Many of the people how died had other health problems and the study did not try to determine if C. difficile was the main cause of death.
If the nature of the infection is changing and other factors played a role in these deaths then reporting the number of cases will only be just a tiny beginning into the understanding of the dynamics of C. difficile. As we know, statistics can be skewed and less than helpful unless taken in context.
Once the reports are in, how will the hospitals be evaluated and what measures will be taken if any to correct the problem? It would seem that tertiary care centres would be more likely to have higher rates of resistant germs such as C. difficile because they treat the sickest of the sick and manage to keep patients supported who might otherwise die. This does not mean that their sanitary measures are less stringent or that the health care workers are careless non-handwashers. There are many other complexities to be understood.
If we are to gather this information then ultimately something must be done with it. It will be interesting to see what transpires if anything or if this issue is just supplanted by something bigger and more urgent. But it is the ethical thing to do and certainly being open and honest about infections harboured in our hospitals and other institutions is a beginning.
Let's hope that China can keep the lid on its own infectious diseases this summer and that all the athletes and visitors from around the world attending the Olympics manage to wash their hands before returning home.
Have a clean day!
Merrilee Fullerton
58 Comments
Reader Comments (58)
Hospitals Move
To Reduce Risk
Of Night Shift
'Nocturnists' Fight Dangers Patients Face in Off Hours; Doing Double Duty in the ICU
May 28, 2008; Page D1, WSJ
Hospitals are waking up to the fact that substandard care on nights and weekends is endangering patients -- giving new meaning to the term "graveyard shift."
"The risks of seeking after-hour care are well documented."
----------------------------------------
And that will not be fixed by hiring night duty hospitalists, as we now have them. Fully staffed specialist care is required.
Currently we can't even get dependable full day time neurosurgical support without transfer to USA.
If this article is distributed throughout Ontario and becomes the new goal for standard for care, the potential liability of hospital privileges will drive more staff out.
Immunity by the government responsible for providing necessary care prevents resolution of the problem. It is not the docs.
May 29, 2008 | Unregistered Commenter eklimek
http://online.wsj.com/public/article/SB121193074899024387.html?mod=2_1566_topbox
May 29, 2008 | Unregistered Commenter realist
If we document what is "right", we have to pay to fix it. We don't have the money to repair all the infrastructure issues. We are use to rationing, not trying to fix.
Fortunately, if issues arise the problems will be legally sorted at at both the hospital and provider level. "Doctor, you knew the rate of infection was double the provincial average, why do you do the surgery knowing this?"
Lawyering is looking good as a future profession. There will be lots of work - and the "documentation" of the issues will be free.
Dr. Michael Baker has been appointed Executive Lead, Patient Safety to oversee Ontario’s patient safety agenda. His appointment was announced along with a new public reporting program for hospitals on eight patient safety indicators including Clostridium difficile (C. difficile) rates. This has been an issue in the legislature in recent weeks with news of 170 deaths from C. difficile since mid-2006. Dr. Baker is physician-in-chief at the University Health Network in Toronto and has twice recommended the government institute mandatory reporting of C. difficile. This will now be done as of September 30. The other seven indicators will be in place by April 30, 2009 and include hand hygiene compliance among health care workers. Health and Long-Term Care Minister George Smitherman is not bowing to demands by the Opposition that he launch an independent inquiry into C. difficile problems. (NR; Tor. Star, May 29; Ham. Spec., May 26) ... The re-use of single-use medical devices is still common in Canada. A study published in the May issue of the journal, Infection Control and Hospital Epidemiology found 28 per cent of 398 hospitals are following this practice. This is down only slightly from 31 per cent in 1986. Furthermore, 85 of hospitals who re-use these devices reprocess them in-house. Only 15 per cent send them to regulated U.S. companies for reprocessing under the watchful eye of the FDA. Health Canada does not regulate reprocessing. (CP, May 25)
http://www.medicalpost.com/news/article.jsp?content=20080523_085327_6148
http://healthzone.ca/health/article/433901
Having spent 12 hours in a teaching hospital ER with a post-op infection a year ago I think what really caught my eye from an infection control standpoint was the lack of staff to clean up between patients and the large amount of dirt and soil on the walls, IV poles, wheelchairs, gurneys, and other rolling stock. I highly suspect these devices which move from room to room and floor to floor are rarely disinfected, and as such allow all the pathogenic bacteria and viruses to hitch a ride out of the ER and up to the ward. In other jurisdictions they have a mobile tractor trailer rolling stock washer where all these items are cleaned on a regular basis using power washers with the appropriate low level chemical disinfection. Just by looking at the IV poles and wheelchairs and the crusts of mystery material on these poles it was clear they had not been cleaned for years. Hand washing alone is not going to solve this problem.
