The InterView: January - March 2017

OCT 2016

MAR 2017

NEWSLETTER INTERHEALTH CANADA TCI

THE

INTER-VIEW

AN INVESTMENT IN THE EDUCATION SECTOR Welcome to the March 2017 edition of TCI Hospital Newsletter, which features stories from across the healthcare organization. A new edition is published at the end of every quarter.

Inside the Issue

Quote of the Quarter

“To know even one life has breathed easier because you have lived. This is to have succeeded.”

-Ralph Waldo Emerson 1

01

An in-depth analysis of patient activity levels at Turks and Caicos Islands Hospital six years later.

02

TCI Hospital received the highest ranking “Category A” by PAHO officials under the Safe Hospital Index.

03

Interhealth Canada Corporate invests $6000 in new computers for the country’s National Library Service.

04

A fundraiser created by a late cancer patient raise funds to purchase an MRI Sound System.

05

Mass casualty incident drill challenge local disaster response agencies with 7.0 earthquake scenario.

06

‘My Kidney Story’ event raises awareness of Renal Failure as patients and special guests share heartfelt stories about their lives.

Patient volumes for certain services offered at TCI Hospital have reached peaks 17 years earlier than projected.

it's about growth.

It is impossible to accurately predict the number of persons who will require medical care in any given year, and therefore patient volume projections can exceed expectations. An increase in patient load is intricately connected to changing healthcare needs, shifts in life-style habits, immigration, population growth and the onset of major local developments, thereby affecting the cost of health care.

TCI Hospital is the National Health Insurance Board’s preferred healthcare provider. 70% of patients treated in the inpatient units of the hospital are covered under the National Health Insurance Plan while the remaining 30% are self-payers.

These private/self-pay patients may be visitors to the island, Resident Certificate holders, or persons presumed to be undocumented or without legal status in the country.

Projections were made and the hospital anticipated at least 20,000 visits to the Outpatient Department (OPD) between April 2010 and April 2011. However, 31,884 visits were recorded during the period under review. Â

2

Within 12 months of operation, this figure had already surpassed the 30,000 OPD visits projected at the close of April 2033. By 2016, the number of outpatient visits climbed to 62,433 visits.

A larger number of persons are accessing acutesecondary healthcare services far beyond what was predicted. These volumes are in keeping with international healthcare facilities, which seek to continuously develop Outpatient Department services as opposed to costly Inpatient care. However, as the data will indicate, even with over 62,000 Outpatient visits, the Inpatient Department is still actively utilised.

service expansion.

By April 2033, a total of 25,000 visits to the Emergency Department was projected. Within the first year, the Emergency Department at TCI Hospital had already recorded 26,378 visits.

With the exception of 2014, which recorded an unusual swell of 31,485 visits, the number of ED admissions only moderately fluctuated since the inception of the hospital in April 2010.

"TCI Hospital has been accredited at the Diamond level since March 2012 by Accreditation Canada."

These fluctuations in Emergency Department visits are attributed to peaks in communicable diseases and other disease related surges.

The Blue Hills Clinic and the introduction of the Ministry of Health extended clinics in July 2016 have also contributed to shifts in patient levels at TCI Hospital.

3

More than 2,000 inpatients who require hospitalisation are cared for during most years and some inpatients are spending even longer periods of time at TCI Hospital after their acutecare has ended. The number of inpatient days climbed from 7,460 days in 2010 to 8,692 days in 2014. Last year patients accumulatively spent 11,050 days at TCI Hospital facilities.

the healthcare landscape: statistical perspective The number of dialysis patients have nearly doubled over the past six years from 23 in 2010 to 41 patients in 2016.  At least five patients are being diagnosed with chronic renal failure every year.

The dialysis unit is quickly approaching the figure projected for April 2033 which is 48 patients.

Persons in younger age-brackets are also being diagnosed with chronic renal failure with the predominate associated illness being diabetes and hypertension. The strengthening of primary health care and preventative medicine continues to be a national priority.

The number of dialysis patients have nearly doubled over the past six years. At least five patients are being diagnosed with chronic renal failure every year.

