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Newmarket, Ontario – September 12, 2004 Committed to continuously improving the delivery of its patient care services, Southlake Regional Health Centre recently elected to perform an internal investigation of its infection control practices relating to Clostridium difficile (or C. difficile). The outcome of the investigation found that three deaths from C. difficile had occurred since January 1, 2004, raising the concern that Southlake’s mortality rate may be slightly higher than the national average (based on 1997 data) of 1% to 1.5% of all patients with C. difficile. Concerned with their data, Southlake’s Infection Control team began a review of all related policies, practices and procedures. In addition, Hospital officials notified the Ministry of Health and Long-Term Care of the situation and requested that mandatory tracking of C. difficile in Ontario hospitals be considered.

“It is difficult if not impossible for us to understand the significance of our experience if we can’t compare it with the current experience of other hospitals”, said Dr. Nancy Merrow, Chief of Staff. “We track our incidence of C. difficile but other hospitals may not be as rigorous because under existing public health guidelines they are not required to track. This needs to change so that infectious disease experts can work with current data instead of working with information that is seven years old.”

“We are concerned by recent media reports that hospitals in Calgary, Montreal and now Southlake are dealing with a ‘super bug’ form of C. difficile. Without adequate data and further studies, it is not appropriate or accurate to make such a determination at this time for any of these hospitals, “stated Dr. Merrow.

C. difficile is a bacterium that in some cases produces a toxin that can cause an inflammation of the intestinal tract. This bacterium is commonly found in hospitals and long-term care facilities, as well as in the community. Anyone receiving antibiotics may be at risk for acquiring an infection from C. difficile. The risk increases in the elderly, people with weakened immune systems, and those undergoing gastrointestinal procedures.

According to Dr. Merrow, all three patients received treatments for C. difficile according to established protocols.

“Any time a death occurs it is a very sad and difficult time for families and for us as health care providers. Unfortunately, these patients died in spite of our efforts to manage their infections,” said Dr. Merrow. “Provincially we need to better understand this virulent organism because it appears to be on the rise across our country. That’s why Southlake is so supportive of mandatory tracking and reporting by all hospitals.”

Dan Carriere, President and CEO stated that the issue of C. difficile has been taken very seriously by the Hospital.

“We have always taken a team approach to ensure we are doing everything possible to manage infectious diseases appropriately at our Hospital. This approach includes the willingness of our physicians, nursing staff, infection control team, housekeepers, basically every one at Southlake, to play a role in minimizing and preventing the spread of infections.”

He added, “If we are experiencing these problems using deliberate and vigilant tracking and treatment protocols, what are the possible repercussions for hospitals that have not elected to track their cases in the absence of mandatory provincial or national guidelines? That’s the question we have presented to the Ministry of Health because, systemically, we need to re-look at infectious disease issues; comparing our situation with 1997 data is not good enough.”

The investigation of the C. difficile situation at Southlake also included a review of related infection control and treatment practices by external infectious diseases and infection control experts.

The review included:

• use of antibiotic therapies
• precautions that patients are placed on when suspected or confirmed to have C.difficile (i.e., Contact precautions)
• cleaning practices of the infected patients’ environment both during hospital admission and immediately following their discharge
• protocols for routine handwashing or cleansing
• a review of C. difficile cases to determine whether or not commonalties existed between patients.

Although the external review concluded that Southlake has been using appropriate protocols to address cases of C. difficile, the Hospital has implemented the following enhancements to its current practices:

• a call to action of the Hospital’s management team and physician leaders to closely monitor and ensure compliance to infection control policies/protocols.
• a memo to all physicians outlining expectations regarding infection control practices and acknowledging their ongoing role in early identification, control and monitoring of infectious diseases at the hospital, particularly C. difficile.
• consultation with the Montreal General Hospital to discuss their recent C. difficile experience.
• re-issued existing C. difficile protocol, which is being reviewed through in-service education sessions in all clinical departments of the hospital.
• information and education sessions for all cleaning staff of the hospital to reinforce the importance of cleaning in infection prevention.
• enhanced room cleaning procedure upon discharge from hospital or when patients have been symptom free for 48 hours. This applies to all patients on contact precautions for diarrhoea (suspected and confirmed C. difficile); procedure similar to that developed by the Montreal General Hospital, following their recent experience.
• development of specialized cleaning team to “deep clean” the entire facility and equipment using a special C. difficile cleaning procedure. It is expected that this initiative will take approximately two months to complete.
• Development of pre-printed order sheet for identification and management of C. difficile cases to provide a guide for physicians in managing all cases.
• Earlier involvement of the Infection Control team in each possible case of C. difficle.
• Working with Mt. Sinai Hospital to arrange for the culturing of all positive C. difficile specimens to determine clone.

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