The French Health Ministry, which has established very specific criteria in this field (ICALIN), noted that since the implementation of national prevention and control measures in 2004, sixty percent (60%) of all establishments received an "A" rating, the highest possible ranking. The main bacteria that cause NI's are: Escherichia coli (25% of all cases), Staphylococcus aureus (19%) of which more than half are Methicillin resistant (MRSA) and Pseudomonas aeruginosa (10%) of which 25% are resistant to Ceftazidim.
Hospitals are not rated on their results but rather on the implementation of and adherence to prevention and control measures. Tabulating results, for example the number of deaths following treatment, is difficult because results often vary greatly from hospital to hospital. Many factors affect a hospital's results; for example the number of severe cases taken on by the hospital or whether the hospital is located in an area that has a high level of social and health problems.
This evaluation method not only shines the light on establishments that have high quality care, but also on those that are less stringent. In the latter case, the purpose is not to lay blame but rather to rectify the situation. Problem management is best accomplished through evaluation and then implementation of corrective measures. Publishing hospital rankings is an excellent way to inform patients, the public, and health care workers who deal with this on a daily basis. Good results should be rewarded, and success becomes a source of pride for the workers concerned. Establishing specific indicators of care quality, and revealing results to the public have been severely criticized by many in the health care field. Nobody likes to be judged, but the huge reduction in NI incidence throughout France's hospitals cannot be denied and clearly demonstrates that the effort is worthwhile. Prevention and control have been made priority one. NI victims are no longer marginalized. One of the best indicators of care quality is a hospital's NI rate.
French health authorities firmly believe that the reason for this success is improved compliance with hand cleanliness measures. However, Health Minister Xavier Bertrand is quick to point out there is room for improvement because NI's still cause 4000 deaths annually. Consequently, Bertrand has added new indicators to the list of surveillance procedures already in place in order to ferret out the most dangerous resistant bacteria.
France has one of the lowest NI rates in Europe due to the implementation of a systematic prevention and control program ten years ago. France's NI rate is only 4.9% compared to 10% in Quebec and the other Canadian provinces. NI victims suffering from incapacitating complications have easy access to compensation. Unfortunately in Canada, it is impossible to obtain compensation without hiring a lawyer and suing the hospital.
If France is still not satisfied with such a low death rate, (4000 deaths annually out of a population of 70 million), what can we say about Quebec where 4000 patients die annually out of a population of only 7 million?
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