Group items tagged

VIHA says the new contract with Crothall raises cleaning standards, increases staffing levels, creates a specialist outbreak cleaning team, enhances monitoring processes and introduces more patient and staff satisfaction surveys.

Mike Old, spokesman for the Hospital Employees' Union, said the union supports the decision of the health authority to retain the experienced workers who currently clean the facilities."Our concerns about crushing workloads for cleaning staff have been recognized through a commitment to higher staffing levels in this contract," Old said.

Improper cleaning methods and insufficient cleaner strength had a significant effect in an 11-month C-Difficile outbreak at Nanaimo Regional General Hospital that infected 94 people and killed five which started in 2008.

Compass employees lacked proper training to use toxic chemicals that caused hair loss, nose inflammation, respiratory problems and skin irritation, according to two failed WorkSafe B.C. inspections issued in 2008 and 2009.

Workers used ineffective cleaners. Staff over-diluted bleach cleaner and later needed to switch to a soil-lifting detergent that would remove the virus from surfaces.

If the housekeeping fails on any of the new measures during monitoring, financial penalties will be applied.

In April last year, VIHA said it was getting rid of Compass and signing a new contract with Marquise to provide housekeeping and food services at residential care facilities on the south Island - Glengarry, Mount Tolmie, Aberdeen, Gorge Road and Priory Hospital - as well as Queen Alexandra Centre for Children's Health and Saanich Peninsula Hospital. But before the ink on the contract was dry, Marquise was bought by Compass.

Compass has three of its divisions working in VIHA's contracted sites: Crothall Services, providing housekeeping services; Morrison, providing food services; and Marquise Group, providing both food and housekeeping services in residential care facilities.

Karl Rinas, 61, who was treated for a bleeding ulcer at a Leamington, Ont., hospital last February, says he ended up wiping down the bathroom himself after his complaints about the dried liquid waste he found on the floor and toilet seat failed to get a reaction, but he worried about older, less mobile patients.

Despite all her efforts, Martin says she has no doubt that the antibiotic-resistant superbug Clostridium difficile infection her mother contracted soon after surgery was related to the hospital's level of cleanliness.

"I know everybody nowadays has to work more with less, but to me, a hospital should be absolutely clean," she said.

Of the respondents who wrote into the fifth estate's survey about being harmed in hospital, most said the harm was a hospital-acquired infection such as MRSA and C. difficile.

Unlike in the food industry, there are no standardized inspections for cleanliness in hospitals.

A World Health Organization report that compared Canada's infection data with that of 12 other wealthy countries found that Canada had the second-highest prevalence (11.6 per cent) of hospital-acquired infections after New Zealand — much higher than that of Germany (3.6 per cent) or France (4.4 per cent).

Is outsourcing to blame?Those who work in hospitals have pointed to the increased outsourcing of housekeeping in recent years as one reason behind the decline in hospital cleanliness that patients and hospital workers have observed

The Canadian Nosocomial Infection Surveillance Program is the closest thing to a federal overview that Canada has, but it relies on voluntary reporting by only 54 hospitals in 10 provinces, most of them teaching facilities, which, according to infection control experts, generally have higher infection rates than other acute care hospitals because they tend to see more seriously ill patients.

But health authorities in other countries are moving away from private cleaning services. Four years ago, Scotland reversed its decision to allow outsourcing of cleaning and catering services because it felt private contractors were not doing a good enough job keeping the spread of infections in check.

Blamey says as long as housekeeping is done on a for-profit basis, employers will reduce the number of staff and cut corners on staff training and cleaning supplies.

"There's no question there's been an impact on the quality of cleaning, and you can see that throughout the years as various hospitals have struggled with very high-profile superbug outbreaks," said Margi Blamey, spokesperson for the Hospital Employees' Union (HEU), which represents 41,000 hospital cleaning and support staff in B.C.

Michael Gardam, who oversees infection prevention and control at the three hospitals that are part of Toronto's University Health Network, agrees that hospitals have fewer resources for housekeeping these days and have to concentrate cleaning on areas that are most likely to transmit bacteria — primarily the surfaces that multiple patients touch.

"I probably get more emails about dust bunnies in the stairwells than anything else in the hospital, and yet, we've done that for a reason. You're not going to catch anything from a stairwell, but you're going to catch it from your bed rails," Gardam said.

