Photo By Sarah Turnbull
Since 2008, there has been an increase in the number of cases of Clostridium difficile or C. difficile within hospitals across Ontario. However, there have only been a handful of official outbreaks at hospitals in Ottawa in the last six years.
This superbug is one of the most recognized in-hospital infections and was made well known to the Ottawa community in 2011 when an outbreak was declared at the Civic Campus of The Ottawa Hospital. There was a total of eight cases in June of that year.
An outbreak is defined as five cases within a four-week period in a hospital ward with more than or equal to 20 beds. Alternatively, in a ward with less than 20 beds an outbreak is deemed as four cases in a four-week period.
So, what exactly is this superbug?
It’s an infection of the bowel causing inflammation. The side affects are: occasional bleeding, diarrhea, and pain in the lower abdomen.
Dr. James Worthington, the Senior Vice-President of Medical Affairs and Quality and Performance at The Ottawa Hospital says the infection becomes an issue when the normal bugs in our bowel die off and C. difficile bacteria takes over.
“You get it after antibiotic use, you get it in patients who are weakened by cancer or if they’re on specific drugs that knock off their immune system so they can’t beat off infections, ” says Worthington.
Worthington says the infection is more common in acute care and large community hospitals, which treat complex patients.
In 2008, an incident of C. difficile at Sault Area Hospital in Sault Ste. Marie exposed the severity of this disease.
An unidentified elderly patient was sent to hospital in June 2008 with vomiting and a history of diarrhea. He had a previous admission, which was treated with antibiotics.
On his second visit, the doctor ordered stool samples and started the patient on Flagyl that day, an antibiotic used to treat C. difficile.
The lab confirmed positive test results for C. difficile. The attending physician ordered an increase of Flagyl but the patient only seemed to get worse. Four days later he died.
In 2012, this case was brought to the Health Professions Appeal and Review Board by the patient’s son. The applicant argued that during his father’s initial admittance to hospital in March, the family should have been notified of the possibility of C. difficile infection.
The hearing of the complainant’s case also came at a time when there was a spike in C. difficile incidents throughout hospitals in Ottawa. From 2011 to 2012, there was a 320 per cent increase at The Ottawa Rehabilitation Site and at the General Campus rates when up 53 per cent within the year.
While data shows a decrease in cases at the General in 2013, there was a steady rise of incidents at the Ottawa Heart Institute and the Civic Campus.
Director of the infectious control program at The Ottawa Hospital, Dr. Virginia Roth says increasing incidents of C. difficile are caused by a combination of patient and environmental factors.
“The hospital is an environment that’s conducive of getting bacteria from one person to another. It can be transferred from the environment itself or through patients and physicians hands,” says Roth.
Roth continues that while the infection is not a common occurrence, it’s something that needs to be monitored closely because of potentially fatal outcomes.
To keep the superbug at bay; her team must perform regular check ups.
“As soon as we get second case in a medical unit, we employ a multidisciplinary team with medical professionals, occupational health and infectious control leaders,” says Roth. “We go on the unit within 48 hours and do a walk around with a checklist.”
Currently, there are an estimated seven cases of C. difficile at the General Campus and with a high occupancy rate at The Ottawa Hospital right now; the chances of an outbreak are greater.