By the year 2033, it was estimated TCI Hospital would perform between 2,100 to 2,700 surgeries in a single year. Surgical and Endoscopy teams performed over 1,541 surgeries last year compared to 957 in 2010. Between the years 2011 and 2015, surgery volumes remained over 1,000 surgeries per annum with an additional 100 surgical operations performed in some years.Â

The Special Care Baby Unit (SCBU) is monitoring new borns for even longer periods of time recording 812 days in 2016, compared to 756 days in 2015 and 258.57 days in 2010. Birth Statistics show that 361 babies were delivered at TCI Hospital in 2010; six years later 518 babies were delivered.

Premature babies may remain in the SCBU for long periods to ensure close monitoring of their growth and manage any complications. 4

bed occupancy waiting times

An inpatient recently spent 276 days at TCI Hospital while some current long stay-patients have been in a hospital bed since mid 2016, and have surpassed 327 days under inpatient care.

Interhealth Canada continues to work with the Ministry of Health, Agriculture and Human Services and Social Services to support their efforts to address these opportunities for social development and support effective discharge planning.

An analysis of the full spectrum of hospital capacity is conducted once volumes exceed those previously experienced. For certain services, these figures have prompted the need to seek approval from TCI Government for adjustments to staff complement, consumables and operational costs through a process called ‘Change Enquiry’ in-order to continue providing quality health care. There has been Change Enquiries approved over the past six years in response to service expansion and increasing activity with additional staffing inclusive of medical, nursing and ancillary.

The increase in patient volume is good news, as it reflects the hospital’s growing role in providing quality patient care to residents who are actively utilising the services, but it has its share of challenges, which are connected to bed occupancy and waiting-times. The issue of bed shortage is affecting hospital’s worldwide.

A recent analysis by BBC showed 137 out of 152 hospital trusts in England have been overcrowded since the start of December 2016. The same trend is apparent in Canada.

Historically, on several occasions, bed occupancy at TCI Hospital is aligned with internationally recognised levels that hospitals are advised to retain in-order to manage the risk of infection and to ensure there is spare capacity to deal with major on-the-day emergencies.

However, due to increasing patient volume, there is an ongoing challenge to find beds for patients who need to be admitted.

A second variable which creates bed blockages is delayed discharges after treatment, which are beyond the hospital’s control. Vulnerable patients cannot be released from hospital after acute-care has ended if there is inadequate social support in the community and limited beds in external long-term care facilities.

5

Commenting on patient activity levels, Chief Executive Officer, Mr. Daniel Carriere said:

“Although there was paucity of data available in the past to accurately predict future volumes, Interhealth Canada and the then Turks and Caicos Islands Government included a shelled space in the planning parameters for future growth and expansion of both facilities. The greater than expected change in patient volume has been the catalyst for accelerated discussions with the previous and current Government regarding the operationalisation of this enclosed space, which requires retrofitting, equipping and staffing in its current form.”

He continued: “We recognise the importance of TCI Hospital to the population and its significant role in the overall health care system. The increased patient activity has affected our staff and the community as a whole. I am proud of our dedicated clinical and non-clinical personnel who, despite the increased workload, continue to exemplify commitment, dedication and most importantly, care and compassion. I wish to also thank the wider community for their patience and understanding as we work with the Turks and Caicos Islands Government to even better accommodate, safely and effectively, the needs of our patients and their families.”

6

Both the Cheshire Hall Medical and the Cockburn Town Medical Centres are structurally engineered to withstand a Category 5 level storm.

SAFE, SMART HOSPITAL

Healthcare stakeholders also participated in a training workshop on March 14-17, 2017 at the DECR conference Room in Providenciales facilitated by PAHO instructors.

More than half of the16,000 hospitals in Latin America and the Caribbean are in areas at high risk for disasters such as hurricanes, earthquakes or flooding. The Safety Index score places a health facility into one of three categories of safety, to help authorities determine which facilities most urgently need interventions: • Category A is for facilities deemed able to protect the life of their occupants and likely to continue functioning in disaster situations.