About two-thirds of hospital-acquired infections are preventable, Gardam said, but making a direct link between cleanliness and infection is not as straightforward as it might seem. Some hospital-acquired infections such as ventilator-associated pneumonia or central line-associated bloodstream infections have little to do with the hospital environment and can be controlled through proper protocols around equipment use. But a superbug like C. difficile is a lot trickier because it is hard to pinpoint its source.

Increasing cleaning staff on nights and weekends could also help. A typical medium-sized B.C. hospital that contracts out cleaning services has 24 cleaners by day but only four at night, says Blamey, and workers are often not backfilled when ill or on vacation.

"Bacteria don't care what time it is," said Gardam.

The infection expert says it doesn’t matter whether a private or public entity oversees cleaning; both have had problems with cleanliness. The bottom line is that hospitals generally undervalue the importance of cleaning staff, Gardam said.

"People don't really think of them as part of the team, but if you think about how infections are spread in hospitals, they're actually an incredibly important part of the team that goes far beyond just the cosmetic appearance of the room."

Boudreau has said the move will save the province millions of dollars through efficiencies brought in by a private company. However, the union's document paints a poor picture of privatization of services in health-care facilities in other jurisdictions. "We believe it is important for New Brunswickers to understand the impact of such a move, especially when it comes to the cleanliness of a building which the public relies on everyday," Robinson said. Last year, the Horizon Health Network started a regular audit of the cleanliness of hospitals being serviced by unionized public sector workers. Auditor General Kim MacPherson reported that health-care workers weren't cleaning their hands as required and that the standards to do so weren't even the same within the two regional health authorities.

Robinson said Friday that policies have been established and changes made that are addressing cleanliness concerns. "And they have improved on their targets of cleaning in the hospital sector," she said. The union claims its research into the three companies they believe are being considered to take over those services - Sodexo, Aramark and Compass - shows a poor track record. The union said it's also concerned about the quality of food declining. The union wants to keep the management of hospital environmental services in-house. It also wants fair wages and benefits for cleaning and food services staff to ensure against high turnover and gaps in training. The union also stated lay-offs and staff reductions would be a poor way to balance the budget.

"The cost associated with treating hospital-acquired infections, managing public relations fiascoes and defending lawsuits would defeat any possible savings while destroying the public trust." The Province of New Brunswick expects to have completed talks with a private contractor for the management of health-care cleaning and food services before the end of the year.

Bruce McFarlane, Health Minister Victor Boudreau's director of communications, said Friday that the province is "still in current discussions with the preferred proponent and we hope to have completed the process sometime this fall." McFarlane sent The Daily Gleaner an email statement Friday afternoon after the New Brunswick Council of Hospital Unions CUPE local 1252 released a 20-page document critical of the government's plan to privatize housekeeping, food services and porter services at hospitals. "We want to clarify that we are only outsourcing the management of the services," said McFarlane, who added that the ministry had not yet received the document.

"CUPE staff will remain in their union and will continue to be employees of the Province of New Brunswick." Norma Robinson, president of CUPE Local 1252, said she is "very concerned that the Liberal government is negotiating with a private firm to take over the management of food and cleaning services in the province's hospitals." Robinson said she's worried the move could lead to further privatization. In an interview with Brunswick News in April, Boudreau said the government wants to give the private sector a greater role in the province's health-care system.

Boudreau has said the move will save the province millions of dollars through efficiencies brought in by a private company. However, the union's document paints a poor picture of privatization of services in health-care facilities in other jurisdictions. "We believe it is important for New Brunswickers to understand the impact of such a move, especially when it comes to the cleanliness of a building which the public relies on everyday," Robinson said. Last year, the Horizon Health Network started a regular audit of the cleanliness of hospitals being serviced by unionized public sector workers. Auditor General Kim MacPherson reported that health-care workers weren't cleaning their hands as required and that the standards to do so weren't even the same within the two regional health authorities.

Robinson said Friday that policies have been established and changes made that are addressing cleanliness concerns. "And they have improved on their targets of cleaning in the hospital sector," she said. The union claims its research into the three companies they believe are being considered to take over those services - Sodexo, Aramark and Compass - shows a poor track record. The union said it's also concerned about the quality of food declining. The union wants to keep the management of hospital environmental services in-house. Calls made to Sodexo, Aramark and Compass were not returned by press time.

