Dusting off hospital cleaning measures would help keep patients safer from superbugs, doctors say

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Cleaning contaminated surfaces in hospitals is critically important to protect patients from drug-resistant superbugs, which are on the rise. But some infectious diseases experts say recent moves to outsource hospital services could compromise the standards of cleanliness and result in poorer infection controls.

In hospitals, cleaning can range from a quick wipe of a door handle to disinfecting sinks to kill microbes or the complete stripping of rooms between patients during an outbreak. Sterilization of surgical instruments happens separately.

One of the latest facilities to consider transitioning to private cleaning is Etobicoke General Hospital in Toronto's west end. The Canadian Union of Public Employees (CUPE) representing cleaning and support staff at the hospital held a rally there last week to protest the possible contracting out of cleaning and laundry services.  

The union says if cleaning staff suffer cutbacks as proposed by William Osler Health System, the network Etobicoke General belongs to, the level of cleanliness could suffer. 

Meanwhile, though it's difficult to show a causal link between outsourcing cleaning and an increase in infections, superbug rates in Canadian hospitals have been climbing. But that hasn't deterred facilities from outsourcing cleaning services. Experts say more rigorous attention to cleaning protocols could keep some outbreaks under control. 

Dr. Dick Zoutman, a retired infectious diseases physician in Kingston, Ont., says privatizing cleaning services in hospitals isn't as effective as in-house cleaning operated by the hospital and could result in fewer staff doing the work with not enough resources.

"That just doesn't work in this setting, and it is hazardous to the quality of the cleaning and hazardous to patient care."

In addition to Etobicoke General, William Osler Health System also includes two other hospitals in the Greater Toronto Area that contracted out their cleaning services when they opened in 2017 and 2007, respectively.

Though the hospital network has issued a request for proposals to contract out cleaning at Etobicoke General, no decision has been made, but a spokesperson for Osler said via email that using the same contractor across all its sites was an opportunity to "improve and standardize services and processes." The network noted it is committed to "minimizing any impact to patients and staff." 

Hospitals in British Columbia, Alberta and New Brunswick have also outsourced housekeeping, according to CUPE.

While Canadian data on infection rates is sparse, it does show that the rate of superbugs in hospitals is rising.

The Canadian Nosocomial Surveillance Program pools data from 88 hospitals across the country to give a sense of the types of infections that patients acquired while in hospital.

The 2017-2021 report revealed increases in most indicators, such as MRSA and vancomycin-resistant Enterococcus (VRE).