• Category B is assigned to facilities that can resist a disaster but in which equipment and critical services are at risk.

• Category C designates a health facility where the lives and safety of occupants are deemed at risk during disasters.

According to PAHO’s website, the Hospital Safety Index provides a snapshot of the probability that a hospital or health facility will continue to function in emergency situations, based on structural, nonstructural and functional factors, including the environment and the health services network to which it belongs. By determining a hospital’s Safety Index or score, countries and decision makers will have an overall idea of its ability to respond to major emergencies and disasters.

The PAHO team visited the Cheshire Hall Medical Centre to make observations and recommendations where necessary. During a round-table discussion,TCI Hospital was also said to have one of the most detailed Disaster Emergency Response plans representatives had ever seen. The Turks and Caicos Islands Hospital maintains an updated and effective, all hazards, Emergency and Disaster Preparedness and Response Plan to respond to both internal and external emergencies and disaster situations.

7

Employees and patients were elated to meet and greet the country’s new leader and Minister for Health during an official tour of Cheshire  Hall Medical Centre on Providenciales and Cockburn Town Medical Centre on Grand Turk a few weeks into their first term as Government of the Turks and Caicos Islands.

8

TCI PREMIER AND MINISTER OF HEALTH WITH EMPLOYEES

Hon Sharlene Cartwright Robinson LLB JP (born 1971) hails from the Island of South Caicos and though she is a lawyer by profession called in 1998, she has spent a great deal of her time in service to her Country.

The newly-elected Premier of the Turks and Caicos Islands, Honourable Sharlene Cartwright-Robinson and Minister of Health, Agriculture and Human Services, Honourable Edwin Astwood conducted their first official tour of TCI hospital visiting Cockburn Town Medical Centre in Grand Turk and Cheshire Hall Medical Centre during the week of 24th January 2017.

Hon. Cartwright-Robinson became the first female Premier of the Turks and Caicos Islands after leading the People’s Democratic Movement to victory in the country’s General Elections on December 15th, 2016. Hon. Cartwright-Robinson became the first female Premier of the Turks and Caicos Islands after leading the People’s Democratic Movement to victory in the country’s General Elections on December 15th, 2016.

Commenting on the official visit, Chief Executive Officer, Daniel Carriere said:

9

“TCI Hospital Senior Management Team and staff are extremely grateful to Premier of the Turks and Caicos Islands, Honourable Sharlene Cartwright-Robinson and Minister of Health, Agriculture and Human Services, Honourable Edwin Astwood for visiting Cheshire Hall Medical Centre and Cockburn Town Medical Centre in the midst of their busy schedules.

Both ministers took the time to interact with our staff members, patients and visitors. Interhealth Canada is looking forward to working with the newly-elected government in the spirit of collaboration. Our company will render assistance, wherever possible, to help create solutions and further enhance the health care system in the Turks and Caicos Islands.”

my kidneystory 10

an ounce of prevention is worth a pound of cure.

11

turning the spotlight on Renal Failure

12

GRENADA MINISTER OF IMPLEMENTATION TOURS CHESHIRE HALL MEDICALÂ CENTRE

13

PROFESSIONAL DEVELOPMENT Dr. Dionne Lightbourne is a highly-experienced health professional and a native of the Turks and Caicos Islands who is training to become a Certified Medical Examiner.

eneral Practitioner, Dr. Dionne Lightbourne is currently participating in an overseas Forensic Medical Examiner’s Course for Rape and Sexual Assault sponsored by Interhealth Canada - TCI Hospital.

This one year course is being offered

by St Mary’s Sexual Assault & Rape Centre (St Mary’s SARC) in Manchester, United Kingdom.

Dr. Lightbourne will travel to the UK four times this year for in-person sessions and SARC visits. Upon completion of the course, the TCI Native will become a certified Forensic Medical Examiner for Rape and Sexual Assault cases.

At least three other clinicians at TCI Hospital have obtained this certification in recent years, however two of these individuals are no longer with the healthcare institution. Doctors assigned to the Emergency Room currently address these sensitive cases, however, TCI Hospital will have a new specially trained doctor to handle these delicate and time consuming examinations.

