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C. difficile outbreaks declared at Greater Niagara General, Welland sites

Posted Jun 23rd, 2011

NIAGARA, Ontario – The Niagara Health System (NHS), in consultation with Niagara Region Public Health, is declaring C. difficile outbreaks at the Greater Niagara General and Welland sites, effective June 23, 2011.

The Greater Niagara General Site currently has a total of 10 confirmed cases of C. difficile on different units. Six of these cases are hospital-associated and four are community-acquired.

The Welland Site currently has a total of 11 confirmed cases of C. difficile on different units. Seven of these cases are hospital-associated and four are community-acquired.

“There is no evidence to support that the outbreaks in Niagara Falls, Welland or St. Catharines are related,” says Frank Demizio, Vice President Patient Services. “Over the last several months, we have seen a significantly higher number of new patients coming to our hospital sites with community-acquired C. difficile.”

C. difficile cases are tracked on a daily basis across all sites of the NHS and at other hospitals across the province. An outbreak is declared when the number of C. difficile cases at a site or in a specific unit is beyond what is normally experienced. The increase in cases of C. difficile at this time can be associated with multiple risk factors which include patient age and underlying health issues, and the use of antibiotics for various conditions.

“Efforts to contain the outbreak at the St. Catharines General Site have been very successful,” says Frank. “Niagara Health System and Niagara Region Public Health are taking the proactive measure of declaring these outbreaks in Niagara Falls and Welland to reduce transmission and resolve these situations safely.”

The St. Catharines General Site has been in outbreak since May 28, 2011. There are currently 20 patients with C. difficile hospitalized at the St. Catharines General – 14 are hospital associated C. difficile and six are community associated. The total number of patient cases of C. difficile associated with the outbreak is 38. There have been five new hospital-associated cases of C. difficile since the outbreak was declared at St. Catharines General Site and nine deaths associated with the outbreak.

The Coroner’s office is being notified of all deaths of patients with C. difficile until the outbreak is declared over. The Coroner will determine whether to conduct its own medical review on a case-by-case basis. The hospital also conducts a review of every patient death related to the outbreak to determine the role C. difficile played or did not play in the death. All of these deaths are also reported to Niagara Region Public Health under provincial legislation. In addition to the deaths at the St. Catharines General Site, NHS has reported to the Coroner and to Public Health the deaths of four patients with C. difficile at the Greater Niagara General Site and one patient at the Welland Site.

The NHS healthcare team is doing everything possible to manage the outbreaks and reduce the transmission of C. difficile. NHS thanks the public for its understanding and cooperation with control practices at this time.

BACKGROUND

What is C. difficile?

Clostridium difficile (C. difficile) causes diarrhea and is one of the most common infections in hospitals and long-term care facilities. People most at risk after exposure are typically of advanced age, and with underlying illnesses such as inflammatory bowel disease or immunodeficiency, who are also taking antibiotics. Antibiotics kill off the “good bacteria” in the bowel and allow the C. difficile to flourish and cause illness.

What Infection Control Practices are used?

Strict adherence to hand hygiene standards is an organizational priority. Hand hygiene is critical for staff, patients and for visitors upon entering and exiting the hospital, and is of critical importance on entering and exiting patient rooms, and upon touching any surfaces.

All affected patients are placed in isolation rooms which are double-cleaned daily with the recommended sporacidal cleaners per our regular practice for C. difficile.

All staff and/or visitors to affected patients must wear proper Personal Protective Equipment per our regular practice. Early detection and intervention is practiced by the Infection Prevention and Control Team at all times. Additional cleaning of the common areas has been put in place on the affected units to further combat the spread.

These measures will contribute to the reduction of transmission and rapid end to the outbreak.

What are hospital-associated cases?

Hospital-associated cases are patients who develop symptoms 72 hours after hospital admission.

CHANGES IN ROUTINE PRACTICES IN NIAGARA FALLS, ST. CATHARINES AND WELLAND

Emergency Department and Elective Surgeries

The Emergency Departments are open.

The ability to proceed with elective surgeries is being assessed daily based on each case and bed availability due to the number of patients in isolation and the number of patients being admitted through the always busy ERs. Emergency surgeries that could potentially affect the patients’ outcome will not be postponed.

Visitor restrictions

As a temporary measure, daily visiting hours will change from 2 to 8 p.m. to 4 to 8 p.m. to reduce the amount of traffic in patient areas and allow for enhanced cleaning. Visitors must be 13 years of age or older except for compassionate reasons. The long-standing visiting policy restricts the number of visitors to two per patient at one time, and that requirement will be enforced.

Visitors are asked not to visit multiple patient rooms when they come to hospital. Please only visit one patient room during any outing to the hospital during the outbreak.

Visitors should clean their hands upon entering and leaving the hospital, and should not visit the hospital if they are feeling ill. Visitors may be required to wear protective equipment, which includes gowns and gloves, when visiting patients.

Restrictions on pets, flowers or plants

The public is asked not to bring pets, flowers or plants to the site until the outbreak is declared over. This restriction does not include service animals.

Animals, flowers and plants are all sources that can transmit bacteria, and we hope people will understand that this temporary measure is important to prevent the spread of infection.

Dedicated community information line

Members of the public can call a dedicated community information line at the hospital with their questions about C. difficile and the outbreaks. The telephone number is 905-378-4647, ext. 44572. A registered nurse or Infection Control Practitioner will monitor the messages and respond to the inquiries in a timely manner.

Declaring an outbreak is a necessary measure to ensure everyone’s health and safety and resolve the outbreak as quickly as possible. We sincerely appreciate the impact that an outbreak of this nature has on our patients and their families as well as our healthcare providers. Good hand hygiene is the best protection in preventing the spread of C. difficile. Our patients and visitors should be reassured that it is safe to come to our sites for scheduled tests, procedures or emergency/urgent care visits.

‐Frank Demizio, Vice President, Patient Services with responsibility for Infection Prevention and Control

Niagara Health System