Hospital infection control will be critical in preventing spread of swine flu

1 May 2009

The severity and extent of the current swine flu outbreak (now officially named influenza A(H1N1) by WHO) are unknown, but the SARS outbreak (severe acute respiratory syndrome) in 2003 taught that rigorous infection control in hospitals may be key to limiting deaths from any disease outbreak.

Much will depend on what hospitals do when the first seriously ill victims arrive. "If hospitals have effective infection controls in place, the disease can be prevented from spreading to visitors, healthcare workers and their families," warns Betsy McCaughey, PhD, and Chairman of the US Committee to Reduce Infection Deaths (RID), a national organization that educates the public and medical community about preventing infection [1].

McCaughey explains that "77% of the people who contracted SARS in the Canadian outbreak were patients, visitors or workers in hospitals. SARS was almost entirely a hospital infection epidemic."

SARS filled the headlines in the spring of 2003, and then disappeared. "A report issued after the fact by the government of Ontario (The SARS Commission, Spring of Fear, December 2006 [2]) shows how hospitals in one city thwarted an epidemic while hospitals in another city made deadly mistakes," says McCaughey, an expert on preventing infection.

The Ontario SARS Commission report says that the importance of the precautionary principle that reasonable efforts to reduce risk need not await scientific proof was demonstrated over and over during the SARS outbreak. "One example was the debate during SARS over whether SARS was transmitted by large droplets or through airborne particles. The point is not who was right and who was wrong in this debate. When it comes to worker safety in hospitals, we should not be driven by the scientific dogma of yesterday or even the scientific dogma of today. We should be driven by the precautionary principle that reasonable steps to reduce risk should not await scientific certainty."

When it received its first case of SARS Vancouver General automatically went to the highest level of precaution and prevented an outbreak. In Ontario there was a systemic failure to recognize the precautionary principle in health worker safety, with the result that SARS infected 375 people, including 169 health workers, and killed 44, including two nurses and a physician.

The Commission set out 21 principles for reforming the shortcomings of the public health system demonstrated by SARS. It also made recommendations to address urgent problems that had to be corrected to prevent another tragedy like SARS, including:

  • a lack of provincial public health leadership,
  • insufficient public health capacity and resources,
  •  inadequate provincial laboratory capacity,
  • a lack of central public health coordination and expertise,
  •  an absence of public health emergency preparedness, and
  • a lack of public health links with hospitals, health workers and others.

Many hospitals in the US are under-prepared for a similar challenge, says McCaughey. As many as 10% of patients contract infections in the hospital, according to the Centers for Disease Control and Prevention. Bacteria such as MRSA (methicillin-resistant Staphylococcus aureus) and Clostridium difficile race through hospitals, spread by unwashed hands and unclean equipment. How can hospitals that are failing to prevent ordinary infections spread by touch contain a new, unknown virus that can spread whenever someone coughs or sneezes?

"The best defense against swine flu and other unknown pathogens is rigorous hospital hygiene and routine infection prevention. That is the lesson of SARS," says McCaughey.

Further information

1. Committee to Reduce Infection Deaths

2. SARS Commission. Spring of Fear. Final  Report.

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