The mission of the Turks Islands Hospital is to provide the community and its visitors with high quality healthcare.

14

In order to ensure that it delivers on this promise, the office of education invests much time in supporting this mission by ensuring that the clinical and nonclinical human resources of the Hospital are afforded the opportunity to develop and enhance their technical skills and abilities. The Office of Education, which is a division of the Human Resources Department, is mandated with co-ordinating and administering a robust suite of programs which include Soft skills workshops, in service training Continuing Professional Education, Web-casts, Online Learning and Professional Re-Certification.

1 Isabelo, more commonly known as 'Billy' just reached another level in his career. He completed his Masters in Nursing program.

Congratulations is extended from the Surgical Services team.

2 Jenifer completed an introductory course in Infection Prevention in the Ambulatory Surgery Care setting. This introductory course, opens up new knowledge and resources for continuing her education in Infection Prevention.

Jenifer is an Infection Control Link Champion at TCI Hospital.

The Information, Management and Technology Department at TCI Hospital participated in the HIMSS Conference & Exhibition at Orange County Convention Centre in Orlando, Florida on February 19-23, 2017. HIMSS means Healthcare Information and Management Systems Society. IM&T Manager, Ryan Smith and HIS Manager Detorrie Tennant were in attendance.

The conference brings together 40,000+ health IT professionals, clinicians, executives and vendors from around the world.

Exceptional education, world-class speakers, cutting-edge health IT products and powerful networking are hallmarks of this industryleading conference. More than 300 education programs feature keynotes, thought leader sessions, roundtable discussions and workshops, plus a full day of preconference symposia.

Topics discussed included: Clinical and Business Intelligence, Cybersecurity and Privacy & Security, Innovation Entrepreneurship and Venture Investment, Health Information Exchange, Interoperability and Data Access and Health IT Public Policy.

Detorrie Tennant said he was most enthused by: ...The unrelenting engagement of the Federal government in the development of Information and communications technologies in the Healthcare Sector; the innovative products and solutions by wide group of private investors, clinicians, engineers and information specialists/experts/academics; the keen interest and contribution by professional women in the industry.

15

3

Shawna, a Lead nurse in the Surgical Suite, attended a Laparoscopic Conference in Jamaica where she was able to share some techniques and processes used at TCI Hospital, as well as learn about new procedures and equipment.

MARYLAND SURGERY CENTRE DONATES MEDICAL EQUIPMENT TO TCI HOSPITAL The Friendship Surgery Centre in Chevy Chase, Maryland has donated a special medical equipment, which will advance the level of Cataract surgical procedures conducted at TCI Hospital.

The Advanced Retinal Vitrectomy Machine valued at around US$60,000 will expand the ability to provide retinal surgery in the near future. The centre specialises in eye procedures including Cataract Surgery and have state-of-the-art equipment. The donation was facilitated by a duo of IHC Visiting Ophthalmologists, Ramzi Hemady, M.D. and Gayatri Reilly, M.D. who are based in Maryland.

Dr. Ramzi Hemady and his team have been visiting the Turks and Caicos Islands for more than 19 years providing tertiary eye-care to patients since the Myrtle Rigby Clinic era. His team performs an estimated 15 surgeries per week and provides Ophthalmology care for more than 40 patients daily during specialist clinics held at TCI Hospital on a quarterly basis.

Discussions have been ongoing for several years to acquire the special medical equipment and shortly after the new year the equipment arrived on island for a special hand-over to TCI Hospital held on 19th Jan, 16 2017.

L-R: Gayatri Reilly - IHC Visiting Ophthalmologist; Dr. Ramzi Hemady - IHC Visiting Ophthalmologist; Douglas Moore IHC Chief of Clinical Services; IHC Chief of Medical Services - Dr. Denise Braithwaite-Tennant; IHC Surgical Care Services Manager - Pheona Brown.

Cataract Surgical Procedures can now be advanced.

NEWSLETTER

KNOWLEDGE IS POWER.

Interhealth Canada Corporate invests US$6000 in modern computers for public libraries country-wide.