Guelph University microbiologist Keith Warriner conducted the tests for Marketplace and found alarming results. “I wasn’t expecting [bacteria] to be so prolific,”

Comforters were the most consistently contaminated spot, rating a "fail" in 23 out of 51 tests

faucets in hotel rooms were quite dirty themselves, with 16 fails out of 54

Over 70 per cent of remote controls tested were rated a caution or fail.

Other major hot spots included bed throws, bathroom sinks, toilet bases and telephones.

a pillow with so much bacteria it has “its own life story.”

Overburdened hotel staff is the main reason that many rooms are so filthy

Canada’s hotel union tries to enforce a cap 15 to 16 rooms cleaned per shift, giving staff approximately 30 minutes per room. Ruiz says that isn’t enough.

many housekeepers work unpaid overtime to reach their daily targets, but many still use time-saving “shortcuts” like not dusting or vacuuming.

"I think these are a real bonus to our units," said Worthington of the specialized teams made of housekeeping and infection control staff.

The risk of developing the infection in hospital is about 1%, he said.

Under the cost-cutting plan, this will no longer be allowed, with the result that some patients might have to wait longer for certain types of care or go to a non-MUHC hospital.

The Gazette has already reported that the Montreal General is closing at least 10 beds on the 19th floor, where urology and plastic-surgery patients are treated, and that a special housekeeping squad that was set up to fight the deadly C. difficile superbug has been eliminated. In December, beds on the 13th and 16th floors were closed, too.

Health Minister Réjean Hébert appointed a special overseer, Michel Bureau, to monitor MUHC finances. In his email to staff, Rinfret said that Bureau was pleased to witness "a phenomenal change at the MUHC since Dec. 17."

The Gazette has learned of other planned cuts, including to medical imaging, where 19 technicians-in-training have been told they won't be hired, and that those who retire will not be replaced.

That basically shows that, although there was a fair bit of C. dif-ficile in the hospital, the steps the hospital was taking during the spike - such as hand hygiene and cleaning protocols, etc. - were actually preventing the spread from patient to patient, said Garber.

"Probably what's happening is that people come into the hospital sick get antibiotics - which is an inevitability; we're never going to eliminate antibiotics, that's for sure - but, in some cases, patients might be at risk but we wouldn't know it until they've actually received the antibiotics."

Dewar couldn't estimate how much money will be saved by the layoffs because staff numbers change constantly. Three full-time and two part-time management positions will not be filled and savings will be re-directed to front-line services in long-term care. For some time, the Saskatchewan Union of Nurses (SUN) has raised concerns that registered nurses (RNs) are being replaced by licensed practical nurses (LPNs). When asked if this could happen, Dewar replied: "For RNs or LPNs, what's really important is how you organize that care team to deliver quality care and there is a substantive overlap between the two professional groups."

He emphasized it's important to assess what care is required by patients and who can best deliver that care. CUPE Local 3967 president Scott McDonald said Friday's announcement was news to him. The local represents most RQHR workers who aren't RNs, including those in housekeeping and maintenance, dietary professionals, technicians and LPNs. CUPE has had brief conversations with the health region, but McDonald didn't think the layoffs were a firm thing until he heard Friday's announcement.

He said CUPE's 5,500 members are already overloaded. "These layoffs are going to affect patient care. I don't see any way of getting around that," said McDonald. SUN president Tracy Zambory agreed. There are already "huge challenges" when it comes to staffing, said Zambory. She pointed to the 28 per cent increase in critical incidents as reported in the Health Ministry's annual report released in July. That includes errors in medication and diagnosis. "Regional health authorities have been told they have to come up with efficiencies; that translates down always to the front-line staff," Zambory said. Realigning staff won't impact services, bed numbers or programs, Dewar said. On Thursday, the Saskatoon Health Region issued 70 layoff notices.

Numerous factors could explain the difference in the number of layoffnotices the province's two largest health regions are handing out - including the SHR's larger deficit, Dewar said.

She says she had greater success at Ryerson University, where she was hired to overhaul the food service from 2013 to 2015. “Ryerson was tremendous. We created a beautiful model and the students responded to it,” she says.Under her direction, staff stopped reheating soup from a bag and learned to cook from scratch with raw ingredients. “Soup easily became one of the most popular things on the campus,” she says. “Because it was good and made with thoughtfulness and not that much more work.”The big take-away for Maharaj was learning to negotiate with the companies that provide the food. “Working with a third-party operator is the undeniable piece you have to address when you’re talking about institutional food,” she says. “And these operators are the people we need to start talking to when we want change.”

