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Crosscheck: C. difficile deaths at B.C. hospitals should not be reduced to a numbers game

Mike Farnworth, seen here during the NDP leadership debate in Vancouver, British Columbia, Tuesday, March 1, 2011.

Rafal Gerszak for The Globe and Mail/rafal gerszak The Globe and Mail

Last spring, 11 people died during a C. difficile outbreak [at Nanaimo Regional General Hospital]which finally ended in August. It's due in part to shoddy housekeeping taking place, not meeting the standards maintained in contracts.

– NDP health critic Mike Farnworth during Question Period this week in the B.C. Legislature

The debate over whether standards of cleanliness have been compromised by privatization of housekeeping services is not an ideological discussion for those who are in hospital, and especially not for families of those who died during an outbreak of the infectious Clostridium difficile.

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But in urging the government to bring back in-house housekeeping services, NDP health critic Mike Farnsworth appears to be relying on ideology by not paying attention to the numbers he uses to bolster his position. He overstates the deaths attributed to C. difficile, making himself an easy target to those who play down the issues raised by privatization.

The C. difficile bacterium is not uncommon and can be found in many patients without showing any symptoms of infection. However, more than 3,000 cases of infections are reported annually in B.C.'s 82 acute-care facilities. The vast majority occur from the germ spreading within a health facility. Over a six-month period last year, 221 people in B.C. died within 30 days of being diagnosed with a C difficile infection.

Mr. Farnsworth linked the deaths at Nanaimo hospital last year to problems with cleanliness. He urged the Health Minister to "do the right thing" by having the local health authority reverse the privatization of housekeeping.

The Nanaimo hospital has been responding to unusual increases in the number of outbreaks of C. difficile since 2003, which, coincidentally or not, was the year that housekeeping at the hospital was privatized and Compass Group Canada was given the contract.

Nanaimo hospital had 94 cases of C. difficile infection between July, 2008, and May 12, 2009, according to the health authority. Five of those patients died directly as a result of the infection. C. difficile was considered a contributing factor in an additional nine deaths.

The B.C. Centre for Disease Control undertook a review that identified several problems. The centre pinpointed an insufficient number of cleaning staff and inadequate training in appropriate cleaning procedures. But the review also found insufficient hand-washing sinks, limited access to alcohol-based hand rubs and insufficient isolation rooms. Overcrowding was also an issue. The hospital had been operating overcapacity on a continuous basis.

Despite improvements in response to the BCCDC review, the hospital had another 15 cases the next year. One death was attributed directly to C. difficile during the outbreak from Nov 17, 2009, to Dec. 24, 2009. The infection was not considered a contributing factor in any deaths.

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Last spring and summer, the outbreak of C. difficile was worse. Forty-nine cases were reported from Mar 29, 2010, to Aug. 24, 2010. But contrary to Mr. Farnworth's statement that 11 people died, two deaths were directly attributed to the infection. C difficile was a contributing factor in two additional deaths. Despite the increase in infections, the BCCDC did not come back for another review.

Replying to Mr. Farnworth, Health Minister Mike de Jong sounded as if he realized that Mr. Farnworth had misstated the numbers. But he did not call him out.

"In raising this issue … he should do his homework," said Mr. de Jong, without citing any numbers. The Health Minister also offered some advice: "Be fair and be clear about what some of the assigned causes for those deaths were, and how the germ was brought into the hospital. That's all I'll say about that." Mr. de Jong then moved on to other matters.

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