See the Cell Tower on the Hospital`s Roof?
Doctors sound alarm after 84 infection deaths at Burnaby hospital (with video)
BY JONATHAN FOWLIE, VANCOUVER SUN MARCH 1, 2012
VICTORIA — Eight senior physicians are ringing serious alarm bells about the risk of patients contracting C. difficile at Burnaby General Hospital, saying 84 people have died there with the infection within a period of two and a half years.
“We would characterize current CDAD [C. difficile] infection control management at Burnaby Hospital, at best, as a serious hazard to the patient population,” said a Jan. 9 letter sent to the head of Fraser Health by members of the hospital’s infection control committee.
“Such is the degree of the CDAD problem and the ineffectual response to it, that we believe it could objectively be considered medical negligence.”
The hospital did post notices in individual wards when outbreaks occurred, but did not issue a hospital-wide notice to the public, according to the Fraser Health Authority.
The doctors — six of whom are department heads at the hospital — say there have been 473 serious cases of C. difficile at Burnaby General from 2009 to mid-2011, and 84 associated deaths.
They say these numbers do not include an outbreak of the infection that occurred in late 2011, which forced unit closures for several days at the hospital.
The doctors also said that for more than the last two years, rates of the infection at Burnaby General Hospital have ranged between two to three times the provincial and national averages.
The doctors made 16 recommendations in the letter for how the issue can be resolved, including the immediate institution of enhanced cleaning within hospital units.
“This is a problem that can be rapidly corrected, should the executive decision be made to do so,” the doctors say in the letter, which was sent to Fraser Health CEO, Dr. Nigel Murray.
The doctors added in the letter the infection rates seen in Burnaby are “reminiscent” of the C. difficile outbreak at Nanaimo General Hospital in 2008, where 94 people were affected and five were killed.
Murray responded to the doctors’ letter within two weeks, outlining several measures that were being taken to control the issue.
“The high rates of CDI [C. difficile] at Burnaby Hospital have been the focus of a number of initiatives for the past several years,” he said in a response dated Jan. 23.
“We have been making significant strides to reduce the incidence of CDI and associated morbidity and mortality.”
In an interview Wednesday, Fraser Health vice-president of medicine, Dr. Andrew Webb, added that not all deaths involving someone who has C. difficile are necessarily caused by, or directly related to, the infection.
He allowed, however, that the hospital does have a problem that needs to be fixed.
“We have a high rate of Clostridium difficile in Burnaby and we accept that,” he said, reiterating the message by Murray that officials are already taking significant action.
He said these actions have ranged from isolating patients with the infection, to increasing cleaning procedures, to shutting down areas of the hospital in the event of an outbreak.
Webb said the level of the infection at the hospital has dropped from 28 infections for every 10,000 patients in 2009 to 17.7 for every 10,000 patients now.
But, he added, this is still above the provincial average and needs to be improved.
“We still have a long way to go,” he said. “That is still too high.”
He said he could not confirm the veracity of the claim made in the letter of 84 deaths related to C. difficile.
Webb also said that Fraser Health recently received the results of an external review done on the issue by a Toronto-based infectious disease expert, and is acting on that as well.
“There are 13 recommendations in the report, most of which we are already implementing,” he said.
“There are a couple of others we will be looking at seriously for implementation. So there may be a few more things we can do about this yet.”
The hospital had posted notification in individual wards when C. difficile outbreaks took place — as it does for other infections outbreaks like Norovirus — but had not posted a general notification to the public for the entire hospital, said Fraser Health Authority spokesman Roy Thorpe-Dorward.
The wider notification wasn’t deemed necessary because the outbreaks were confined to individual wards that range from 16 to 30 beds, he said.
The ward notifications — it wasn’t known how many were issued — alerted the public to the outbreak and advised them to take precautions such as washing their hands before and after visiting, said Thorpe-Dorward.
Burnaby General Hospital is now working on a general notification on C. difficile hospital-wide, added Thorpe-Dorward.
New Democratic Party leader Adrian Dix, who publicly released the doctors’ letter Wednesday, called on the government to bring in the BC Centre for Disease Control to conduct its own review.
“The evidence tells us that action needs to be taken,” said Dix.
“These are extraordinarily serious concerns expressed by the clinicians at the hospital,” he added.
“The crisis at Burnaby Hospital is a real one and one that the evidence tells us we can do something about.”
A spokeswoman for the Hospital Employees’ Union, which represents cleaners at Burnaby General Hospital, also called for action.
“What the doctors laid out in the letter is right on and it is not new information,” said Margi Blamey, adding the issues raised in the letter are similar to those identified in an independent report in 2005 by Doug Cochrane, then chair of B.C.’s Patient Safety Task Force.
At the time, Cochrane was examining Surrey Memorial’s sanitary conditions and emergency room procedures after the hospital had high infection rates in its birthing unit. He issued 19 recommendations to Fraser Health in his report.
Blamey said she believes a focus needs to be put on resources for cleaning.
“Cleaning is integral to infection control,” she said.
That is about people. You need to staff it adequately.”
On Wednesday, Health Minister Mike de Jong said he had not seen the doctors’ letter until after Dix raised it in the House, but said he has been aware of the general issues facing the hospital in Burnaby.
“Burnaby Hospital is in the midst of a more comprehensive site redevelopment plan,” he said.
“It’s an older facility and this is something that we have seen in older facilities where you have two- and four-patient rooms, where some of the bathroom facilities are older,” he added.
“So that’s why we have invested so heavily in new hospitals across B.C.”
De Jong added that serious work is being done on the issue, and did not rule out another external review if that’s what experts deemed appropriate.
He also said that the situation has been improving.
“In the last year the folks there have managed to bring the levels down,” he said.
“Burnaby Hospital is safe.”