NIAGARA, ON: The Niagara Health System today declared the C. difficile outbreak at the St. Catharines General Site over.
“This has been an extremely challenging time for the hospital and the Niagara community,” says Dr. Sue Matthews, NHS Interim President and CEO. “We must continue to be vigilant with our infection prevention and control practices, and we will work to our fullest capacity to maintain a quality and safe patient environment.”
Throughout the outbreak, NHS has held regular discussions with infectious disease specialists, including Dr. Michael Gardam, Director of Infection Prevention and Control for the University Health Network in Toronto.
“I think the NHS has done a fantastic job getting this challenging situation under control,” says Dr. Gardam. “The organization has made a number of important improvements and has an excellent system in place to monitor and control C. difficile going forward.”
NHS has taken many steps to enhance our infection prevention and control practices and will continue to do so.
“Dozens of ‘new normal’ practices have been in place for several months now, and it is our commitment to embed these practices into our daily routine on an ongoing basis,” says Dr. Matthews.
These practices include: regular hand hygiene audits of staff and physicians to ensure 100 per cent compliance with best practice; screening of ER patients, inpatients and outpatients; and the restriction of food or drink in patient care areas unless it is for the patients.
Also today, an outbreak of Vancomycin-resistant enterococci (VRE) was declared over on Unit C at Greater Niagara General Site in Niagara Falls. This outbreak was declared Friday, Oct. 7.
Summary of C. difficile outbreaks at the Niagara Health System
Prepared on Monday, October 24, 2011
The C. difficile outbreak at the St. Catharines General Site was declared on May 28, 2011, and declared over on Monday, October 24, 2011.
The C. difficile outbreak at the Welland Site was declared on June 23, 2011, and declared over on August 5, 2011.
The C. difficile outbreak at the Greater Niagara General Site was declared on June 23, 2011, and declared over on September 6, 2011.
| As of Monday, October 24, 2011 | St. Catharines | Niagara Falls | Welland | TOTAL |
|---|---|---|---|---|
| Patients who contracted hospital-associated C. difficile | 69 | 18 | 15 | 102 |
| Patients with community-associated and other non-hospital-associated C. difficile *These numbers are approximate as we do not use the same tracking method for non-HAI cases |
59 | 15 | 12 | 86 |
| Patient deaths | 27 | 5 | 5 | 37 |
| Average age of patients who died | 75.2 years |
82.4 years |
77.2 years |
78.2 years |
| Number of patient deaths in which C. difficile was the cause of the death | 5 | 2 | 0 | 7 |
| Number of patient deaths in which C. difficile was a factor but not the cause of death | 8 | 1 | 2 | 11 |
| Number of patient deaths in which C. difficile was not attributable to the death | 12 | 2 | 3 | 17 |
| Number of patient deaths in which impact of C. difficile is inconclusive | 2 | 0 | 0 | 2 |
Some of the recommendations from the provincial Infection Control Resource Team that were immediately implemented and remain in effect today included more intensive cleaning, restricted visiting hours and enhanced communications to the frontline regarding hand hygiene and the use of personal protective equipment.
Examples of what the “new normal” looks like in terms of regular infection prevention and control practices:
- We have a new trigger system that will enable us to quickly respond to suspected C. difficile cases with enhanced cleaning and patient isolation.
- Our cleaning practices related to C. difficile and other hospital acquired infections have been enhanced.
- There will continue to be regular hand hygiene audits of staff and physicians to ensure 100 per cent compliance with best practice. This means staff and physicians must clean their hands before and after every contact with a patient and the patient environment, as well as before an aseptic procedure and after body fluid exposure risk.
- There will be ongoing screening of ER patients, inpatients and outpatients, including those coming to clinics and for tests.
- We will continue to cover all equipment that has been cleaned with plastic covering. This will ensure staff use only equipment that has been thoroughly cleaned according to infection prevention and control standards.
- Our staff will continue to have daily huddles at the beginning of each shift to share any questions or concerns.
- Food and drink will be restricted in patient rooms unless it is for the patients.
- We have moved to genetic testing (PCR) for C. difficile; more accurate, detecting more cases.
- We have stopped the practice of cohorting patients.
- There are limits on movement of equipment between units.
- Increases in housekeeping resources in place during the outbreaks will be maintained.
- We have extended the use of sporicidal agents across the hospital, vs. use solely in patient bathrooms.
- Terminal clean – more intensive cleaning – has occurred across facilities; units with recurrence have been terminally cleaned again.
- Enhanced housekeeping audits and checklist.
- Antibiotic stewardship enhancements ongoing across our sites.
- Enhanced transparency and clear communication approach.
- Clear signage, hand hygiene stations, and overhead voice message concerning the outbreaks and need for hand hygiene.
