Ontario hospitals hit by deadly bacteria; 15 dead

15 patients have now died from an outbreak of C. difficile in southern Ontario. The appearance of this highly contagious bacterium is raising questions about the adequacy of procedures to prevent and control the spread of hospital-acquired infections. A demonstration is planned for this coming Wednesday at the Greater Niagara General Hospital where 4 people have succumbed. Nine have died at St. Catharines General Hospital and two at Welland Hospital. Apparently 42 patients remain in hospital of which 26 are known to have been infected there.

The Niagara Health System which is made of seven hospitals across the Niagara peninsula serving nearly half a million people has declared an outbreak of Clostridium difficile at three of its sites. Clostridium difficile or C. difficile is a dangerous infection that causes among other things severe diarrhea. It travels from person to person through hand contact and is one of the most common infections in hospitals and long-term care facilities.

Mandatory reporting of the infection was introduced in 2008 by the provincial government after a severe outbreak in Quebec led to the deaths of 62 people at Joseph Brant Memorial Hospital in Burlington. – The most effective was to prevent the spread of the infection is something as simple as good hand hygiene. – While the incidence of C. difficile has been lower in Ontario than elsewhere, the rate has gone up over the past year so that in May 2011 it stood at 0.40 per 1,000 patient days which represents a 33% increase.

On Sunday, July 3, 2011, the Niagara Health System issued an outbreak notice which reads:

The Niagara Health System (NHS), in consultation with Niagara Region Public Health, has declared C. difficile outbreaks at the St. Catharines General effective May 28, 2011 and Greater Niagara General and Welland sites, effective June 23, 2011.

The article lists the total number of cases at each of the three sites after the outbreaks were declared: St. Catharines, 40, Niagara, 14, and Welland, 12. This same article lists “hospital-associated cases” which is explained as: Hospital-associated cases are patients who develop symptoms 72 hours after hospital admission. The numbers listed show: St. Catharines, 11, Niagara, 9, and Welland, 6.

What is C. difficile?

Clostridium difficile (C. difficile) causes diarrhea and is one of the most common infections in hospitals and long-term care facilities. People most at risk after exposure are typically of advanced age, and with underlying illnesses such as inflammatory bowel disease or immunodeficiency, who are also taking antibiotics. Antibiotics kill off the “good bacteria” in the bowel and allow the C. difficile to flourish and cause illness.

The same outbreak notice describes the Infection Control Practices currently being enforced at the various facilities.

Strict adherence to hand hygiene standards is an organizational priority. Hand hygiene is critical for staff, patients and for visitors upon entering and exiting the hospital, and is of critical importance on entering and exiting patient rooms, and upon touching any surfaces.

All affected patients have been placed in isolation rooms which are double-cleaned daily with the recommended sporacidal cleaners per our regular practice for C. difficile.

All staff and/or visitors to affected patients must wear proper Personal Protective Equipment per our regular practice. Early detection and intervention is practiced by the Infection Prevention and Control Team at all times. Additional cleaning of the common areas has been put in place on the affected units to further combat the spread.

The notice goes on to explain that a Provincial Resource Team visited the various sites to see firsthand what measures had been put in place to reduce the possibility of infection. Their assessment was that everything which could be done was being done. Their only suggestion was to increase signage to ensure the public was aware of what was going on and what procedures to follow (washing hands) and to remove all printed reading materials from patient areas and waiting rooms.

(The Globe and Mail, The Hamilton Spectator, Examiner.Com)

References

Wikipedia: Clostridium difficile

Clostridium difficile (from the Greek kloster (κλωστήρ), spindle, and Latin difficile, difficult), also known as “CDF/cdf”, or “C. diff”, is a species of Gram-positive bacteria of the genus Clostridium that causes severe diarrhea and other intestinal disease when competing bacteria in the gut flora have been wiped out by antibiotics.

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