The health of hospitalized Canadians and their visitors is being seriously put at risk by hospitals that have cut corners in cleaning budgets to save money, a Marketplace investigation has revealed.
The program took hidden cameras inside 11 hospitals in Ontario and British Columbia. What they found in many of them were surprisingly inadequate cleaning regimens – in short, dirty hospitals that could make you sick.
In many hospitals, Marketplace staffers applied a harmless gel to places that many people would touch – hand rails, door handles, light switches, elevator buttons.
The gel glows when seen under an ultra-violet light. But most of the time – and this was true in every hospital where Marketplace carried out gel tests – the gel was still there more than 24 hours later, meaning the surfaces had not been cleaned at all.
The program talked to cleaners, supervisors, nurses, doctors, and hospital administrators to get a handle on what has become a major problem at Canadian health-care facilities – a shocking number of hospital-acquired infections.
While Canadians love to crow about their first-rate health-care system, it also leads in one area that doesn't get the same glowing reviews.
About 250,000 Canadians come down with life-threatening infections while in hospitals every year. That’s the highest rate in the developed world. As many as 12,000 people a year die.
Denise Ball's husband Gary became one of those statistics last year.
He was admitted to Niagara General Hospital for treatment of pancreatitis. While there, the 63-year-old retired school teacher contracted C. difficile – a life-threatening illness that is all too common in Canadian hospitals. It ended up playing a role in his death a few months later.
Denise Ball remembers the cleaning regimen in her husband's room was less than adequate, saying the cleaners would spend only 10 minutes on a room everyone knew was infected with C. difficile. She says a proper cleaning would have taken much longer.
"This has to stop," she says. "This is Canada."
More with less
Time and again, hospital insiders told Marketplace that cleaners were being asked to do more with less. "We used to have one person to one wing of a hospital to clean," one cleaner said. "Now, we have three floors to clean."
A cleaning supervisor at one hospital told Marketplace host Erica Johnson that it's "common practice" for cleaners not to change the cleaning solution in the bucket when mopping up. "They just don't have the time," the supervisor said.
Sometimes there aren't enough cleaning supplies. A nurse, whose identity Marketplace protected, said she's seen a cleaner mopping common areas after having mopped the rooms of infected patients because she didn't have enough mops to change. "She's just cross-contaminated the whole area, so there's no area that was actually clean."
Sometimes, only one cleaner would be on staff in an entire hospital during night shifts. "That kind of day-night difference is very common, and it makes no sense," says Dr. Michael Gardam, an infectious disease expert at the University Health Network in Toronto.
Gardam has seen enough in his time looking at hospital cleaning practices to know that some hospitals are worse than others – much worse. "Some hospitals are a real freaking disaster," he told Marketplace."They've been told to actually cut their number of housekeeping staff by outside auditors who are trying to help them balance their budgets."
In recent years, many hospitals have cut the portion of their budget that is devoted to cleaning. Sometimes, they've done that by contracting out cleaners or their management.
C. difficile outbreaks common
It's not like we haven't seen the devastating results of hospital-acquired illness. Newscasts and newspapers have been filled with stories of hospitals under quarantine because of C. difficile outbreaks. In the last decade, outbreaks have hit hospitals in most provinces. A huge outbreak in 2003 and 2004 led to as many as 2,000 deaths in Quebec.
Last year, there were outbreaks in at least 10 hospitals across Ontario alone. One of the worst was the Niagara Health System in Ontario. More than 100 cases were diagnosed and the infection was a factor in the deaths of 37 patients, including Gary Ball, the patient mentioned earlier in the story.
The man appointed by the Ontario government to get the Niagara outbreaks under control, Dr. Kevin Smith, denies that hospitals have been cutting back on cleaning. "I think they're experimenting with new models of cleaning," he says.
When informed that workers in the Niagara hospital system told Marketplace that they still don't have the time or resources to do an adequate cleaning job, he says, "I haven't heard that message," saying "everybody" feels rushed in health care these days.
The outbreaks are officially over in the Niagara Health System. But when Marketplace showed Smith several areas where researchers had applied test gel in three hospitals he supervises, most of the surfaces showed no evidence of cleaning. The ultra-violet light showed uncleaned hand rails outside an isolation room, uncleaned support rails in a public washroom and uncleaned hand rails in a ward with highly contagious patients.
"I'm obviously very disappointed to see that. That is a less than optimal cleaning opportunity. We need to fix it," Smith said.
There's something else that some observers think is helping to drive the pressure to skimp on cleaning. In Ontario and British Columbia, for example, hospitals are given bonuses for turning over beds quickly – hundreds of extra dollars each time a hospital gets a patient out of a room before a certain time. More money is dangled for quickly transferring a patient from the emergency ward to a room. Hospital CEOs, already well-paid, receive bonuses that depend, in part, on reducing wait times.
While the goal of such rewards may be admirable, critics say the actual effect has been to speed up cleaning to an unhealthy degree.
"They just don't get it," says Denise Ball. "And maybe until one of their loved ones that went in healthy and … a few months later ... they're going to their grave. Maybe that's what will wake them up."