More rooms needed to stop C. difficile, medical expert says

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Canadian Press


POSTED AT 2:24 PM EDT Thursday, Oct 28, 2004

Montreal ― A public-health expert warned Thursday that there are not enough private hospital rooms in Quebec to isolate patients infected with the deadly C. difficile bacterium.

Experts also said existing hospitals may not be properly equipped to deal with the outbreak, which has killed at least 109 people in Quebec this year.

“Generally speaking, we never have enough private rooms,” Dr. Marie Gourdeau of the Quebec association of microbiologists told a news conference. “Modern hospitals should be built … with almost exclusively private rooms for infection-control purposes.”

C. difficile is spread through feces and can cause severe, and sometimes fatal, diarrhea. The spore-forming bacterium can survive for weeks on almost any surface.

A committee set up by the provincial Health Department reiterated prevention and control measures Thursday to deal with the epidemic.

Hospital staff are urged to wash their hands, isolate infected patients and review their use of antibiotics.

Antibiotics can alter the flora of the digestive tract, making it easier for C. difficile to grow.

The McGill University Health Centre says the C. difficile death toll in Quebec stands at 109, with an additional 108 deaths indirectly linked to the bacterium.

The fatalities occurred in 10 hospitals in the Montreal area and Sherbrooke, Que. The 8-per-cent death rate among people who get C. difficile is high compared with the normal rate of 1.5 per cent.

Also on Thursday, officials played down a published report that said C. difficile has spread into the community despite being mainly confined to elderly patients in hospitals.

The Montreal Gazette, quoting McGill's Dr. Sandra Dial, said two students at the university became infected with the superbug.

She added: “We've seen quite a fair amount of young patients.”

Experts said the infected students were studying and working in medicine and had greater exposure to C. difficile than average Canadians.

 

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C. difficile superbug likely to spread beyond Quebec: microbiologist

Last Updated Fri, 22 Oct 2004 09:47:54 EDT

TORONTO - Quebec's epidemic of C. difficile shows all hospitals need to be vigilant about hygiene to prevent the dangerous strain from spreading across Canada, public health experts said Thursday.

Researchers found 7,000 people have been infected with C. difficile in Montreal since 2003, an infection rate that is four times higher than the preceding year.


At least 600 of the 7,000 people infected with C. difficile in Montreal have died.

INDEPTH: Clostridium difficile FAQs

Clostridium difficile can cause severe diarrhea and death from dehydration.

"We need to take it very seriously," said Dr. Allison McGeer, an infectious disease specialist at Toronto's Mount Sinai Hospital. "[C. difficile] is an increasing problem in the United Kingdom and the United States. We've had a number of big outbreaks in Canada."

Aside from Montreal, hospitals in Calgary and Ottawa have experienced periodic outbreaks.



FROM OCT. 20, 2004: C. difficile infection rates still twice the normal level, study warns

So far, evidence suggests the more virulent strain is confined to Quebec. The province is seeing four times the number of infections as the national average.


Tracking C. difficile across Canada

The bacteria may not stay in Quebec, according to Dr. Andrew Simor, a microbiologist at Sunnybrook and Women's College Health Sciences Centre in Toronto. He is a leading a national study on the extent of the C. difficile problem.

"Some of the patients transferred to us from Quebec or from the United States may well bring this organism with them and introduce to Ontario or to other parts of the country," said Simor.

The strain that is killing patients in Quebec has also caused outbreaks in hospitals in at least six states.


Dr. Andrew Simor


RELATED STORY: C. difficile lawsuit in the works CBC Montreal

Infectious disease experts said conditions at hospitals in Quebec probably helped to escalate the epidemic. At many older hospitals, three or four patients stay in the same room and share the same bathroom.

The problem is that microscopic spores from feces can survive on surfaces for months. The bacterial spores are very difficult to clean off or kill.

Others said the main factor is health-care workers who fail to wash their hands. People in Quebec are worried about sending family members to affected hospitals, and some are angry the public wasn't told sooner about the problem.

"In this particular outbreak, patients could have done things to protect themselves had they known," said Dr. Ken Flegel, a specialist in internal medicine at Royal Victoria Hospital. "Visitors could have done things to help patients be protected."

Written by CBC News Online staff