Aging Royal Alexandra’s C. difficile rate average
Patients who stay in old hospitals where patients share rooms and bathrooms have a higher risk of obtaining a hospital-acquired superbug that is resistant to antibiotics, says the doctor in charge of infection, prevention and control for Alberta.
But although the number of C. difficile cases has been rising in northern Alberta hospitals in the last two to three years, Edmonton’s Royal Alexandra Hospital — where 80 to 85 per cent of patient rooms are shared by up to four or five patients — has an infection rate equal to the national average, says Dr. Mark Joffe, senior medical director for the infection area of Alberta Health Services.
“We’re at the national average, but we want to be better than that,” Joffe said following a letter last week in the Edmonton Journal by the president of the Royal Alexandra Hospital Foundation that called for a new hospital because of crowding and high infection rates.
The hospital had 530 hospital-acquired C. difficile and antibiotic-resistant infections between January and November 2012, Andrew Otway wrote. Of those cases, 85 per cent happened in the hospital’s old building rather than such new additions as the Lois Hole Hospital for Women, the Orthopedic Surgery Centre or the CK Hui Heart Centre.
“Designed in the 1950s and opened in 1963, this main building holds 502, or about half of the total in-patient beds in the hospital,” Otway wrote. “Only 16 per cent of the rooms are private.” Joffe agreed that is a concern.
“It is difficult to provide 21st-century health care in a building that was designed in the middle of the 20th century. That’s a reality,” Joffe says.
“It’s four-bed rooms, which used to be the standard in hospital design. That’s the problem. Modern hospitals are not built with four-bed rooms. That’s the challenge. The more crowding there is, the more patients you have in a room, the more problems you have with C. difficile.”
Even so, the rate of infection at the Royal Alex was 6.9 per 100,000 patient days in the last quarter of 2012, the same as the Canada-wide figure.
That’s higher than the provincial average of 3.9 cases per 100,000 patient days, but follows the spread of the bug from Eastern Canada to the West, and from southern Alberta to the north, Joffe says.
The University of Alberta Hospital and the Mazankowski Alberta Heart Institute have a rate of 9.9 per 100,000 patient days, the Foothills Medical Centre in Calgary sits at 6.9 and the Grey Nuns Hospital at 5.2.
The hard number of cases is likely going to go up, in large part because a new lab test, rolled out one month ago, is catching more cases of the superbug, ensuring people receive the right treatment and are isolated in private rooms.
Because there are so few single-bed rooms available at the Royal Alex, Joffe says much work goes into finding who most needs them, such as those with C. difficile or palliative care patients.
“We have to prioritize who gets a single room. That’s not new. We’ve done that a long time, but there’s more pressure on a single room than ever,” Joffe says.
He says hand-washing campaigns as well as pilot projects to reduce anti biotic prescription use aim to bring infection rates down.
And while Joffe agrees a new hospital is needed, he says that decision lies with the province.
A 1998 master plan for the Royal Alex identified the need to renovate or replace the building, Otway’s letter stated. “Ultimately, it’s up to the Alberta government to decide when it’s the right time. And when we’re in a deficit situation budget-wise, that may not be the time to build a new hospital,” Joffe says. “This is taxpayer money they’re spending, and they have to decide what’s the best way to spend it.”