Another area which most of us never give a thought to is what happens to all that hospital linen after being soiled with blood, urine, or feces? I had my eyes opened this week after having lunch with a fellow who manages a non-profit facility to wash hospital linen. While a standard exists for the sterilization of hospital instruments there is apparently no standard yet for the proper washing of hospital linens . They are only now working at putting a standard together. Some facilities follow current best practices which involves a sequential processing using chemical and heat treatment of the linen followed by the removal of these disinfectants with multiple water rinses. Not all linen washing companies, of which there are non-profit and profit, are following the same protocols hence the need to come up with a standard asap.
Just as the poor patient experiences in the ERs can be traced to cutbacks in nursing care, the rapid rise in hospital infections can be traced to patient overcrowding and lack of cleaning staff and supervisors to ensure the job is done properly. The cleaning of my room on the weekend consisted of a two minute Swifter pass down the aisle between the beds and the hard surfaces in the bathroom or hospital room were not cleaned from Friday to Sunday night. All this emphasis on hand washing, while important part of a multi-faceted problem, represents a great smoke screen used to cover up far more important issues such as the paucity of cleaners in our hospitals due to inadequate funding of services which administrations thought the public would not notice.
The chickens are coming home to roost as evidenced by the large number of Canadians dieing from hospital acquired infections, and the fact it seems Canadians have finally realized there is a link between filthy hospitals and the resurgence of these infections.
All valid points.
Central has stripped away resources to keep this all budgetable. The infrastructure costs to repair, upgrade, and maintain at an estimated appropriate level hits another $12,000,000,000 a year. We can't afford it.
We have issues over infection (first reaching public eyes with 42 deaths from SARS), 1-3% of all hospital patients with hospital acquired infections, misdiagnosis in supportive diagnsotic testing, medication errors, record errors, etc.
But it is all free. So the public is happy. All needed now is to bring the disruptive elements under control, and this can run a while longer.
The plan is good.
The Patient Safety/Infection Reporting AND the ER and ALC strategies out in the same week. Normally , one would have glowed about the ER and ALC investment announcement through a provincial "spread the love and money".
Guess the heat in the LEG was a bit too much and the Minister didn't want to let the former issue incubate for too much longer.
Nor should he have. It took far too long to get to this "announcement". No amount of FREE health care is enough if it is going to be provided in substandard buildings and in under- staffed departments.
The public is NOT happy, mFO. On top of these tragic deaths, a WWII veteran's experience at NYGH will only be the the tip of the iceberg and the Toronto Star has hit a veritable vein of news gold. They'll be able to mine stories for a while.
It is still a very very long time until the last day of the current legislative session. The month of June will likely produce some great political theatre during question period.
Ontario Health (Care) Light (and Dirty)...its simply not good enough anymore.
Based on what criteria!!
We are not reporting ED wait times yet, so how do you determine which sites are having the difficulties?
Why not be transparent and let loose the criteria.Heaven knows our GTA hospital is having ED wait time and overcrowding issues and yet.....nada.
Same old...same old!
The plan is good.
By the way, isn't this all just about unfunding.
Ontario Health Lite - love it or leave.
More likely to visit the ER? I would think so... No FP to call first.
http://en.wikipedia.org/wiki/Orphan_patient
Ontario leads the way as usual!!
Ontario Health Lite - Yours to Discover
The hospital system needs more nurses that actually nurse actual patients and less non nursing nurses, who are "too posh to wash", busying themselves with bureaucratic matters that detracts from authentic patient care.
Ontario Health Lite - love it or leave.
We are going to create another layer of buerocracy of course. And more nurses will be taken away from front line care to make the reports. And the numbers will be reported. And 18 months from now we will know that the numbers will still be increasing.
Great
Next on the agenda: "family health care for all".
That might be a tad more challenging.
I attended a LHIN "workshop" on primary care yesterday in my LHIN region. After Ben Chan gave his talk on the recent findings of the Ontario Health Quality Council I had a queasy feeling mostly to do with the realization that we are chasing our tails when it comes to monitoring and documenting chronic disease indicators.
My point to him was that without better long term care strategies and better understanding of the long term repercussions of increasing longevity, we may keep running in circles, never able to catch up.
