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4- The Oakville Beaver, Friday December 21, 2007 www.oakvillebeaver.com Superbug poses deadly challenge By Krissie Rutherford OAKVILLE BEAVER STAFF VISIT US ONLINE Spot! Since 1952 Save 25% Bottle removeof spot each orr with der! FREE! C. difficile infected more than twice as many patients at Oakville Trafalgar Memorial Hospital this year compared to last year. It has also proven to be more deadly. Of the 74 patients at the hospital infected with the bacteria in 2007, nine patients ­ all seniors ­ died either as a direct result of the infection, or with C. difficile playing a significant role, said Halton Healthcare Services Infection Prevention and Control Specialist, Dr. Neil Rau. The remaining infected patients either recovered with the use of antibiotics, or died from another cause, the doctor said. "We don't consider this an outbreak, but we do consider it a concern," Rau told The Oakville Beaver. "We have seen a doubling in rates per admission. That, to us, is significant." This information is the result of an infection control monitoring and surveillance program at Halton Healthcare Services (HHS). According to the program's findings, the 2007 C. difficile incidence rate was 5.1 per 1,000 patients admitted to OTMH, compared to an incidence rate of 2.3 per 1,000 patients the hospital admitted in 2006. Rau says the number of deaths caused by C. difficile at OTMH in 2006 is not available because the full year of surveillance data was not conducted. C. difficile ­ also known as Clostridium difficile ­ is a bacteria that damages the intestinal track, causing symptoms like diarrhea, fever, loss of appetite, nausea and abdominal pain. Most vulnerable to the infection are seniors, and people taking antibiotics or stomach medications that kill the good Dr. Neil Rau bacteria that keeps C. difficile in check. "Problems arise when antibiotics taken for other illnesses kill the `good' bacteria, which in turn allows the C. difficile bacteria to grow out of control," Rau said. While numbers of infected patients are up at OTMH, Rau noted the local hospital is below provincial incidence rates, which sit at 5.53 infections per 1,000 admissions. The reason for the increase, the doctor said, is a new "more virulent" strain of C. difficile called NAP1, which is resistant to regular hospital cleaning products. It was found in Quebec hospitals in 2005, and has now been identified in the GTA. "This new strain has a capacity to cause more severe disease," Rau said. It produces more toxins and has landed more patients in intensive care than the previous strain. The doctor noted some patients infected with C. difficile even need surgery ­ their colons removed ­ though to date this has not been necessary at OTMH. C. difficile spreads when it's picked up from surfaces and ingested. Rau gave the example of an infected patient excreting the bacterium into the environment, which forms an invisible spore that hides out on surfaces and is picked up by other people. This new strain of C. difficile produces more of these spores, Rau says, and they're "remarkably resistant to disinfectants, even the harsher ones." As a result, hospitals have to revamp their cleaning methods. "It's a challenge facing all of us because the standard cleaning mechanisms we use aren't good enough," said Rau. Shirley Lanza, the manager of Infection, Prevention and Control with HHS, said Halton hospitals anticipated the arrival of the new strain of C. difficile and "implemented additional control measures to enhance infection prevention over the past year to help reduce the risk of infection throughout its three community hospitals." Despite OTMH's best efforts to improve its cleaning practices and monitor its C. difficile cases, the number of infected patients rose dramatically this year. "Despite being proactive and preemptive, how do we keep the number of infections down?" said Rau. "Can we get our numbers down to 2002 levels? I doubt it, because we have a new strain that's more virulent." The spores produced by the new strain of C. difficile are surrounded by a capsule, which is "remarkably resistant to the standard hospital disinfectants," Rau says. Bleach and a costly accelerated hydrogen peroxide are some of the new cleaning practices OTMH has adopted. Hand washing and hand hygiene are also high on the list to prevent C. difficile from spreading, the doctor says. Rau noted OTMH is especially vulnerable to C. difficile because of the complexity of the patients it serves, including many long-term care patients. BOXING WEEK SALE STARTS TODAY! DON'T PAY 'TIL 2009* ALL TREADMILLS · ALL ELLIPTICALS · ALL HOME GYMS 40 UP TO THE AB TRAINER NOW $2999 boxing week special % NO PAYMENT NO HASSLE OFF OUR REGULAR PRICE · ALL EXERCISE BIKES LAST MINUTE GIFT GIVING IDEAS! 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