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  • Canada: Hospitals under pressure to reveal C. difficile outbreaks

    Source: http://www.theglobeandmail.com/servl.../National/home

    Hospitals under pressure to reveal C. difficile outbreaks

    KAREN HOWLETT

    From Thursday's Globe and Mail

    May 9, 2008 at 5:41 AM EDT

    TORONTO Patient advocates are calling on governments across the country to force hospitals to tell the public about the outbreak of a highly contagious superbug that claimed the lives of 62 patients at one Ontario health-care institution.

    The province has the highest incidence of Clostridium difficile, commonly known as C. difficile, according to a study of 44 Canadian hospitals done by the Public Health Agency of Canada. But Ontario Health Minister George Smitherman was forced to acknowledge yesterday that he has no idea how many of the province's 157 hospitals are grappling with C. difficile.

    Amid this week's news that a severe outbreak of the so-called Quebec strain of the disease led to 62 deaths at Joseph Brant Memorial Hospital in Burlington, Mr. Smitherman vowed to introduce mandatory reporting of such infections by the end of the year.

    "I believe that moving forward with mandatory reporting will prove to be a very, very powerful enhancement to patient safety in the province," Mr. Smitherman told reporters.

    But he is not moving nearly quickly enough, according to opposition members and the head of a union representing hospital cleaning staff, practical nurses and technicians.

    The minister should have set up a system to have hospitals tell the public years ago about the number of patients who contracted C. difficile while in their care, said Progressive Conservative MPP Laurie Scott, a former registered nurse.

    "It is appalling that the Minister of Health doesn't even know how many deaths caused by C. difficile have taken place in Ontario," Ms. Scott said during Question Period.

    Michael Hurley, president of the Ontario Coalition of Hospital Unions, yesterday accused the minister of "foot dragging" on getting hospitals to disclose the numbers. "People should be able to make informed choices about hospitals they are taking their loved ones to."

    Mr. Hurley also said downsizing and contracting out of cleaning services have contributed to a significant increase in hospital-acquired infections.

    Phil Hassen, head of the Edmonton-based Canadian Patient Safety Institute, said every province should adopt similar disclosure measures. Currently, only Quebec and Manitoba have mandatory reporting for hospital infections. But he said one in 10 individuals admitted to a Canadian hospital comes down with an infection.

    C. difficile is a particularly menacing infection that causes diarrhea and travels from person to person through hand contact. Patients can become infected after touching a contaminated surface and then touching their mouths.

    Joseph Brant is among a handful of hospitals in Ontario that voluntarily report incidents of C. difficile. It reported the 62 deaths after an exhaustive investigation into 177 patients diagnosed with C. difficile over a 20-month period ending last December. The hospital will spend $1.4-million this year, about 1 per cent of its operating budget, on measures to combat infections.

    While Joseph Brant has been hit with the highest known casualty rate in Ontario, it is not alone. Royal Victoria Hospital in Barrie declared an outbreak of C. difficile in February, 2007, which led to the deaths of seven patients. The infection was also responsible for 10 deaths at a hospital in Sault Ste. Marie in 2006.

  • #2
    Re: Canada: Hospitals under pressure to reveal C. difficile outbreaks

    Source: http://www.thespec.com/News/Local/article/370031

    Fatal C. diff outbreak may not have peaked

    May 16, 2008
    Joan Walters
    The Hamilton Spectator
    (May 16, 2008)

    Pressure is intensifying for an inquiry into C. difficile outbreaks in Ontario, amid warnings that a North American epidemic of the deadly superbug has yet to peak.

    The top expert on C. difficile at the Centers for Disease Control in Atlanta, Ga., says there is reason for alarm about the spread of the highly toxic NAP1 version of the disease.

    "This strain requires extra care because of its severity," said Dr. Clifford McDonald.

    "It is alarming. We have not seen the peak of this epidemic yet."


    Ontario Conservative Leader John Tory called on Premier Dalton McGuinty to launch an independent investigation into the widening tragedy. Tory said yesterday that the Liberals have shown a "dismissive attitude" toward a set of circumstances that could pose continuing risks.

    Since mid-2006, the Quebec strain of the bacterium has rampaged through Joseph Brant Memorial Hospital and four other facilities, killing at least 125. Nearly 600 mostly elderly patients have been infected, a Spectator tally showed.