And while the emphasis seemed to be on how the health system should do a better job of monitoring patients for their various conditions (the one to receive priority appears to be hypertension according to Dr. Andrew Pipe), there was no discussion or deeper understanding apparent of the role that individuals must play in their own care.
Dr. William Hogg's presentation included small working groups where I happened to be teamed up with a variety of FHT directors, CHC docs, Nurse Practitioners and LHIN administration leaders and in which we were to discuss the "Edinburgh evaluation questionnaire" for peripheral vascular disease in order to better address peripheral vascular disease care in the community.
I'm sure you can google it but the questionnaire is a series of questions like "do you get pain in your leg(s) when you walk?" which would ordinarily take just a few seconds to ask a patient who might have risk factors for PVD or who might present with lower limb discomfort indicating the possibility of PVD.
Instead of leaving this in the realm of a family doctor to quickly and efficiently ask a few simple questions, the process of identifying PVD is to be assisted by "nurse managers" who will visit health teams and doctors' offices to help them set up a system so that other personnel can screen patients for PVD.
I asked what the "positive outcome" would be in this scenario...making sure that all patients at risk were screened for PVD or that all patients with potential for PVD could get the care they needed.....the nurse manager could not answer the question other than to say that physicians who are so overworked these days may need help to identify PVD patients.
I asked if there was going to be nurse managers to help identify the thousands of other diseases as well and if there would be "questionnaires" to be administered by nurses for other clinical problems as well.
Of course her answer was no..that there are too many diseases for this particular approach.
So the reason for my ramble is to show that the the people driving these processes are so wrapped up in their own little worlds of whatever disease they study, that they can't see the bigger picture...which is that increasing resources are going to be spent on a handful of diseases without addressing the patients' responsibility.
Without addressing the patients' responsibility and without addressing the long term care issues that are imposing themselves rather prominently, we aren't going to find any real long term solutions.
But it was clear that many of the followers have bought into these ideas without much analysis.
I felt queasy, yes indeed.
http://www.health.gov.on.ca/english/media/news_releases/archives/nr_08/may/nr_20080528.html
Once government "owns" our health care system, incentives to improve come by demand only and not by free will....which ultimately will lead to sluggish productivity....exactly when we need it the most.
The health policy "experts" who live in their small egocentric realms will eventually come to understand who the real team players are...and they are not the followers necessarily.
Why the delay on C. difficile?
May 30, 2008
" ...Smitherman's failure to act sooner is puzzling (he blames conflicting
advice), ..."
Free health care, you know....
The Brits did a study a couple years back and determined we will never achieve a societal smoking rate of zero percent. Instead the researchers said the smoking rate will always exist between 9 and 10 percent of hardcore, crusty, old, curmudgeon "I'm going to smoke whether I bloody well feel like it or not doc" types.
These older smokers make for an interesting office visit with their defiant attitude, but I agree had health care in the past involved some sort of increased payment for smokers they might have been more apt to quit. Now all these guys are getting the cheap Native smokes and pay no taxes to offset their monthly trips to the office and hospital but that is another story,....
Smoking isn't going down in Canada.....maybe it is for cigarettes and regular tobacco....but Canada has one of the largest pot habits in the world.
Smoking cigarettes is going down, smoking pot is going up.
Inhaling plant material can't be that good for you unless it helps you with your symptoms related to malignancy.
And I suspect we will continue to see many people with smoking related diseases despite the fall in tobacco use.
MOre people chewing tobacco I hear as well...no longer smoking it. We will see an increase in mouth and GI cancer related to this.
As always, as one problem seems to be solved, another emerges.
Interesting to note that the auto insurance agencies are finding ways to give drivers who drive at speed limit and who drive at off peak times better rates. The vehicle is equipped with a box that details what speed the care was driven at and when.
Now I wouldn't want to have Big Brother following us all around via microchip but it shows that people are capable of modifying their behavior for a carrot of sorts.
As long as patients bear little responsibility for their health, we will see health care costs continue to rise.
I found that interesting British study on hardcore smokers.
http://www.bmj.com/cgi/content/full/326/7398/1061
Perhaps I am being a simpleton here, but with so many Canadians desperately seeking a 'family physician', why waste your incredibly valuable time on patients so decidedly hell-bent on ignoring/defying your practical advice?
I recall some time ago that a general practitioner in Manitoba threatened to fire patients who chose to keep smoking (http://www.cbc.ca/canada/story/2002/02/28/smoking020228.html).
