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Monday, 19 September 2011

Klebsiella superbug - a real life Contagion.

Even in Public Health, the urgent can bump the more important longer term preventative measures.   With the hit "Contagion" in the theatres, what better than a real life terror story of bugs running rampant.
Homelessness will be later this week and will have killed more people in the meantime. 
Superbugs hit the headlines again, this time it is KPC -  Klebsiella pneumonia Carbapenemases .  Not your everyday  bug, but for hospital Klebsiella is a well known problem causing sepsis and not infrequently contributing to death amongst persons struggling with other disease challenges. The Carbapenemases are a sub class of antibiotics of beta lactamase antibiotics (typified by penicillin and cephalsporins)  which were designed to work against resistant organisms.    The organism which can be resistant to all known antibiotics was first identified in 1996 in North Carolina, and found in Canada in 2008.   This weekend the Jewish General Hospital in Montreal reported on an outbreak that has lasted for about one year.   Supposedly the second “outbreak” in Canada with upwards of 80 known cases having been identified. 
The challenge with the superbugs is that they become colonized in hospitals and readily spread from patient to patient, usually through less than ideal infection control practices amongst very caring individuals.  The volunteer who distributes books, the pastoral community who visit multiple patients, the health care workers who we know are less than ideally diligent in the use of handwashing techniques.  Combine this with older physical structures that include multiple bed rooms, sharing of washrooms, lack of handwashing facilities, and difficult areas to houseclean. 
Those that work in hospitals recognize the balance between the need for constant care and the risks that the hospital environment entails.  These days the risks are starting to exceed the benefits.   While home care is a viable option, in the efforts to maintain the bastions of political generosity to communities, home care programs have been compromised and certainly do not provide the level of service that could be used to replace hospital care (and still be at a lower cost).  
Hospital utilization rates have decreased over 50% in the past 25 years, in some places they are down to almost 1/3rd their previous rates of utilization (bed days per 1000 population).   They remain the flagships of our overweight   health care system and continue to be fuelled by public desire, vested interests and political aspirations rather than strictly driven by contributions to the overall health of a community.   We remain fortunate in Canada that other than individual health care workers, there is limited influence by corporations that include financial profit within their “balanced scorecard”. 
If you need to go to a hospital, remember to wash your hands going in and out of rooms, only visit one person, and limit what you touch.  Not just for your own protection, but you can easily become the vector that transmits organisms from one person to another without your knowledge or any symptoms.

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