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A complex set of factors behind TOH’s C. difficile challenge

March 26, 2013 — A complex set of factors is behind The Ottawa Hospital’s persistently high rates of the C. difficile bacterial infection, according to an independent review of the hospital’s infection control and prevention practices.

The review was conducted by experts at Public Health Ontario, a provincial agency that provides infection-control assessments and advice to hospitals.

After conducting its review in September 2012, the expert team concluded that no single factor is responsible for the increase in C. difficile cases at TOH. Instead, the team identified seven key areas of focus for the hospital in its ongoing efforts to reduce C. difficile rates:

  1. Epidemiology: A follow-up study should be conducted to investigate whether rising rates of C. difficile infections that have been observed in long-term care facilities and other places in the community could be contributing to rising rates at TOH.
  2. Environmental cleaning and disinfection: Standardize cleaning procedures, products and audits of housekeeping practices at TOH.
  3. Logistics: Reduce the clutter of equipment and supplies on inpatient units.
  4. Hand-hygiene compliance: Improve unit-by-unit rates of hand hygiene and ensure audits to monitor compliance are conducted to the highest standard.
  5. Antimicrobial stewardship: Ensure the appropriate and careful use of antibiotics.
  6. Communications: Ensure staff is equipped with the right information on how to handle a C. difficile outbreak.
  7. Administration: Ensure there is a formal process to review serious cases of C. difficile and apply lessons learned.

Since receiving the expert panel’s findings in October 2012, The Ottawa Hospital has acted on all of its recommendations. TOH is using the recommendations to guide the planning and implementation of hospital-wide efforts to change staff behaviours and practices for the better.

Indeed, TOH is working toward higher standards that what Public Health Ontario’s report recommends, especially in monitoring hand-hygiene compliance and environmental cleaning.

In recent months, for example, TOH has introduced a SWAT team of infection-control, housekeeping and de-cluttering experts to offer rapid-response support to units dealing with a C. difficile outbreak. A key goal of the SWAT team, the first of its kind in Ontario, is to ensure that the highest standards of disinfection, hygiene and cleaning are achieved.

And while TOH is open and willing to address patient-safety concerns, we also recognize that this not a challenge that will be solved overnight, given that C. difficile is a difficult-to-eradicate bacteria that is increasingly resistant to the drugs we have to fight them.

As the Ontario Medical Association pointed out in a recent report, our society is running out of antibiotics that work, resulting in an ever-constant rise in drug-resistant infections such as C. difficile.

The Ottawa Hospital is not alone in confronting this challenge. Hospitals and long-term care facilities across the country and around the developed world are struggling to control C. difficile.

It’s important to note that while TOH has seen a steady rise in C. difficile rates over the past year, the risk to patients remains relatively low. In February, for example, there were a total of 20 lab-confirmed cases of C. difficile at TOH, translating to a rate of 0.66 per 1,000 patient days. Patients who need care at The Ottawa Hospital should continue to expect that they would be treated according to world-class standards.

As part of our commitment to patient safety, The Ottawa Hospital is releasing Public Health Ontario’s report to increase awareness among patients, families and our health-care partners about the role they can play in helping prevent the transmission of C. difficile.

We also believe that more needs to be done by our own staff to reduce the number of cases. In the end, infection control is everyone’s business.

Media Contact:
Hazel Harding
Communications Advisor
The Ottawa Hospital
Email: hharding@toh.on.ca
Tel.: 613-737-8460