A predicted outbreak in an overcrowded, administratively neglected and run-down haemodialysis unit as an offer of “New Public Management” in Norwegian hospitals

Abstract

Background: Scandinavian countries had a low rate of vancomycin- resistant enterococci (VRE) until 2007. Since 2007, there has been an alarming spread of VRE in Sweden and later on in Norway. From 2002 on, public hospitals in Norway were transferred from the County administration to a few regional state enterprises, drifted and organized according to the “New Public Management” (NPM), to save money. Four hospitals in Oslo, including Ullevål University Hospital, were, of the same reason, further merged into a 1500 beds Oslo University Hospital in 2009. Methods: This study included the hospital management of infection control and attitudes to reports from routine inspections in a haemodialysis unit at Oslo University Hospital (OUS) - before and after an outbreak of VRE in 2011. Results: Before the outbreak of VRE, repeated site inspections by infection control personnel revealed overcrowding, a poor hospital design, a low hygienic standard, and an imminent risk for hospital infection in a haemodialysis unit at OUS. Reports concerning deviation from proper infection control were sent to the hospital administration. Two project groups were set down consecutively within a year to solve the problems. They were both nearly immediately put on hold because of lack of economic resources. The Board of Health in the Counties of Oslo and Akershus (having the overall supervision of the health care in the Counties) was then notified by the infection control doctor. The outbreak of VRE was detected in May 2011 in this haemodialysis unit. It was promptly stopped after one month, by using a combination of several restrictive infection control methods. All VRE cases were negative after repeated negative samplings for a year. The outbreak resulted in a response from the hospital administration to the serious conditions in this unit. One and a half year later, an extended, refurbished new unit was ready for the patients. Conclusion: A low hygienic standard in an overcrowded and run-down haemodialysis unit was neglected by an administrative organization lacking economic resources after following the ideas of NPM through many years. This situation finally led to an outbreak of VRE. An early and restrictive intensive intervention leads to a rapid termination of the outbreak.