Wonder whatever became of that? Was there ever any ethic repercussions?
This sounds like a better and more transparent method of roster management than "one complain one visit" or fundamentally cherry-picking your roster to begin with.
If you want to "go out" with a burning cigarette between each toe (any every orifice too, that's fine with me)...but not at the expense of a patient that is compliant or is making every effort to attain compliance.
Health care is not free, but common sense is. You just can't legislate it...
===========================
Druggists may get power to prescribe drugs
Minor conditions would be targeted
By CHINTA PUXLEY, THE CANADIAN PRESS
Ontario patients could soon get drug prescriptions from their local pharmacist as the governing Liberals look to join other provinces and expand the prescribing powers of pharmacists, nurses and other non-physicians.
...cut...
"You are seeing more and more the capability of the pharmacists being unlocked to serve patients," Smitherman said.
...cut...
for patients, it can be a matter of extraordinary convenience."
ELB...the CPSO has made it very difficult to ask patients to leave one's practice...in one case I followed all the guidelines, sent the patient a letter...she still turns up as if nothing happened...bit like br'er rabbit and the tar baby.
The one visit one symptom trend originated with the MRC/OPRP auditing system that Judge Corey was so critical of...there are two codes for an office visit...an A001 and an A007...the first is for 'simple' and the second for more complex the definitions of which were arbitrarilly interpreted by the auditors which resulted in doctors become bankrupted and the lives and families destroyed...if a patient presents with 10 uncomplex problems one can only bill for one A001 no matter if one took an hour with the patient...as an audited doctor was told "more fool you...which one of the 10 do you want to bill for?"...ten A001's do not make one A007.
The Auditing system is to be resurrected with reeducation camps to reeducate those who they believe 'abused' the billing...the government has predecided how many A001's there will be in relation to A007's and its computers light up if the ratio is violated...so, out of a sense of self preservation doctors request "one visit, one complaint"...see the patient more than three times per month...the computers light up again and the auditors will come knocking on the door...so, our colleagues play safe in this Kaffkaesque Health [care] System Light [and dirty].
*****************************
From Sujit Choudhry, Scholl Chair,
Associate Dean,
Faculty of Law,
University of Toronto
It is with great sadness that I announce the
death of Dr. Sheela Basrur after a valiant fight against a rare form of cancer.
I am making this announcement at the request of Dr. Basrur's family, who, in the interest of maintaining their privacy, do not wish to speak to the media at this time.
A private funeral will be held for Dr. Basrur. At a date to be announced, a public memorial will be held in recognition of the life and professional contribution of Dr. Basrur, who was a former Chief Medical Officer of Health for Ontario, and a former Medical Officer of Health for the City of Toronto.
Donations may be made in memory of Dr. Basrur to:
The Grand River Hospital Foundation
835 King Street West
Kitchener, Ontario, Canada
N2G 1G3
A great lady whose expertise and courage during the SARS crisis was second to none. The images of her sitting on the floor at the public health office during the SARS outbreak with hundreds of 3M Post-It notes stuck to the wall in order to track new cases at the start of the 21st century said it all. Others with less patience and fortitude would have walked away in frustration.
Andris, up here where we are, physicians do have dispensing licenses, and do dispense.
Sheela Basrur was a former colleague when we worked in Toronto. She was indeed motivated for the public good and tireless in her efforts toward it. Yes, a great lady.
But I do overall believe that people including patients are capable of far more than they are given credit for. Yes, there are some people who really can't help themselves, but there are many more who really could be more empowered if our system would allow them to be. Patients should not be treated as dependent victims of social ills.
Not sure I agree with everything Dr.Day has to say here but some things seem reasonable.
http://www.canada.com/ottawacitizen/news/opinion/story.html?id=d674d053-7b55-472f-b32e-8e2ac9c84dad
From info@healthedition.com:
May 30, 2008
Volume 12 Issue 21
HHR issues get attention at Committee hearings
Health human resource issues stand to figure prominently in the House of Commons Health Committee’s status report on the 10-Year Plan to Strengthen Health Care later this month.
This issue stood out among the presentations of the 20 organizations that appeared before the committee as it conducted a statutory review of the 10-Year Plan, otherwise known as the 2004 health accord. The last of four meetings the Committee held with witnesses as part of its review took place Tuesday.
Since the hearings began in April, more than one presenter has said Canada’s shortage of health professionals is approaching the crisis point.