    "When you have a patient quoted in The Spectator as saying she checked out of hospital to save her life, you know you have a problem with public confidence and probably much more," Tory wrote to McGuinty.

    Tory was referring to Pat O'Sullivan, 73, who contracted C. diff at Jo Brant in August during a stay there. She said she went downhill so fast she felt she had to leave to survive.

    She was one of 177 patients infected in a 20-month C. diff outbreak at Jo Brant that caused 62 deaths.

    The hard-to-control organism swept through hospitals in Barrie, Belleville, Mississauga and Sault Ste. Marie during the same period.

    "We owe it to what now appear to be hundreds of families who have already been touched by tragedy, to take a much more urgent approach," Tory said.

    He said an investigation of 30 to 90 days would answer pressing questions, such as what the scope and scale of infection is at other hospitals and in nursing homes.

    The Ontario ombudsman has also called for an investigation, saying the deaths are "an absolute human tragedy of the worst kind."

    Health Minister George Smitherman says an investigation is not on.

    Recommendations of a coroner's review of deaths in the Sault are already being implemented, he said.

    "I feel very, very confident that the medical system knows all about the problems, that they're working quite proactively on it," he said.

    Smitherman also plans to make C. diff a reportable disease.

    But in the legislature, Conservative deputy leader Elizabeth Witmer said Smitherman "has been unable to grasp the seriousness" of C. diff.

    At just the five hospitals that have declared official outbreaks, C. diff has killed almost three times as many people as the 44 who died in 2003 of SARS.

    Criticism of Ontario's weak hospital infection monitoring system has poured in. Disease experts say the province had years of warnings about the high risk of infections, including 2,000 Quebec deaths from the NAP1 strain since 2002.


    McDonald, the CDC's C. diff expert, says the epidemic version of the disease is worrisome.

    "The increases in disease and severity that we're seeing with NAP1 now tell us we really need to mobilize increasing resources and efforts to control this," he said.

    Wherever this strain appears, health officials should know "you are going to have high rates."

    McDonald said NAP1 has been around since the early 1980s, but was rare until overuse of certain antibiotics triggered its proliferation in the late 1990s.

    By the time NAP1 hit Quebec, it was an epidemic strain 20 times more toxic than its predecessors.

    The NAP1 infection rate is also higher than strains seen before.

    Figures assembled at the CDC show skyrocketing rates of C. diff in patients leaving U.S. hospitals.

    The number of discharges in which C. diff was a primary or secondary diagnosis more than doubled from 2001 to 2005, the latest year for which data is available.


    jwalters@thespec.com

    905-526-3302

    Comment


    • #3
      Re: Canada: Hospitals under pressure to reveal C. difficile outbreaks

      Source: http://www.thespec.com/Opinions/article/377468
      What if the superbug were killing kids?
      May 30, 2008
      Andrew Dreschel
      The Hamilton Spectator
      (May 30, 2008)

      Ask yourself this simple question.

      If the 264 patients who died after being infected with the superbug C. difficile had been kids instead of mostly seniors, do you think the McGuinty government would be stonewalling about calling an independent investigation of some kind?

      Sure, it's a hypothetical. But answer it anyway.

      Do you honestly believe Premier Dalton McGuinty and Health Minister George Smitherman would still dismiss an investigation if we were reading accounts about scores of kids dying excruciatingly painful deaths in Ontario hospitals?

      Violent watery diarrhea, severe stomach cramps, high fevers, vomit-provoking nausea.

      Kids? Dying like that?

      No way.

      You know as well as I do that McGuinty and Smitherman would be falling over themselves to order a comprehensive review to restore public confidence and trust.

      If we were talking about youngsters instead of oldsters, it wouldn't matter that a coroner's review into a C. diff outbreak in Sault Ste. Marie had already provided useful information about dealing with the potentially lethal superbug.

      It wouldn't matter that we well know it is spread by touching skin or surfaces contaminated by fecal matter and that basic hygiene -- soap, water and elbow grease -- by hospital staff and visitors is the best preventative.

      If scores of kids had suffered and died, Smitherman wouldn't spuriously suggest, as he did the other day, that an inquest or inquiry would somehow delay the progress that's being made to protect patients.

