The impact of health care restructuring on nosocomially acquired blood stream infections
Health care delivery has always undergone evolutionary change as disease patterns evolve and their treatments are modified. In the past decade, Canadians have witnessed much more rapid and revolutionary change in health care delivery than has been previously experienced. Some of the changes include a reduction in global spending by the government on health care services and a transfer of a great deal of care from hospitals to community settings. As a consequence, hospitals across the country have been reduced in size and number. On average, present hospital patient populations are likely more seriously ill than they have been in the past.
Radical changes in health care delivery occurred in Alberta in 1995. Provincial government per capita funding of health care fell by 16%. Individual hospital boards were dissolved, and a smaller number of Regional Health Authorities were formed, responsible for the continuum of health care in their region. In Edmonton, 1995 saw one hospital closed and three were downgraded to community health centres. A 35% reduction in hospital beds occurred in the Edmonton region that year. Where feasible, health care was transferred from the hospital to the community. Two referral hospitals remained with a wider range of ‘high intensity’ services, one of which was the University of Alberta Hospital (UAH).
At UAH, we wanted to assess the impact of health care restructuring on the occurrence of nosocomial infections. Using prospectively collected data on nosocomial blood stream infections, we compared infections for the two years before restructuring (1993 and 1994) with those for the two years after restructuring (1996 and 1997).
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