I

nterhealth Canada Corporate has delivered on its commitment to invest US$6000 in the education sector with the procurement of eight HP ProDesk 400 G3 Small Form Factor Desktop PC’s for the National Library Service of the Turks and Caicos Islands. The pledge was originally made during TCI Hospital’s anniversary celebration last year.

A press conference was held at Cheshire Hall Medical Centre on Thursday, February 9th 2017 to formally handover the much-needed modern computers to the country’s public libraries. The team from Interhealth Canada led by Chief Executive Officer, Daniel Carriere included Chief of Medical Services, Dr. Denise Braithwaite-Tennant and Hospital Information Systems Manager, Detorrie Tennant.

Minister for Education, Honorable Josephine Connolly accepted the donation on behalf of the Turks and Caicos Islands Government and praised the company for its consistent investment in community projects. Other corporate companies were encouraged to make similar investments as part of their social responsibility.

Head of the National Library Service, Cecil Graham who was accompanied by Library Assistant, Sharene Gibbs said the computers were highly-anticipated as the five branches across the country are in dire need of functional and modern computers. These libraries are located on Providenciales, Grand Turk, South Caicos and two branches can be found in North Caicos. Plans are underway to introduce computer classes for library users on everyday software packages such as Microsoft Office.

17

community connected Everyday we touch lives in the medical setting, but our impact surpasses our four walls.

Health Fair Sponsor 01 Career Expo 02 Skeletal System 03 HJRH Exit Readiness 04 Good Samaritan 05 18

community connected Everyday we touch lives in the medical setting, but our impact surpasses our four walls.

Media Blitz 06 $5,000 for Autism 07 HJRH Careers Day 08 CHHS Exit Readiness 09 Handmade Blankets 10 19

WENDY HAYWARD

"EVERY TIME A SONG IS PLAYED, WENDY’S LOVE FOR MUSIC WILL BE REMEMBERED

BY OUR TEAM.” 20

WENDY LOST HER BATTLE WITH CANCER IN 2016.

MUSIC IS POWERFUL.

GIVING BACK.

21

Road to Diamond

22

23

ANTIMICROBIAL RESISTANCE

CLINICAL RISK MANAGEMENT

24

Lorenzo Seymour PROMOTED TO HUMAN RESOURCES MANAGER I wish to express my heartfelt thanks and appreciation to the Management and staff at InterHealth Canada TCI Ltd for the awarding opportunity of being promoted to Human Resources Manager. The word “award” was deliberately used as it is an honour to serve in such a capacity.

I have worked with the company for over two years and have been with employees during the smiles and tears. I will continue to do my utmost best to ensure that the company continues to move forward with improvements to the services that we currently provide, while also looking to find new ways to recognise, motivate, educate and develop our human resources.

As there is no 'I' in team, please note that the Human Resources and Education team is committed to refocusing our view of customer service to a more customer care approach. I understand this will not be easy, however this can be accomplished with the assistance of employees. The Human Resources & Education Department exists to serve employees and we look forward to forging an even stronger relationship.

Seymour brandishing his thankful thursday note reflecting what he is grateful for.

Lorenzo Seymour

World Kidney Day at CTMC After visiting two schools in recent years, the Dialysis Team at Cockburn Town Medical Centre made a presentation to Ona Glinton Primacy School on Renal Failure, which was greatly received.

25

An information boot was set-up in the hospital foyer with information material. Staff members from Facilities Management and Dental Clinic were given a special educational session on prevention of Renal Failure.

26

SAFETYFIRST

SAFETY TIPS FOR LONE WORKERS ON THE JOB Know Your Risks Employees also have a duty of care to look after their own health and safety. Employees should review all the risks identified in their areas and work within the established guidelines.

Line managers should be notified if there is a possible risk that could put employees in harm’s way. For TCI Hospital staff members, these risks may be reported via an internal system called Pavisse. Employees are trained on how to respond to emergencies and have clear action plans. Should a medical condition arise that could put an employee at risk working alone, line managers should be notified immediately.

