Cover

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Title Page, copyright

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Contents

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p. vii

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Acknowledgments

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pp. ix-xi

I thank the many people who helped me complete the research behind this book and its publication. First and foremost, the interview participants, who remain anonymous, made this work possible by sharing their time, stories, and invaluable insights. While their stories, at times, broke my heart, I applaud their hard work, dedication, and commitment. I also extend an extraordinary thank you to Melita Ptashnick, who began working on this project before returning...

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1. “Stuff Gets Missed”: An Introduction to a Growing Health Care Crisis

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pp. 1-18

Tracy Melucci cleans a hospital for a living.1 Well, sometimes clean is a strong word. More realistically, she makes her hospital less dirty than it was before. Short on time, short on resources, and long on responsibilities, she cleans what she can. And she knows it’s not enough. “Basically, you do the big stuff and then you start cutting corners,” she says. “You just cannot get it all done. And when I say ‘cutting corners’ that means bathrooms, offices, hallways. Stuff gets missed.” Stuff gets missed. Hospitals across...

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2. Germs, Blood, and Cost-Cutting: The Daily Struggle to Keep Hospitals Clean

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pp. 19-35

If you want to find the most germ-ridden building in any city, head straight for the hospital. Not even the grungiest day care center or locker room can match the bacteria and viruses that float through hospital hallways, cafeterias, and even operating rooms. After every major outbreak, microbiologists and infectioncontrol specialists descend on the scene to find the source of the infections. Time after time, they reach same conclusion: the hospital simply isn’t clean enough. Experts in public safety have recognized...

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3. Compromising Cleanliness: How Outsourcing Keeps Hospital Workers from Doing Their Jobs

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pp. 36-50

The more time I spent with hospital workers, the more I realized that the impacts of outsourcing went far beyond a hospital bottom line. The people cleaning the floors and preparing meals suffer at both work and home. But their stories also point to a much bigger problem, a problem that has the potential to affect the health of the entire community. Simply put: outsourcing has made hospitals less clean and more vulnerable to outbreaks...

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4. Untrained Workers, Unfit Managers

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pp. 51-66

For all their hard work, cleaners and cooks know they are not doing a good job. In fact, they are surprisingly open about the kinds of shortcuts they feel forced to make.2 Juan Laguatan, housekeeper, says, “It’s screwed, of course. Quality of service? Only just on paper. But in reality it is not. Just like maybe on bulletin boards and elevator: ‘We are at your service...

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5. Breaking Up the Team

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pp. 67-80

Prior to outsourcing, hospital support workers were part of the health care team. They might have been on the bottom rung, but they were still on the ladder connecting cleaners and cooks to doctors and nurses. But not anymore. Outsourcing has fundamentally compromised the teamwork required for effective infection control.1 Even if workers still had the benefits and wages they enjoyed prior to outsourcing, they still would be facing an uphill battle in their efforts to keep the hospital clean and safe. In a...

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6. Down and Out in Vancouver: Struggling, Stressed, and Exhausted Hospital Support Workers

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pp. 81-104

Hourly wages, injury rates, staffing levels—statistics can tell us a lot about the struggles of hospital support workers in the aftermath of outsourcing. But, as I talked to housekeepers and dietary aides, it became clear to me that their daily experiences tell the real story. These workers aren’t complainers or malcontents; they are people trying to get by in incredibly difficult circumstances. And because their work directly affects hospital hygiene—and thus a patient’s risk...

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7. Cleaning Up

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pp. 105-126

In the early afternoon of April 29, 2007, after my spouse went through thirty-six hours of labor and a caesarean birth, I held our beautiful baby girl in my arms. As I looked down at this little bundle swaddled in a yellow towel, I realized that she was more important to me than anything in the world. Looking back, I think about all the people behind the scenes. Somebody had to clean that room—the very first room that my daughter would...

Notes

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pp. 127-148

References

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pp. 149-174

Index

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pp. 175-182