C'est c. difficile
According to an article in the Toronto Star dated July 4, 2008, over 463 elderly patients have died of Clostridium difficile (c. difficile) in Ontario hospitals in the past 30 months.
This and other coverage has prompted a flurry of concern around this issue. Ontario hospitals are now required to report the number of cases of c. difficile on a public website - Patient Safety Ontario, the CBC reported last week. However, this website does not list c. difficile-related deaths. Because c. difficile typically attacks patients who are already sick, cause of death is sometimes difficult to determine. Also, consumers should bear in mind that it is not easy to compare hospitals:
Since the number of cases a hospital has depends on how large it is, what type of patients are admitted and how well the hospital controls it, the website doesn't give a sense of "good" or "bad" hospitals, cautioned Dr. Alison McGeer, a microbiologist and director of infection control at Toronto's Mount Sinai Hospital. (source)
What is c. difficile?
bacteria found in feces that can cause diarrhea and more serious intestinal conditions such as colitis (inflammation of the colon), sepsis (disease-causing bacteria or toxins are found in the bloodstream and tissues) and even death.
Because it is commonly abbreviated, many people miss the association of c. difficile with related bacteria clostridium botulinium (which causes botulism or food poisoning) and clostridium tetani (which causes tetanus or lock jaw).
According to the Public Health Agency of Canada, c. difficile is one of the most common diarrheal infections in hospitals and long-term care facilities in the industrialised world. Whereas healthy people don't usually get c. difficile, the elderly and people who have other illnesses or conditions requiring the use of antibiotics are at greater risk of infection. In these people, toxins produced by the bacterium can damage the bowel and cause diarrhea. This condition is known as Clostridium difficile associated disease (CDAD). (source)
On June 17, 2008, an article in the Canadian Medical Association Journal noted that c. difficile rates in Ontario hospitals have surpassed those in Quebec, but that the most virulent strain of the bacteria "remains associated with Quebec, where outbreaks led to an estimated 2000 deaths earlier this decade". This article goes on to observe that mandatory reporting is hampered by a lack of clear legislative authorities for surveillance activities.
How can you avoid c. difficile? (source)
The bacteria in feces can contaminate surfaces such as toilets, handles, bedpans, or commode chairs. When you touch a contaminated surface, your hands can become contaminated. If you touch your mouth or food without washing your hands, you can become infected. Your unwashed hands can also spread the bacteria to other surfaces.
If you are visiting a hospital, hand hygiene is the most effective way avoid spreading or catching c. difficile and a number of other infections. Use an alcohol-based hand sanitizer or wash your hands with anti-microbial soap and warm water, for as long as it takes to sing the alphabet (about 15 seconds). Turn off the tap with a paper towel. Do this before and after visiting and between seeing patients (if you are visiting more than one person).
Although healthy people are not usually affected by the bacterium, if you have concerns that you might have been exposed, a thorough cleaning of your home, clothes and dishes with soap and hot water will minimise the risks posed to you and your family.
Donna MacLeod for Consumer Health Information Service, Toronto Public Library
- Patient Safety Ontario website (Find by hospital name)
- Government of Ontario. Clostridium difficile Associated Disease (CDAD) Fact Sheet for Patients (no date provided)
- Toronto Public Health Clostridium difficile fact sheet (November 2006) and Handwashing instructions (no date provided, available in many languages)
- Public Health Agency of Canada Fact sheet: C. difficile (June 20, 2008)
- Canadian Medical Association Journal Ontario's hospitals surpass those of Quebec in C. difficile rates. CMAJ, June 17, 2008; 178 (13). doi:10.1503/cmaj.080804
- Mayo Clinic's comprehensive overview of C. difficile (December 13, 2006)
- MedlinePlus's Clostridium difficile infections (June 24, 2008)
- Physician's Desk Reference Clostridium difficile infection (2008)