“The vegetables are almost non-existent. They’ll throw a couple on the plate. You’ll have a spoonful of some nasty peas. And they’re not even green no more. They’re grey,” says Tom, who also says powdered mashed potatoes are served multiple times a week (“Both dehydrated and fresh potatoes are used in both the cook-chill and institutional kitchens,” Ross says.)Tom avoided eating chicken entirely when he was in jail. Another woman I spoke with, who spent a year at Vanier from 2010 to 2011, says the poultry was routinely served undercooked and pink. She says she relied on food purchased at the canteen, mostly ramen noodles. When dinner was “fish slop” – a dish she describes as “garbage with fish parts in it” – inmates would run to their stashes, softening the noodles with hot water from the sink over the toilet.

In 2012, Paulette Padanyi, a now-retired faculty member of the University of Guelph, co-wrote a research paper called Food Provision in Ontario Hospitals and Long Term Care Facilities. Of the 55 hospitals studied, 19 hospital administrators agreed to discuss their food budgets. All of them outsourced the food production. Most told Padanyi that they took their cue from long-term-care facilities, which have a prescribed Ministry of Health and Long Term Care rate of $8.03 per day per patient to spend on food.In 2012, the average amount spent per patient in the hospitals Padanyi looked at was $7.91 a day. “They say to the contractors, ‘You’ve got x number of dollars, eight bucks a day per patient or whatever,’ effectively downloading the responsibility of meeting that budget,” she says.Often, these contracts are not just for patient meals, but the staffing and operation of food franchises within the hospital, plus housekeeping and custodial. The main conclusion of Padyani’s report was that food service is considered unimportant relative to the entire hospital.

Tom, a former prisoner introduced to me through the John Howard Society (which asked that I not use his last name), has served time at various correctional facilities around Ontario and suffers from diabetes and Crohn’s disease. He challenges Ross’s statement. “They don’t follow diets,” says Tom, who is in his 30s, was first locked up at the age of 12 and has spent more than 10 years behind bars. “Any jail food, you’re going to be on the toilet six times a day because what they’re giving you is running though you.”

Compass employs half a million people around the world (including 30,000 in Canada), and supplies food to schools, offices, stadiums, museums, mining camps and offshore drilling platforms, as well as hospitals and correctional centres. Of the company’s many customers, patients and inmates have two things in common: First, they are unable to go buy themselves something more healthy, or at least more tasty; and second, we, the taxpayer, are responsible for feeding them.Last November, Compass took over food services at the Regina Correctional Centre, a move that saved the Saskatchewan government $2.4-million a year. Lacking a Yelp page, inmates went on a hunger strike in January to protest against the quality of the food. “If you don’t like the prison food, don’t go to prison,” Premier Brad Wall responded. In March, inmates refused food again, in part because Compass had raised prices at the canteen.Ontario spends $14.54 a day per inmate to feed about 8,000 prisoners in 26 correctional facilities, for a total of $41.3-million a year, including labour and transportation. The food cost is $9.17 for three meals. Perhaps inmates should not, per our punitive view of criminal justice, be dining on lamb racks and truffles. But it’s hard to imagine eating healthy on $9.17 a day.

May 10, 2016

For my entire life, my doctors, my parents and my government have sent me one clear message about food: Nutrition is a key component of physical and mental health. So I had assumed (and hoped) that if MDs or MPPs were choosing menus for those in their care, the result would be a 3-D version of the Canada’s Food Guide chart I coloured in elementary school.

CUPE 1502 (Canadian Union of Public Employees), which represents Registered Practical Nurses, technical staff including x-rays and diagnostics and support staff at the hospital, is seeking to reverse the cutting of five medical beds and two paediatric beds and the contracting out of services once provided by the Central Service and Reprocessing (CSR) department. CSR provides patient-care areas with clean and sterile supplies and include all reusable patient care equipment such as bowls and basins, anaesthetic supplies and surgical instrument sets. While the 10 people who worked there didn't lose their employment, they were reassigned to housekeeping, and the job they once did will now be handled by a Toronto-based company.