Dealing with the Public Healthcare professionals are subjected to unpredictable situations. Employees should always be attentive and aware of their surroundings.

Always note where a security officer is located. Read the verbal and non verbal signals being shown by a patient. Ensure there is clear access to an exit door. All sharps should be stowed away in a locked cabinet, i.e. scissors and scalpels. Panic buttons are easily accessible and should be tested regularly to ensure they are functional.

Alert Security Once security is notified, the frequency of patrols can be increased to look after the safety of a lone employee.

SAFETY FIRST

THELONEWORKER Welcome to the second edition of 'Safety First’ created by the Health & Safety Committee at TCI Hospital. Each edition seeks to provide useful tips and information to help improve safety in the workplace.

This article focuses on lone working and outlines six ways for employees to keep safe.

Who is considered a lone worker? Lone workers are people who work by themselves without close or direct supervision. One example may be a person working alone in a small workshop. Persons working alone outside of the normal working hours may also fall into this category. These individuals may be healthcare workers, security personnel, housekeepers, porters or even engineers. Employers have a duty to assess the risks associated with lone workers and ensure steps are taken to avoid or prevent risks where necessary.

We hope you found this information useful. Together, we can build a safer working environment.

Your Limitations

CCTV in the employees specific work area will also be closely monitored. If an employee should leave for any reason, the security department should be advised of the length of time.

27

It is important to know your physical limitations.

Do not perform tasks such as heavy lifting or moving mechanical devices alone. Employees should ask for assistance. Injuries may occur and it may be a considerable length of time before someone is aware of the injury.

Build Contact Lists As employees begin their shift, landlines should be checked to ensure they are working. The security department should be on speed dial and contact numbers for persons working within the same hospital should also be saved.

Giving Back.

28

NEWS

Glo Germ was used to demonstrate how germs can quickly spread from one person to another during a special hand hygiene workshop held in mid January.

There were a total of 80 participants across the two hospital sites.

The liquid product contains proven safe ingredients formulated to be the same size as bacteria, basically 5 microns in size. To demonstrate proper hand washing, employees were instructed to rub Glo Germ lotion on their hands. This simulates the spread of thousands of tiny plastic fluorescent 'germs' on their hands. Then, each employee was asked to wash their hands as they normally would. Finally, a fluorescent ultraviolet flashlight was used to spot the remaining 'germs'. Under the lamp, the plastic 'germs' glow brightly so that they may be easily seen by the employee.

Members of the Facilities Management team at Cockburn Town Medical Centre have successfully completed training in Cardiopulmonary Resuscitation also known as CPR instructed by Nurse Michael Williams.

The group consisted of FM Management, Heads of Department from Administration, Security, Engineering and Soft Services.

The training will allow persons to take immediate action in the event of a cardiac arrest in non-clinical areas and in the community until a medical team arrives. It is an essential life-saving skill.

Members of the team were thrilled to participate in the training, and have encouraged their FM colleagues to participate in the next session scheduled for April 2017.

29

Both clinical and non-clinical staff were found to be following the proper technique for hand washing, which is particularly important for healthcare workers to prevent the spread of health care related infections or bacteria.

SUPERBUG RESISTED 26 ANTIBIOTICS

ARTICLE WATCH

“People keep asking me, how close are we to going off the cliff,” says Dr. James Johnson, professor of infectious diseases medicine at the University of Minnesota.

The cliffside free fall he is talking about is the day that drug-resistant bacteria will be able to outfox the world’s entire arsenal of antibiotics. Common infections would then become untreatable. Here’s Johnson’s answer: “Come on people. We’re off the cliff. It’s already happening. People are dying. It’s right here, right now. Sure, it’s going to get worse. But we’re already there.”

People in the U.S. have died from so-called superbug infections before. The CDC estimates that 23,000 die every year from multidrugresistant infections. A British report, The Review on Antimicrobial Resistance, estimates that globally, 700,000 people die each year from infections that are drug-resistant. In many of those cases, the infection’s resistance was discovered too late, perhaps before a last-line, effective drug was finally initiated. In poor countries, those newer, more expensive antibiotics often are not available. The Nevada case is different in that resistance was discovered early in treatment, but even the drugs seen as the last line of defense didn’t work. “This one is the poster child because of resistance across the board,” Johnson says.

