Canada

Ottawa clinic infection scare a 'wake-up call'

The infection scare at an Ottawa clinic revealed this week suggests the potential for lapses in sanitizing standards, according to experts, who say Canadians have a right to ask if equipment used for their treatment has been properly disinfected.

Equipment sterilization can 'slip through the cracks'

More colonoscopies are being performed in non-hospital clinics as stepped-up prevention practices include screening for those thought to be at risk of colon cancer. (Reuters)

The infection scare at an Ottawa clinic revealed this week suggests the potential for lapses in sanitizing standards, according to experts, who say Canadians have a right to ask if equipment used for their treatment has been properly disinfected.

"I don't want to say the sky is falling, because overall we can be reasonably assured that things are not that bad," says Douglas Angus, a health economist and professor at the University of Ottawa's school of management. "By and large most organizations are pretty vigilant about safety procedures and practices … but we have systemic errors in health care.

"When you get into the private clinics and facilities of that nature, it appears we don't have the same kind of oversight and regulatory environment as hospitals," adds Angus.

Quality control concerns were raised this week when Ottawa Public Health announced that about 6,800 people have been sent registered letters informing them a "non-hospital" clinic run by Dr. Christiane Farazli didn't always follow infection prevention and cleaning protocols for endoscopic equipment. The letters said there is a tiny risk that patients may have been exposed to hepatitis or HIV after undergoing procedures between April 2002 and this past June.

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Canada's medicare system is increasingly sharing patient care with privately operated clinics, due to factors including hospital funding shortfalls, efforts to reduce wait times and new screening guidelines. For instance, there has been a growth in preventive care for colon cancer and other conditions that require the use of probes such as endoscopes — devices with a light attached that are used to look inside a body cavity or organ.

Provincially monitored hospitals must adhere to certain quality-care standards and are regularly inspected, but private clinics generally aren't subject to the same stringent sanitation and infection-control monitoring.

Dr. David Armstrong, a gastroenterologist at the Hamilton Health Sciences Centre and a McMaster University associate professor, says his work with the Canadian Association of Gastroenterology includes developing a quality-control system in the area of endoscopy services.

"You need a framework to say, 'Do we have processes to determine how well an endoscopist is performing, do we give them benchmarks to achieve and address any deficiencies that are found?' Once one takes that approach, there are many other areas of endoscopy that are important: Does the patient have access, is the procedure safe, is the equipment clean, are the rooms clean? To put all of that in place requires that one looks at this as a system issue."

'There are gaps'

Angus and other experts also say the health-care system needs more uniform quality control standards.

"I look at this [the Ottawa clinic situation] as a wake-up call and I would think governments across the country should be saying that this is something we should be taking a careful look at," says Angus.

Dr. Michael Gardam, director of infection prevention and control with Toronto's University Health Network, says that while the onus on whether hospitals are properly sanitizing equipment is on the hospitals — which are monitored by the provinces and territories involved —  "if you're opening a clinic, the onus is on the owner of the clinic to make sure they follow proper sanitation practices.

"One of the challenges is that as a doctor, no one teaches you this stuff. Patients are well within their right to ask if their equipment is sanitized appropriately, and [clinic staff] may say yes, but they may not know much about it.

What to ask before undergoing an endoscopy? Click here.

"If you're a doctor who is about to strike out on your own and open a new clinic, while you're busy picking out your office furniture, remember there's a huge chunk of [opening a clinic] — and that is equipment reprocessing … and that is the piece that can slip through the cracks," says Gardam.

The Canadian health-care system has endured scandals that have shaken public confidence, and have led to major changes in procedure and governance following inquiries. They include:

  • The tainted blood scandal, when more than 1,000 Canadians were infected with HIV and up to 20,000 others with hepatitis C from blood distributed by the Canadian Red Cross between 1983 and 1990, and more than 1,000 people became infected with HIV and up to 20,000 others contracted hepatitis C from tainted blood.
  • The Newfoundland and Labrador Eastern Health authority scandal, involving inaccurate hormone receptor tests given to breast cancer patients between 1997 and 2005, and the death of more than 100 patients.

The Ottawa clinic scare isn't the first incident involving sanitation concerns at private clinics.

Last year, the Vancouver Island Health Authority notified about 500 patients about possible viral contamination after they  underwent endoscopic procedures at Victoria General Hospital between June 2008 and January 2010.

Public confidence in health care a concern

Such high-profile failures to meet proper patient-care standards can undermine public confidence in the health-care system, notes Hugh MacLeod, CEO of the Canadian Patient Safety Institute.

"It raises in the consciousness of the public, 'What about the overall safety of the enterprise called health care in general?'" he says.

MacLeod said on Tuesday he hadn't received any concerns from patients regarding the Ottawa incident. But he points to the growing rolls of the non-profit group Patients for Patient Safety Canada, which aims to improve patient safety a priority.
Dr. Isra Levy of Ottawa Public Health said Monday that some infection prevention and cleaning protocols were 'not always followed' at a private clinic that performs endoscopies. ((CBC))

During Canadian Patient Safety Week starting Oct. 31, the video stories of five patients who have been harmed during health-care treatment will be highlighted, but each person's story emphasizes the hope that something has been learned from the tragedy.

"The whole infection-control issue has multi-levels to it," says MacLeod. When it comes to patients, he adds, "they have a right to ask" if the right sanitation procedures have been followed.

So who is overlooking sanitation practices of health-care providers?

The Ontario College of Physicians and Surgeons (OCPS) and a local investigation by Ontario Public Health uncovered sanitation shortfalls at Farazli's clinic, but not every province oversees private clinics, although there are various accreditation agencies, such as Accreditation Canada.

Strive for '100 per cent accuracy and non-failure rate'

Pamela Fralick, president and CEO of the Canadian Healthcare Association, says that although the health-care system can "go months and years and decades without anything happening, clearly we want a 100 per cent accuracy and non-failure rate."

However, Fralick, who is part of a multi-stakeholder group discussing issues of mutual concern in the health-care system, says  "there's a lack of integration in this country. When you have so many stakeholders and official bodies involved — we have municipal and public health officers, the provinces, the public officers of health, the Public Health Agency of Canada and all the health provider groups that oversee the behaviour component of the health profession.

"As we increasingly farm out various procedures to private-sector organizations, we have to look at if they are under the same standards," she says.

"I would say things have gotten better and out of crisis comes opportunity," Fralick adds. "The vigilance has been heightened. Does this mean we're never going to uncover another situation, probably not. We're not infallible."

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