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On the day that Ontario Minister of Health George Smitherman asked why hospital cleaners are paid more than the people who clean banks and shopping malls, Montreal physicians reported that over 100 patients at Quebec hospitals have died due to C. difficile infection. Together with 39 deaths in Calgary hospitals, this is five times more deaths than Canada saw during the SARS epidemic. Poor hospital sanitation is cited as a major factor in the transmission of C. difficile in Montreal.

The C. difficile deaths should be a wake-up-call for a Minister who clearly misses the relationship between containing infection and hospital cleaning. Otherwise he would never have suggested that Ontario’s hospital staff and in particular hospital cleaners are overpaid and that their jobs should be contracted out to cut hospital costs.

His comments trivialized the contribution of a productive and tired workforce and demeaned the contribution of people who every day play a key role in ensuring that hospital patients go home healthier than when they arrived for treatment.

In the vast medical and hospital hierarchy, the wages and wage increases of hospital cleaners are not responsible for driving up health care costs. So what is? Over the past two years hospital CEOs’ salaries have gone up an average of 18.3%. And drug costs to the Ministry of Health have ballooned by 40%. Minister Smitherman recently cut a very generous deal with Ontario’s doctors, giving them an average 24% increase over 4 years. A deal doctors rejected. In contrast, hospital cleaners’ hourly wage rates are up by 6% since 2002.

Lacking the courage to attack the major reasons why health care costs are rising faster than inflation, the Minister of Health has found a target group with whom to do battle – hospital support workers.

In the last 10 years, 12,000 hourly paid positions, including cleaners, have disappeared in Ontario hospitals (over this period hospitals added 10,000 managers). Over the decade hospital stays have shortened, and the number of patients in hospitals has increased, as has the acuity of their illnesses. There has had to be a dramatic increase in the productivity of cleaners to keep the hospital system operating relatively free of widespread outbreaks of hospital-acquired infections.

There have been at least seven deaths in Ontario hospitals in the last two months due to C. difficile (Ontario, unlike Quebec, does not require facilities to report C. difficile infections or deaths ). C. difficile is one of a number of virulent organisms, like MSRA and Norwalk virus, which thrive in a hospital environment.

The same workers that Minister Smitherman has targeted as overpaid and unskilled were hailed as heroes during the fight against the SARS virus by the previous Conservative minister of health.

During the SARS epidemic in Ontario, 14 cleaners represented by CUPE were infected. They have not returned to work and, in some cases, may not work again. The job of fighting infection in a hospital is a dangerous and highly skilled occupation.

Sterilizing the room of a patient who has had SARS or Norwalk virus is a painstaking procedure. And this is as it should be. These organisms can live for long periods of time on unwashed surfaces, waiting for a host.

In British Columbia contracts for hospital staff were broken through legislation and widespread layoffs and contracting-out of hospital cleaning and other services followed. Wages have fallen to $9 an hour for cleaners in B.C. hospitals. This would approximate the wages paid to the people who clean banks in British Columbia.

There is a now a high degree of turnover in B.C. hospital cleaners. There is almost no training provided to cleaners working for contractors, even though the organisms these workers are dealing with are highly evolved and deadly.

Ominously, contract cleaners in B.C. report that they must skimp on supplies – using the same materials to clean toilets and supposedly sterile surfaces. Contract cleaners in B.C. are restricted to using one pair of disposable gloves for an entire shift. In the world of infection control these are not best practices.

Yet it is to British Columbia that Ontario’s Minister of Health looks as a model – not for its prowess in containing the spread of hospital acquired infections, but for its muscle in wrestling hospital staff wages to the floor.

Rumours swirl that the Ontario government is preparing legislation to over-ride hospital collective agreements to allow for widespread contracting-out of cleaning and support services. Lacking the courage to take on the private interests, drug companies and hospital managers that are driving up health care costs, the Minister of Health has targeted a group he thinks he can beat up.

Everyone who has been to school knows that the only way to deal with a bully is to fight back.

Ontario’s hospital cleaners and other staff have also been watching events unfold in British Columbia. We will fight.