Superbugs Are Lurking In Hospitals

The pandemic isn’t the only crisis we should be concerned about

“The very first requirement in a hospital is that it should do the sick no harm.” Florence Nightengale

Nosocomial infections are commonplace in hospitals. The very place that you go to for help can cause more problems.

I’ve seen it all too often; a patient comes in for elective surgery such as a hip replacement and ends up with an infection, likely due to unsuspecting contamination during surgery. Sure, there are strict protocols in place from sterilizing equipment to aseptic techniques to ensure infections are prevented, but there is always the odd case that slips through those procedural cracks.

Hours or days later, a patient spikes a fever; their incision — or system — turns into a septic tank and so, of course, they are prescribed antibiotics.

Well, guess what? Those pills that are meant to cure a raging fire inside you can do a number on your gut and then expose you to another more problematic issue, Clostridium Difficile, commonly referred to as C. Diff.

Another round of antibiotics to cure that sucker — usually Vancomycin — and holy moly, you can then end up with a Vancomycin-Resistant Enterococcus, or VRE.

I’m not shitting you.

I’m meaning that both literally and figuratively. The stomach cramps and stinky diarrhoea associated with these infections can be brutal.

And I haven’t even mentioned MRSA — Methicillin-Resistant Staphylococcus Aureus, the initial scary bug that proliferated hospitals before these horrors surfaced.

Of course, more antibiotics are required to treat this new infection. Can you see the vicious circle all this creates? Unfortunately for humans, microbes are smarter than we are and the World Health Organization has every right to be concerned about these superbugs infesting our hospitals.

“Anti Microbial Resistance is one of the most urgent health risks of our time and threatens to undo a century of medical progress” (World Health Organization 2019). Globally, today, 700,000 people die of resistant infections every year; and, if no action is taken, it’s estimated that by 2050, 10 million lives are at risk worldwide due to the rise of drug-resistant infections (Review on Antimicrobial Resistance, 2016).

Pandemic precedence

Right now, we are worried more about the pandemic.

Yes, it is a global concern. We have seen how ill-prepared our governments and the health industry were to cope with the outbreak — and the terrifying consequences. Here in Montreal, an outbreak in a nursing home sent 47 residents to their graves. Now, whether they died of Covid, or neglect when a large chunk of the caregivers jumped ship, is still debatable — and it’s thankfully still under the coroner's beady eye.

I was horrified that these poor souls were left to waste away; unfed, not washed and alone. They died emaciated, dehydrated and covered in their own excrement.

I hope every single caregiver that ran from the scene is held accountable, despite not being given the tools to protect themselves or to properly administer care for their patients.

We — healthcare professionals — know better than to run. We are ethical and accountable for our actions. Any one of those ‘caregivers’ could have done better, even if it meant picking up the phone and alerting the media; something we are not akin to.

Someone finally pulled the alarm bell— but it was a little late.

But guess what? That buggar— the virus — has cloned itself and found different ways to proliferate a host; humans.

Systemic pressure

Our fundamental aim as healthcare professionals is to help people in times of illness. To do that, we need knowledge, support and equipment — and in many hospitals, that was severely lacking during the pandemic.

We were essentially caught with our pants down.

Thankfully, I have seen some significant changes because of the pandemic*. Finally, we have more equipment available to perform basic tasks such as taking vital signs. We used to scramble to get our hands on an electronic machine as there was only a few to service a unit. Now there is one in every room.

Cross-contamination for C.Diff and VRE was probably rampant pre-Covid. Proper handwashing with soap and water — that is not using antiseptic washes — is the only way to kill these microbes.

I’ve often wondered why institutions don’t screen their health care workers — and I’ve come to the conclusion that if they did, they would probably find many of them are the contaminators. But that’s my own opinion and it has not been proven.

Personal Protective Equipment — PPE — is now prevalent after an initial shortfall of items. Although it was always available for C.Diff, VRE and MRSA patients, there wasn’t an abundant supply for every nurse, patient attendant or doctor to change gowns, gloves and mask in between caregiving during Covid.

Heck, pre- Covid, I didn’t assign isolation patients to my nursing students, aware of the finger waggling I’d get for blowing the equipment budget. Students tend to check on their patients more often, and their visits usually require supervision.

Which accounts for more dollars.

It’s all about money, unfortunately.

Now, I literally don’t give a shit. The only patients I am not allowed to assign to my students are Carbopenom-resistant Enterococci or CRE ones. Yup, another superbug that has reared its ugly head from the use of antibiotics. Patients who have this micro-organism in their system actually have a security guard sitting outside their door to ensure proper procedures are respected to avoid cross-contamination.*

I kid you not.

The takeaway

My message isn’t that you shouldn’t go to a hospital if you are unwell or have an elective procedure for fear of picking up a superbug— far from it.

Not everyone ends up with a nosocomial infection. But the stats here in Canada are rather staggering. I have no doubt they are no better anywhere else. The sad thing is, the general population has no idea about the risks, and yet, there are some easy things to do to prevent the spread.

I’m approaching this issue from both sides of the fence: as healthcare professionals, we must stand firm and have the equipment necessary to provide safe patient care. If it is not forthcoming, you have to speak out or SHOUT out if necessary. Your health impacts that of the ones you are caring for.

If you don’t respect the PPE guidelines, then you are proliferating the spread of these superbugs. Take a stance and stop this nonsense of not having the proper tools to provide safe care. Go to the union. Collaborate with each other. Make your situation heard to governmental bodies.

Secondly, we must educate families on why they have to gown and mask up and wash their hands before and after visiting their loved ones — and be honest about the reasons they are being asked to do so. If they know the potential consequences of not following the directives, they’re more likely to oblige. We are not depriving them of visiting; we understand more than ever the importance socialization plays in recovery. We’re cognizant of them and their loved ones.

They must follow the rules because it can impact them — and us. It can feed the beast that is invisibly rampant.

And my last point defies all the rules of not bringing up something new in a conclusion, but it needs to be stated:

Antibiotics are for bacterial infections. If you are prescribed them, you need to take the full course. Do not stop them if you feel better. Stopping them mid-course feeds the superbug beast.

If you don’t eradicate a bug completely, the microbe sits back in dormancy and awaits another infection. It then laughs its head off as the same antibiotic is sent to tackle the next infection. It remembers its predecessor.

It likes the antibiotic because they became friends. It had time to figure out it’s deathly strike. The antibiotic tried to eradicate the microbe — but the microbe played dead, when it really wasn’t.

It is now better armed, and more vicious.

A microbe is a human terrorist.

It waits in the background; presumably obliterated from an initial attack but, like a terrorist cell, it has tentacles penetrating surreptitiously, just waiting for the call.

It’s an invisible threat with potentially dire consequences.

Our only defence is to wash our hands — with soap and water — respect the prescribed dosing regime, and follow the PPE rules instigated by institutions.

• The changes I have mentioned are what I have witnessed as a nurse in the healthcare industry during the pandemic here in Montreal and are not reflective of all institutions, or of Canada.