This article is continued from last week’s issue. Antibiotic-resistant organisms(AROs) are usually subdivided into community-acquired (CA) and healthcare-associated (HA). In this second article, I will focus on the latter, as they are for the greater part considered preventable and may be indicative of problems related to general sanitation and disinfection, staff compliance with prevention measures (such as proper hand washing and use of personal protective equipment), and/or antibiotic stewardship (which means following appropriate prescribing standards or guidelines) within a health care facility.
HA infections (HAIs) are a significant threat to vulnerable patients. About 8 per cent of children and 10 per cent of adults in Canadian hospitals have an HAI at any given time. The severity is greatest among those who are elderly, very young, have weakened immune systems or have one or more chronic conditions. Of greatest concern are the bacteria that are resistant to multiple types of antibiotics. More than 50 per cent of HAIs are caused by bacteria that are resistant to at least one type of antibiotic. The HA methicillin-resistant Staphylococcus aureus (MRSA) infection rate increased more than 1,000 per cent from 1995 to 2009. About 80 per cent of these infections are spread by healthcare workers, other patients and visitors. Proper hand hygiene is the single most significant factor for reducing the spread of infection. Unsurprisingly, the intensity of “hands-on” care required by a patient is predictive of the risk of acquiring one of these antibiotic resistant germs. This means that places like level 3 and 4 long-term care units, intensive care units and surgical wards are at greater risk.
NWT statistics compared with Canada
Although laboratories must report all cases of antibiotic- resistant organisms to the Office of the Chief Public Health Officer, the reporting system does not automatically distinguish those originating from hospitals from those acquired in the community. However, we are still able to estimate the relative burden that we experience from AROs within the health care system as compared with those that are community acquired. For example, Stanton Territorial Hospital, the NWT’s only hospital of more than 50 beds, keeps track of its own hospital-acquired infections. These rates have so far remained lower than the national averages. From 2009 to 2011, the MRSA rate was 1 per 10,000 patient days, as compared to an average of 2.8/10,000 for Canada; C. diff rate 1 per 10,000 patient days, compared to 6.04/10,000; and VRE numbers, all acquired in hospitals outside the NWT, are too few (less than 5) to report against a national average rate of 0.74/10,000. Reasons why HA-ARO rates are lower in the NWT as compared to the rest of Canada may include:
- Our hospitals are smaller and we don’t have the types of large hospitals providing tertiary level clinical services where such infections occur more frequently.
- Rigorous infection control standards and protocols are in place in all NWT health care facilities. Standards include the Hospital and Healthcare Facility Standards Regulation, the NWT Infection Prevention & Control Manual, and the Communicable Disease Manual. Health and Social Services Authorities are required to meet these standards through their operational protocols and comply with the manuals in accordance with the Reportable Disease Control Regulations under the Public Health Act. In addition, hospitals must regularly meet the demanding infection control and prevention requirements of Accreditation Canada in order to attain and maintain their national accreditation. These standards incorporate strict protocols governing housekeeping and cleaning practices in facilities.
Here is some advice that will help you reduce your risk of acquiring an infection while in hospital:
- Make sure that you wash your hands properly, especially after using the toilet. Remind hospital staff to do the same before and after they attend to you.
- If you have an IV drip, let your nurse know if the site around the needle is not clean.
- Tell your nurse if the dressings are not clean, dry or attached around any wounds you may have.
- Let your nurse know if tubes or catheters feel displaced.
- Do your deep breathing exercises as instructed. This is very important because they can help prevent a chest infection.
- Ask relatives or friends who have colds or are unwell not to visit.
This article will conclude in next week’s paper.
Dr. André Corriveau; NWT Chief Medical Officer