      The sad suspicion is, C. diff patients, both those who died and those who survived the agonizing experience, have been doubly victimized because they're mainly elderly.

      Their age and underlying health problems place them at greater risk of infection in the first place.

      And then their age makes them more likely to be treated as if they belong to an expendable subclass of citizens, one whose usefulness and therefore importance diminishes the older they get.

      It's called ageism. It's a form of discrimination. It's rampant in our society.

      And I suspect it's playing a strong, if unconscious, role in the McGuinty government's languid response to the emergence of C. diff as a major new menace.

      How else to explain why it has taken the province so long to impose a mandatory C. diff reporting program on health-care facilities?

      After all, it's almost two years since the dangerous strain hit Ontario hospitals.

      It's four years since the Canadian Medical Association recommended making it a reportable disease.

      And it's five years since it claimed the lives of 2,000 people in Quebec.

      You can intuit the attitude behind the province's complacency because it's so ingrained in our treatment of older frail people in general: The victims were old. The old are more vulnerable to sickness. Many were already seriously ill, maybe even nearing the end of their lives.

      So what good would an investigation do when we're already taking the necessary corrective steps?

      The answer should be obvious to everyone, including the McGuinty government.

      An official review would transparently establish facts about the causes and extent of the problem.

      It would focus debate and promote education about the growing dangers of superbugs and their deadly resistance to medications.

      And it would make public policy recommendations.

      Recommendations that hopefully would ensure elderly patients, including those with chronic illnesses, aren't painfully drained and dragged without dignity off this earth by a vir- ulent but combatable infectious disease.

      You know the province would do it if kids' lives were at stake.

      If the McGuinty Liberals can't see the value in doing it for the elderly, they've clearly lost something more than their way.

      Andrew Dreschel's commentary appears Monday, Wednesday and Friday.

      adreschel@thespec.com

      905-526-3495

      Comment


      • #4
        Re: Canada: Hospitals under pressure to reveal C. difficile outbreaks

        "And then their age makes them more likely to be treated as if they belong to an expendable subclass of citizens, one whose usefulness and therefore importance diminishes the older they get.

        It's called ageism. It's a form of discrimination. It's rampant in our society.

        And I suspect it's playing a strong, if unconscious, role in the McGuinty government's languid response to the emergence of C. diff as a major new menace.

        How else to explain why it has taken the province so long to impose a mandatory C. diff reporting program on health-care facilities?"


        If the "upper" citizens would be forced by law to treat themselves in the same hospital wards where was treated the mass of others, it would be seen an sharp, exponential surge of quality and desinfection control (fast decrease of hospital aquired infections), with many separate new-generation rooms and closets, and an increase in number of medic/paramedic/auxiliary hospital personnel ...

        Comment


        • #5
          Re: Canada: Hospitals under pressure to reveal C. difficile outbreaks

          Source: http://southwesternontario.ctv.ca/news.php?id=1960

          C. difficile cases up in Ontario
          Updated Fri. Jun. 20 2008 6:17 AM ET

          At least 22 outbreaks of the lethal bacteria C. difficile have hit Ontario in 19 months -- three times the number previously known.

          A published report says there have been C. difficile outbreaks at 19 Ontario hospitals -- not just the seven where 264 deaths are confirmed.


          Some of the hospitals to report multiple outbreaks, include Toronto Western, Royal Victoria in Barrie and suburban Toronto's William Osler Health Centre.

          A C. difficile expert at the U-S Centers for Disease Control in Atlanta says such a high outbreak rate, combined with the viciousness of the bug involved, is cause for concern.

          Ontario does not yet have a definition of what constitutes a C. difficile outbreak, but guidelines exist for gastrointestinal outbreaks.

          Uniformly tracking C. difficile outbreaks is to begin in September.

          Comment


          • #6
            Re: Canada: Hospitals under pressure to reveal C. difficile outbreaks

            Source: http://www.thespec.com/News/Local/article/389780
            More C. diff outbreaks reported

            EXCLUSIVE New numbers don't include all known cases
            June 20, 2008
            Naomi Powell and Joan Walters
            The Hamilton Spectator

            Click here to see C.difficile stats


            At least 22 outbreaks of the lethal superbug C. difficile have swept Ontario in 19 months, three times the number previously known.

