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www.oakvillebeaver.com The Oakville Beaver Weekend, Saturday January 3, 2009 - 5 Hospital disputes C. difficile outbreak status By David Lea OAKVILLE BEAVER STAFF Officials at Oakville-Trafalgar Memorial Hospital (OTMH) are disputing claims by Ontario's Ministry of Health that the hospital is currently in the grip of a C. difficile outbreak. The ministry reported the outbreak finding late last month as part of an ongoing program that has seen C. difficile rates at Ontario hospitals made public every month since September. Under this program, OTMH was one of only two hospitals in the province reported to be undergoing an outbreak. Halton Healthcare Services (HHS) Infectious Disease Specialist and Medical Microbiologist Neil Rau disagrees with the outbreak characterization noting that the hospital is actually seeing reduced levels of C. difficile, with 10 cases emerging in September, seven in October and two in November. "The issue is there are two competing definitions (of what an outbreak is) and because of one definition, now being publicly reported by the ministry, they believe we're in an outbreak until we have another favourable month of C. difficile numbers," said Rau. Rau would not speculate as to whether December's low C. difficile numbers (one case) would take OTMH out of the outbreak category. He further noted that under this definition, which says anything above a hospital's baseline number of C. difficile cases constitutes an outbreak, OTMH has been undergoing an outbreak throughout 2007 and 2008. Rau points out that under the new definition of an outbreak, developed since public reporting on C. difficile rates started in September, OTMH does not fit the characterization. In that definition, the Ministry of Health notes that for an outbreak to occur, a hospital has to have three C. difficile cases take place in one ward in one week or six cases in one ward during one month. As this has not happened for November or December, there is no outbreak, said Rau, who also pointed out there is no infection control team at OTMH trying to bring the outbreak under control as previously reported. "They came for a one-day visit on Dec. 10. They provided us with valuable feedback and ideas to move for- ward and that's it," said Rau. "There's no team parked at our place doing an investigation. It's unfortunate that that's the way it's been portrayed." While he is adamant no outbreak is taking place, Rau noted that infection control efforts are being conducted at OTMH as though such an epidemic were. C. difficile is a bacterium that can damage the bowel and cause diarrhea. Normally harmless, it causes problems in hospitals because it thrives in patients who have recently received antibiotics and in severe cases can cause death. As C. difficile is an infectious disease, cleaning surfaces touched by infected patients is the primary means of combating its spread, however, as Rau pointed out, sometimes cleaning is not enough. "A place can look visibly clean, but still have C. difficile spores, which are still viable even after you use a standard hospital disinfectant that we used to use. We expanded our use of RESCUE, a very costly chemical compound ($50 per bucket) that kills the C. difficile spores," said Rau. "We've gone from using it on just C. difficile patient rooms to much more than just that, just because of this issue of leftover spores that may have been there from many weeks before, but are still viable." Tracing a patient's movements to find out where in the hospital they contracted C. difficile and then improving infection control in that area is another measure that has been introduced. Rau believes these measures are having a positive effect given the recent drop in the number of C. difficile cases at OTMH. Dr. Michael Gardam, the head of the infection control team that visited OTMH on Dec. 10, applauded these measures, stating he was confident C. difficile levels would remain low as a result with the exception of the blips all hospitals experience. He also agreed with hospital officials that OTMH is not experiencing a C. difficile outbreak under the new definition. NEW YEAR'S RESOLUTIONS? l takes care of them all. in to do ings Th 2009 If you would like to get in shape, meet new people, and have a ball this year, call the dance professionals at Fred Astaire Dance Studios and start the year off on the right foot. One call will make 2009 a year to remember! y NEW YEAR'S ire Asta F redStudios Call nce Da Are You Happy With Your Smile? 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