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
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
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
“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
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.”