Elizabeth Ballermann, Co-Chair of the Canadian Health Professionals Secretariat, representing physiotherapists, pharmacists and a host of non-physician, non-nursing health professionals, started off Tuesday’s meeting by saying the accord has failed to live up to the commitment to produce a national plan to “address the large and growing shortages of health professionals.”
She was followed by Dr. Marlene Smadu, President of the Canadian Nurses Association, who said progress on a pan-Canadian health human resources action plan “remains slow” and her association is concerned about the lack of national coordination.
Dr. Brian Day of the Canadian Medical Association had similar comments. The CMA released a public opinion survey coinciding with his presentation finding the doctor shortage will influence the vote of over nine-of-10 Canadians in the next election.
“Political parties that ignore this issue in the next election could pay a price at the polls,” Dr. Day said. “We must increase the numbers and we must be self-sufficient in the supply of health professionals.”
Electronic health records (EHRs) was another prominent issue which is sure to find its way into the Committee’s report.
Pamela Fralick of the Canadian Healthcare Association said at the May 13 meeting that an EHR system is “pivotal” to health renewal but “is emerging in a fragmented manner that will not serve Canadians well.”
At the May 6 meeting, Dr. Jeanne Besner, Chair of the Health Council of Canada, said Canada is “not on track to meet (Canada Health) Infoway's goal of 50% of Canadians having a secure electronic health record linked to other aspects of health care delivery by 2010.”
Home care was another theme. Ms. Fralick said the accord’s focus on providing a limited amount of post-acute and palliative home care “is a tremendously positive start” but still “a narrow and unrealistic as a view of home care in Canada.” Dr. Besner had a similar opinion. She said what has been provided is simply “not adequate for what many people need.”
Yet another issue raised by many presenters is the lack of progress in implementing a National Pharmaceuticals Strategy (NPS). No one could tell the Committee where things now stand. The last progress report on the federal-provincial-territorial initiative was produced almost two years ago.
At Tuesday’s meeting, Michael McBane of the Canadian Health Coalition laid the blame for the NPS situation on the federal government’s doorstep. He said provincial health ministers are “extremely frustrated” by the federal government’s lack of interest in pursuing this agenda item from the 2004 accord.
“They don't even have regular meetings anymore, and it's because the federal government will not come to the table with financial resources—they want to cut and run from health care,” he charged.
He said pharmaceutical coverage will not be expanded without federal financial contributions.
Mr. McBane raised another issue shared by more than one witness – the lack of accountability for the money being spent on the accord.
“Why is the accountability gap in health care growing? We have a lot more money on the table, $41 billion plus the six per cent escalator, and there's less accountability for the money. That's a huge problem,” he said.
On a number of occasions, the Committee heard that governments are not living up to their reporting obligations. Getting consistent reports across the country on the wait-time picture is another issue, although the Committee heard there is general progress in improving wait times on five priority procedures chosen by First Ministers in the accord. HE
Productivity changes could boost surgeries in Quebec
Some relatively small changes would allow Quebec hospitals to perform 50,000 more operations a year — an 11 per cent improvement — a joint study by the Ministry of Health and Social Services and the association representing specialist physicians (FMSQ) has found.
The study, obtained by La Presse, was launched last fall. A team of experts discovered that no operating room is functioning at full capacity, and a number of surgeries are being cancelled at the last minute because patients have not had the requisite number of tests. Among other things, they found surgeries are being cancelled because the necessary equipment is not on hand. If, on average, hospitals each received $400,000 for new instruments, their surgical output could be increased by 20 per cent.
Health and Social Services Minister Philippe Couillard is promising action by the fall to put the necessary “corrective measures” in place. HE
----------------------------------
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080602/drug_reactions_080602/20080602?hub=TopStories
Of the drug-related emergency room visits, the researchers found that:
Almost 28 per cent were due to patients taking medication incorrectly or not at all.
Peter Zed, PhD, of Queen Elizabeth II Hospital in Halifax, said that many drug-related problems could be avoided if doctors better monitored their patients' compliance with taking their medications as prescribed.
...cut
Notice how the mess at Peel, the goverance issues at Scarborough, the nurses being fired at Rouge valley, the financial imbalances at Kingston,the veteran lying in feces in North York, all have gone away.
Central is getting good at handling the bad PR issues, a few calls, a little money, and POOF all goes away.
The beauty of having such a big pot of bottomless tax money, is that all problems can be solved to maintain the status quo.
Nothing is going to change.
Ontario Health Lite - Yours to enjoy
Silly rabbit, trix are for kids. Nothing ever "goes away". At best, things cycle on a loop - what goes around comes around.
