Two health care workers who contracted Clostridium difficile (C. difficile) are the latest victims of the bacterial infection since an outbreak began in three hospitals in the Niagara, Ontario, region in recent months, according to a report from the Canadian OH&S News. The infection causes severe diarrhea and other intestinal disease and is usually the result of eliminating “good” intestinal bacteria with antibiotics or other treatments.
The Ministry of Labor (MoL) received confirmation of one of the two new cases July 7 and the other shortly afterwards, said Dr. Leon Genesove, chief physician with the MoL. Genesove could not reveal the hospitals where the two employees worked due to confidentiality, but he confirmed they worked in two sites under the St. Catharine’s, Ontario-based Niagara Health System (NHS).(WCxKit)
As of July 20, 24 fatalities related to C. difficile had been reported since the NHS declared an outbreak at St. Catharine’s General Hospital May 28 and at Greater Niagara General Hospital and Welland Hospital June 23. Thirteen fatalities were reported at St. Catharine’s General, four at Greater Niagara General, six at Welland Hospital, and one at Niagara-on-the-Lake Hospital (which is not a site of outbreak), said a notice from the NHS.
MoL inspectors visited NHS sites July 13 and met with the employer and joint health and safety committee representatives to discuss issues relating to the outbreak. "As part of those visits a number of orders were issued to NHS related to updating their measures and procedures for infection prevention and control to protect workers," Dr. Genesove said.
In particular, the orders touched upon hand hygiene and updating workers' training as it relates to C. difficile exposure. Additional orders related to not having food and drinks in clinical areas were also issued.
"C. difficile is a particularly difficult hospital-acquired infection to deal with," said a report from Public Health Ontario (PHO). An Infection Control Resource Team (ICRT) reviewed the outbreak management system at St. Catharine’s General during a site visit June 29.
The report yielded a series of findings and recommendations in the area of infection prevention and control, outbreak management, hand hygiene, environmental cleaning, use of antibiotics and communication. The ICRT team noted that at times, the NHS would cohort suspected and confirmed patients with C. difficile together.
"This practice should be discontinued immediately as [C. difficile] cannot be diagnosed symptomatically and C. difficile may be easily transmitted between undiagnosed diarrheal cohorted patients," the report said. In situations when a shortage of single-room accommodation may require isolated patients to be grouped together, the report recommends grouping patients with C. difficile together as a last resort, as re-infection can occur.
The ICRT team also found that prior to the declaration of the outbreak, transfer of both patients and patient care equipment between units was common. This "increases the risk of spreading C. difficile and its spores, through environmental contamination and unwashed hands," the report states, noting that St. Catharine’s General has since limited the movement of both patients and equipment between units.
A July 21 report by the Ontario Health Coalition (OHC) in Toronto found that Ontario has the fewest hospital beds per person of all provinces in Canada, with hospital occupancy rates near 97.8 percent, compared to 68.2 percent in the United States. "Ontario's hospital occupancy levels are at untenable levels, far above other comparable jurisdictions," Natalie Mehra, director of the coalition, said.
Apart from posing occupational risks to health care workers, the consequences of overcrowded hospitals include inappropriate staffing ratios, increased hospital-acquired infections and backlogged emergency departments, the OHC report concludes.
While outbreaks may occur, "they can also be reliably stopped through early identification and treatment, aggressive environmental cleaning, health care worker hand hygiene, and control of antibiotics," Dr. Michael Gardam, an epidemiologist and researcher for the University of Health Network in Toronto, said in a release from the Ontario Hospital Association.(WCxKit)
The PHO report recommends that all inpatient units in NHS sites affected by the outbreak, including all common areas and nursing units undergo a full terminal clean with a sporicidal agent. Measures that were put in place as part of the outbreak management, such as increasing housekeeping resources and de-cluttering inpatient areas, should be maintained permanently. The report also called for the infection prevention and control manager to be made a full-time position.
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