Spring 2012 Report Released
Infection prevention and control practices are inadequate in some Nova Scotia hospitals, and the Cape Breton district has a poor culture of infection prevention and control, Auditor General Jacques Lapointe said in his report released today, May 30.
The auditor general said poor infection prevention and control practices may have contributed to a C. difficile outbreak in Cape Breton hospitals in early 2011. He added that the district's response to the outbreak was ineffective.
His report identifies numerous deficiencies such as poor monitoring of hand hygiene practices and inappropriate cleaning in patient rooms.
The auditor general discovered significant problems at Cape Breton Health in ensuring reusable medical equipment such as internal gastro, broncho and colon scopes were properly cleaned and disinfected. He reported two cases in which no evidence could be found that scopes were cleaned and disinfected before being reused.
While processes overall at Capital Health were significantly better, one instance was found in which a scope might not have been disinfected.
Both districts routinely used flash sterilization of surgical instruments as an alternative to a full sterilization process. This technique is meant to be used only in an emergency.
Three years ago, the province established an infection prevention and control unit at the Department of Health and Wellness, but it lacks the resources to effect change. The best practices guidelines it developed are not mandatory; the department does not know what infection prevention and control practices and policies are in place in district health authorities and is not aware of the level of hospital acquired infections.
Mr. Lapointe said his recent audits suggest the department needs to do more to meet its responsibilities under the Health Authorities Act to monitor, measure and evaluate the quality, accessibility and comprehensiveness of health services delivered by the authorities. An accountability framework for district health authorities has been more than a year in the making.
The auditor general also uncovered weaknesses in processes to monitor prescribing and distributing controlled prescription drugs, which he said can be corrected through improvements in monitoring and control systems, and in technology.
His report identifies monitoring system issues that could allow abuse or misuse of monitored prescription drugs to continue undetected. He makes 17 recommendations in order to bring greater rigour to the system.
An audit of addiction services in the Annapolis Valley found that the services are well managed. Policies are based on best practices and service delivery is timely. The Health and Wellness Department's oversight, however, is not adequate to ensure the district is complying with established provincial standards for addiction services.
Mr. Lapointe said government's overall record in implementing recommendations from past reports remains poor. Recommendations dating back to 2005 and 2006 have still not been completed and he has written them off as a failure to implement.
He pointed to the Department of Education as the weakest performer, completing only 13 per cent of recommendations between 2005 and 2009.
"Last year, senior management in that department gave their undertaking to address outstanding recommendations as a priority. Clearly this was not done," said Mr. Lapointe.
He cited the same department for unco-operative behaviour.
"My office encountered significant difficulty completing this review, as we experienced delays in obtaining information from the Department of Education."
He said the failure across government to implement recommended measures to improve efficiency, reduce risk and improve government services constitutes poor management, and represents a deficiency in accountability to the people of the province, the legislature and, in the case of internal reporting, to Cabinet.
Information provided by Treasury Board Office to Cabinet on the status of recommendations contained numerous errors. As a result, the first provincial update issued last year by the premier on the status of implementing recommendations was inaccurate. Nevertheless, Treasury Board Office rejects the need to improve this information.
Mr. Lapointe identified some weaknesses in the Office of Public Trustee's processes for collecting and safeguarding clients' assets and made 16 recommendations to correct the problems. He did not discover any loss of clients' property.
The 140-page report contains 77 recommendations to government.
The full report is available at www.oag-ns.ca .