Hospital to spend more than $4 million to control C. difficile

Sault Area Hospital's plan to protect its patients from C. difficile is costing $4 to $5 million, says Interim Chief Executive Officer and President Ron Gagnon.

Aggressive control measures introduced by the hospital since November will continue indefinitely, Gagnon told a meeting of the hospital's board last night.

"We won't go back to our baseline," Gagnon said.

The control measures were introduced as a result of recommendations by Dr. Michael Gardam (shown), director of infection prevention and control from Toronto's University Health Network.

C. difficile infection control measures now in place at SAH include immediate isolation of patients who may have the infection, new toilets and sinks and some changes to housekeeping products and procedures used, as well as new antibiotic use protocols.

Gardam was contacted after the local hospital realized it had a serious outbreak of C. difficile beginning June 1, 2006.

"This is a significant outbreak and it will not be over for several months," Gardam told the board.

The really bad news, he said, is that it's quite likely to be here to stay.

"It's not going down to zero any time soon," Gardam said.

But with an effective plan, the Sault can keep things at a manageable level and minimize the outbreak's impact, Gardam said.

The good news is that the hospital's plan is working well, he said.

"The hospital's response to the recommendations is very commendable. There was a 33 percent reduction in cases when we began our aggressive control measures."

Gardam said that the outbreak was most likely a result of the introduction of the hypervirulent Quebec strain of C. difficile.

Gardam said that C. difficile is a common spore-forming anaerobic bacterium found in many hospitals and elder-care facilities.

The Quebec strain is relatively new and produces more cases, with much more severe symptoms, he said.

Because spores from any strain of C. difficile can survive in a state of dormancy for about four months, a person can become infected but not show any symptoms for some time, if ever.

Gardam said the spores can only be killed by prolonged exposure to a very highly concentrated bleach solution that would be at least as dangerous to patients as the spores, so they are best controlled by physically wiping them away.

The spores can be found on any surface where an infected person has been and can survive on those surfaces for a long time.

Factors Gardam listed as contributors to SAH's outbreak of C. difficile included chronic over-crowding of the hospital, outdated facilities that are poorly designed to prevent the spread of infectious diseases and a shortage of doctors and nurses.

He said that SAH is consistently at more than 100 percent occupancy.

"People get very busy and sometimes neglect good infection control measures such as hand-washing," Gardam said. "Especially if there is no sink nearby and several patients in a room."

Despite these control measures, 22 of the 76 patients who contracted the infection since June 1 have died.

Gardam said the coroner's office is examining evidence to see whether any of those patients died directly as a result of the infection or from other conditions that may have been aggravated by the infection.

Gardam said he'd like to see all new hospitals built with more private rooms and fewer rooms where patients share toilets and sinks.

He also said an ideal occupancy rate for infection control is about 85 percent and the ideal level of private rooms is about 30 percent, but he realizes that reality is not likely to approach the ideal any time soon.

Meanwhile, Gardam recommends that anyone who's been in Sault Area Hospital for any reason since June 1 seek medical advice if unexplained diarrhea or other symptoms of C. difficile are experienced, especially if antibiotics are being taken at time.