            The Spectator has learned that C. diff outbreaks occurred at 19 Ontario hospitals -- not just at the seven institutions where 264 deaths are confirmed to date.

            The list suggests the scope of C. diff is far more widespread in Ontario than has come to light.

            Some of the hospitals have reported multiple outbreaks, including Toronto Western, Royal Victoria in Barrie and suburban Toronto's William Osler Health Centre.


            Such a high outbreak rate, combined with the viciousness of the bug involved, is cause for concern, says Dr. Cliff McDonald, a C. diff expert at the U.S. Centers for Disease Control in Atlanta.

            "There's a lot of signals that the number of deaths have increased markedly."

            The Ontario ombudsman, opposition politicians and victims' families have pressed for an investigation into how the province and its health system handled C. diff's assault.

            Ontario's chief medical officer of health had never investigated the extent of C. diff's spread until asked to by The Spectator in May.

            Dr. David Williams agreed then to review two years' worth of reports from hospitals that had notified health officials of diarrhea-like outbreaks. Hospitals are required by law to report abnormally high levels of such gastrointestinal cases.

            For the first time, Williams' staff combed these files to determine whether C. diff was responsible for the diarrhea. The analysis revealed 22 outbreaks at hospitals in almost every part of the province, the latest in Alliston on May 20.


            Yesterday, The Spectator received a document naming all the institutions that Williams knows have coped with the superbug.

            "This is a list of hospitals within Ontario that have had outbreaks that we have been able to identify as C. difficile," said Mark Nesbitt, a Ministry of Health spokesperson.

            But the list is incomplete, he acknowledged, because there is no system yet for uniformly tracking C. diff. That starts Sept. 30.

            The list does not include some outbreaks known to The Spectator through calls to hospitals.

            For instance, 37 patients died of C. diff at Hotel-Dieu Grace Hospital in Windsor from April 2006 to March 2008, an obvious omission.

            Ontario does not yet have a definition of what constitutes a C. diff outbreak. But guidelines exist for gastrointestinal outbreaks.


            An outbreak occurs when the number of cases spikes above what hospital officials deem the normal diarrhea rate for that institution.

            Conservative Leader John Tory said it is appalling that the ministry had not gathered this information for itself.

            "You would have thought they would have had their act together and they cared enough about the hundreds of people who died that they could have a complete picture for themselves by now," Tory said.

            He also complained about the timing of the list's arrival, the day after politicians left Queen's Park for the summer recess.

            "It's not an accident or a coincidence this stuff arrived on your desk today, the day after anybody could ask a question about it," he said.

            Critics of Health Minister George Smitherman, who is being shifted into a new portfolio, say they are alarmed by his ministry's indifference since an epidemic NAP1 strain entered Ontario in 2006.

            C. diff ripped through Jo Brant, claiming 62 lives in 20 months, before it was brought under control.

            "Jo Brant is the tip of the iceberg," said NDP health critic France Gelinas. "I have a feeling we're now talking about many icebergs throughout the province."

            npowell@thespec.com

            905-526-4620

            jwalters@thespec.com

            905-526-3302

            Comment


            • #7
              Re: Canada: Hospitals under pressure to reveal C. difficile outbreaks

              Source: http://www.owensoundsuntimes.com/Art...aspx?e=1086059

              C. Difficile Spreads In Hamilton
              Posted By THE CANADIAN PRESS

              Hamilton General Hospital has declared an outbreak of C. difficile after a cardiac patient transferred in from Welland infected at least four others.

              As well as the five confirmed cases of C. difficile, seven other patients are being monitored after they had contact with the infected patient on the cardiac post-surgery ward and the cardiac intensive care unit.


              All were in their 50s and 60s and had just had heart surgery.

              Dr. Mark Loeb, medical director of infection control at Hamilton Health Services, says the infection moved unusually rapidly.

              Loeb says none of the five infected patients is showing "catastrophic complications."

              At least 264 C. difficile deaths have been confirmed at seven Ontario hospitals since 2006.

              "It's a very explosive type of outbreak," said Loeb. "Our concern is there have been so many cases over a short period of time."

              Hamilton General has temporarily stopped admissions to the 27-bed cardiac post-surgery ward and will only do emergency heart surgery for the next 48 hours, hospital president Murray Martin said.

              Comment

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