It is not like a infant strapped securely in a high chair playing with a toy that gets dropped. From the infants' perspective (and seemingly from the government's perspective, too it appears) the toy is "all gone".
From an adults perspective (which is obviously analogous to a health care provider's) the toy is on the floor and is something else that has to be picked up before it becomes a serious trip hazard.
At the very least these stark images paint a very hostile landscape of political liabilities that if not addressed holistically, will ultimately hurt the governing party.
Having said that, with two absolutely frail and ineffective opposition parties, I guess the government just don't care and will be happy to stumble their way to the end of this sitting and retreat to the cottage for summer vacation in a few weeks.
Ontario Health Care Light and Dirty and Indifferent
St. Michael's battling C. difficile outbreak
SARAH BOESVELD
From Tuesday's Globe and Mail
June 3, 2008 at 4:46 AM EDT
St. Michael's Hospital in Toronto is battling an outbreak of C. difficile after seven patients tested positive for the infectious bacterial disease, hospital officials revealed last night.
A patient started showing symptoms of Clostridium difficile some time between Friday and Saturday, prompting hospital staff to test for the bacteria, which grow in the intestine and can be fatal, said hospital spokesman Steve Williams.
After testing a number of patients - including some on antibiotics, which make them susceptible to C. difficile infection - staff put a total of seven patients in isolation.
The isolated patients are allowed to have visitors, but only one at a time. Visitors and staff are also required to wear hospital gowns and wash their hands thoroughly before attending the patient's bedside, Mr. Williams said.
Officials are still investigating whether the bacterial infection started in the hospital or came from outside.
There are no reported surgery cancellations and no other preventative measures that will affect other hospital guests and visitors, Mr. Williams said.
The outbreak comes just over a week after the Ontario government announced hospitals will have to track and report each case of C. difficile they see starting Sept. 30, 2008. This move came under fire by critics saying reported cases should become immediately available to the public.
Health Minister George Smitherman recommended last week that reporting begin after a website was set up as a tool for hospitals. Mr. Smitherman also rejected calls for the government to pursue an investigation into 260 deaths by C. difficile in seven of the province's public hospitals.
The Progressive Conservative Party and the New Democrats pressed for an inquiry, pointing out that the government had plenty of time to prevent 2,000 deaths in the 2003 C. difficile outbreak in Quebec.
Healthy people are usually not vulnerable to C. difficile, which often manifests itself in the large intestine and is spread through contact with feces. When it grows, it can cause colitis, an intestinal disease, and complications can be fatal. The Canadian Public Health Agency says hand-washing is the single best defence against C. difficile.
In most cases, C. difficile doesn't present symptoms, but when it does, sufferers have reported watery diarrhea, fever, loss of appetite, nausea and abdominal pain or tenderness.
http://www.theglobeandmail.com/servlet/story/RTGAM.20080603.wcdifficile03/BNStory/National/
I can just see them in the bunker saying problem "all gone".
Hasn't happened, as capitation is flawed (many ER patients aren't readily rosterable) and the typical end result of a THAS call is a trip to the ER.
109 million isn't going to turn this ship around overnight.
The next step will be to target the typical ER patient - unrosterable, orphan, unassigned, whatever you want to call them. Identify, prioritize and then somehow 'encourage' a FHT/FHN/FHO to take them on.
Might actually be something written in to our upcoming (and eagerly anticipated) new agreement.
In one town of about 10,000 people that I know the local capitation groups offered the FHG docs a deal the couldn't refuse to join the FHN (now FHT) in order to stop the fee negation by the FHG's walk-in clinic. All's well that ends well for the capitation docs however the ED docs are not happy with the large increase in CTAS 4 and 5 patients after this "merger".
Certainly this is something for central to look more closely at - the volume of rostered patient ER visits.
Got to love it.
an 18 year old brought in by his mother...he had fractured his lateral malleolus (for laymen: broken ankle)
He had been a patient of a doctor in my area for many years but when he went back to that office he was declined as a patient and was told he was no longer a patient there since the doc had joined a Family Health Team.
The kid had been well for four years and had not made regular visits and ended up losing his doctor. Now he is an orphan patient largely because the FHT had reached its limit.
Interesting how this primary care transformation is turning out.
You could argue that a well 18 year old male does not need a family doctor and the fact that he did not attend for 4 years is enough fact...but you don't plan on getting sick or in an accident.
My last visit to my own physician was probably that long ago.