Strengthen Medicare: Safe Health Care

CUPE calls on the federal government to:

Implement a national strategy to reduce healthcare associated infections, with dedicated funding for microbiological cleaning standards, more in-house cleaning and infection control staff, lower hospital occupancy and mandatory public reporting.

Canada needs a national strategy to combat healthcare associated infections (HAIs).

Canada has the second highest rate of HAIs among high-income countries, and we have no national strategy. Hospital overcrowding, contracting out and understaffing hamper infection prevention and control efforts. Public reporting on HAIs and federal oversight are weak.

Thousands of Canadians are injured and die unnecessarily from healthcare associated infections each year.

• Over one in 10 patients suffer from an infection they acquired in hospital.1
• By the last estimate, in 2002, up to 12,000 die from these infections each year.2
• Canada has the second highest HAI prevalence rate among high-income countries at 11.6 per cent, considerably higher than the pooled rate of 7.6 per cent.3
• At least 30 per cent of these infections are preventable.4

Beyond causing avoidable suffering and deaths, failure to prevent HAIs costs our hospitals dearly – between $1 billion5 and $4.5 billion6 annually. On top of that are costs borne by patients, unpaid caregivers, home and community care programs as well as litigation costs, lost work time and other economic impacts.7

There is robust evidence that understaffing and contracting out of health care cleaning contribute to our high infection rates.8

Contracting out leads to cuts in staff, higher turnover rates, less training and a rift between clinical and support services.9

The auditor general of Scotland found that hospitals with contracted-out cleaning, compared with those with in-house cleaning, had fewer cleaning hours, less monitoring and supervision, greater use of relief staff and lower scores on cleanliness.10

The UK Department of Health found that 15 of the 20 “worst” National Health Service hospital trusts for cleanliness had outsourced cleaning.11

Compounding the problem, Canadian hospitals are overcrowded. Eighty five per cent occupancy is recognized as a minimum standard for safety; above that, hospitals cannot effectively isolate patients, ensure hand-hygiene and clean.12 UK research shows that hospitals with occupancy over 90 per cent have 10 per cent higher MRSA rates than hospitals below 85 per cent.13

Across Canada, hospital beds were cut 36 per cent from 1998 to 2002,14 and now Canada has one of the lowest bed-to-population ratios and highest occupancy rates among countries in the Organisation for Economic Co-operation and Development (OECD).

• Canada’s hospital bed numbers (relative to population) are less than two-thirds the OECD average: 3.2 beds per 1,000 compared to the OECD average of 4.9.15
• Hospital occupancy in Canada was 93 per cent on average in 2008 – the second highest of 26 OECD countries, the average being 76 per cent.16
• Occupancy rates in Ontario and British Columbia are at the dangerous level of 97.9 per cent17 and 96.8 per cent18 respectively. Alberta Health Services reports that Calgary and Edmonton hospitals have run above 100 per cent occupancy for a decade;19 the Health Quality Council of Alberta recommends 85 to 90 per cent.20

Understaffing and overcrowding will worsen with federal health funding cuts, as happened in the 1990s.

Even at the level of monitoring HAIs and contributing factors, Canada does poorly. The Health Council of Canada has been critical of inconsistent reporting on adverse events,21 and leading public health experts call for mandatory reporting of HAI rates across Canada.22 We also have poor pan-Canadian data on hospital occupancy, health care cleaning, and contracting out. The Canadian Institute for Health Information ignores cleaning services and workers in its reports on spending and health human resources – and even in a report on HAIs.23 Health Canada tackles only a sliver of HAIs in its health indicators reports and doesn’t even mention environmental contamination.24 Statistics Canada inadequately tracks cleaning and other ancillary health care services; it counts privatized cleaners as hospitality and service workers, undervaluing the complexity of health care cleaning.25

The Canadian government’s fragmented and weak HAI initiatives stand in contrast to federal responses in England,26 Scotland and the Netherlands,27 and they fail to meet our obligations under global health governance standards.28 Strong pan-Canadian standards and enforcement mechanisms must be put in place to turn the tide on these deadly infections.

• Download a printable copy of this fact sheet
• Read all of the fact sheets on CUPE’s health accord proposals