The woman described in the report was in her 70s and treated in a hospital in Reno. About two years ago, on an extended visit to India, she broke a thighbone, according to the report.

His declaration came in response to a report of a woman in Nevada who died of an incurable infection, resistant to all 26 antibiotics available in the U.S. to treat infection. Her death was reported in the Jan. 13 Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention. That kind of bacterium is known as a “superbug,” which belongs to a family of bacteria resistant to antibiotics. In cases like the Nevada woman, who was infected with Klebsiella pneumoniae, the term “nightmare superbug” has been coined because this particular specimen was even resistant to antibiotics developed as a last resort against bacterial infection.

She had several hospitalizations in India because of infections, says Dr. Lei Chen, of the Washoe County Health District in Reno and an author of the MMWR report. When the patient was admitted to the Reno hospital, health workers discovered that the bacteria specimen tested was resistant to a class of antibiotics called carbapenems — carbapenem-resistant enterobacteria. “Before, we could go to carbapenems, and they could reliably squash the bugs,” says Johnson. “This case broke down even our last great gun.”

The woman’s most recent hospitalization for infection in India had been in June 2016. She was admitted to a hospital in Reno in August, and state health department officials were notified that she had CRE. 30

THE DANGERS OF INCURABLE INFECTIONS “Lab results showed she was resistant to all 14 drugs we tested,” says Chen.

Further tests at the CDC lab showed resistance to 26 antibiotics. She died in September of multiple organ failure and sepsis. “This was my first time to see such a resistant pattern,” says Chen.

CRE infections are rare in the U.S. The CDC does not require that hospitals report CRE cases but estimates that some 175 cases have been reported in the states as of January 2017. “The majority of [CRE] cases still respond to one or two classes of antibiotics,” says Chen. CRE infections are more common in India and Southeast Asia. The reasons aren’t clear, but all infections spread more easily in parts of the world with inadequate sanitary facilities. Then, as people cross borders and board airplanes, the bacteria spread in the same way that brought CRE to Reno.

That’s why Dr. Randall Todd, director of epidemiology and public health preparedness at the Washoe County Health District, says all hospitals should double down on preventive efforts, including a travel history. “It’s important that health care providers and hospitals keep in mind that our world is ever shrinking,” he says. “When someone comes in, it’s important to know where in the world they’v e been.”

Then, if CRE or other resistant infections are diagnosed, the hospital can set up appropriate precautions, like isolating the patient, and immediately start lab tests to try to find an effective antibiotic.

But in this case, there was no effective antibiotic. “And we’re going to see more of these, from a drip, drip, drip of cases to a steady drizzle to a rainstorm,” predicts Johnson. “It’s scary, but it’s good to get scared if that motivates action.”

The action needed is to use antibiotics wisely, in people and in animals, so strains of bacteria don’t get a chance to develop resistance, says Johnson. And to continue research into development of new antibiotics. “We do have some new drugs coming along, so there’s hope,” he says. But as new antibiotics become available, “we have to use them selectively, not willy-nilly.”

Earthquake Drill Tests Local Agencies

31

let's start fresh TCI HOSPI TAL INDOOR RESTAURANT Refresh features a wide variety of international and Caribbean inspired dishes. Refresh is known for its shake and baked chicken, vegetable spring rolls, blackened Mahi Mahi with tropical fruit salsa. Our homemade baked cheese-Cake is the envy of the island. Refresh is open for breakfast, lunch and light meals throughout the day with a wide variety to tantalise all taste buds.

Refresh restaurant is open daily and offers an extensive range of snacks, beverages and hot food services to visitors and members of the local community. The menu selection covers traditional local fare, Caribbean, and international cuisine at highly competitive prices.

We additionally have extensive Hospitality Services, able to cater and accommodate for internal and Government meetings and conferences within the facilities.

The Catering Department works to deliver nutritious balanced and appetising quality food to our patients and external customers.

32