LONDON Greek hospitals are in such dire straits that staff are failing to keep up basic disease controls such as using gloves and gowns, threatening a rise in multidrug-resistant infections, according to Europe's top health official.
Greece already has one of the worst problems in Europe with hospital-acquired infections, and disease experts fear this is being made worse by an economic crisis that has cut health care staffing levels and hurt standards of care.
With fewer doctors and nurses to look after more patients, and hospitals running low on cash for supplies, risks are being taken even with basic hygiene, said Marc Sprenger, director of the European Centre for Disease Prevention and Control (ECDC).
"I have seen places...where the financial situation did not allow even for basic requirements like gloves, gowns and alcohol wipes," Sprenger said after a two-day trip to Athens, where he visited hospitals and other healthcare facilities.
"We already knew Greece is in a very bad situation regarding antibiotic resistant infections, and after visiting hospitals there I'm now really convinced we have reached one minute to midnight in this battle," he told Reuters in an interview.
Sprenger said the situation means patients with highly infectious diseases such as tuberculosis (TB) may not get the treatment they need, raising the risk that dangerous drug-resistant forms will tighten their grip on Europe.
Greece spends 11 billion euros ($14.4 billion) a year on its healthcare system - accounting for just over 5 percent of its total economic output. The government says the system is around 2 billion euros in debt and spending must be cut drastically.
Many health workers have lost their jobs and others say they have not been properly paid for months. A banner hung up by doctors outside Athens Evangelismos hospital in October said simply: "The health system is bleeding".
Exhausted doctors at Greece's 133 state hospitals cite a lack of staff as well as basic supplies such as absorbent cotton, catheters, gloves and paper used to cover examination beds.
Panos Papanicolaou, a member of a doctors' union and a neurosurgeon at Athens' Nikea General Hospital, said staff cuts mean as many as 90 to 100 patients a day wait in corridors with many unable to get treatment. In the chaos, some go untreated or come back again when they are far more seriously ill.
He said overworked nurses often treat twice as many patients as before and confirmed that the shortage of basic items such as disposable gloves meant corners were having to be cut.
"If a nurse has to see 10 patients instead of five without disposable gloves it's certain that the transmission of infections will rise rapidly," he said.
Greece could soon face even more problems with its health care system if it runs out of money to buy drugs.
Another health official who asked to remain anonymous said a senior Athens hospital worker had told him there was no budget left for supplies at that hospital, so all its drug purchases were on credit.
Germany's Merck KGaA said last month it was no longer delivering its cancer drug Erbitux to Greek hospitals , and Biotest, which makes products from blood plasma to treat haemophilia and tetanus, stopped shipments in June because of unpaid bills.
Roberto Bertollini, the World Health Organisation's chief scientist and representative to the European Union, told Reuters he too was worried about the rate of hospital-acquired infections in Greece. He said cuts to resources and staff only make it harder to adhere to infection control and hygiene rules.
"Countries have to be very careful when ... choosing what to cut and what to keep," he said. "This is a very serious business which might impact the health of the population much more in the medium term, thus increasing rather than decreasing costs."
Greece's problems with drug-resistant infections predate the economic crisis: Greece is Europe's highest user of antibiotics, and health experts say overuse of them is one of the main causes of drug resistant disease.
Sprenger's ECDC warned last month that infections caused by a bug called K. pneumoniae and resistant to the very last line of antibiotics is "high and increasing in some EU countries".
"It's no longer a risk, it's already very bad - the challenge is to turn that around," Sprenger said. "But you can only focus properly on this if you are not overloaded with patients."
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(Additional reporting by Karolina Tagaris in Athens; Editing by Peter Graff)