Portrait of an Outbreak: Ontario’s Fight With Clostridium Difficile

July 12, 2011

If you’ve been reading any news from Canada, you are no doubt familiar with the Clostridium difficile outbreak occurring at several health sites in Ontario, Canada. The outbreak has gained considerable news attention from the media.  (The links to several of the news articles can be found in today’s and previous issues of In Focus, In the News).

On July 5, HAI Focus reported about an outbreak notice issued by the Niagara Health System in consultaion with Niagara Region Public Health.  The notice declared C. difficile outbreaks at three Ontario, Canada health sites: St. Catharines General, Greater Niagara General, and Welland sites. The following information was provided in that notice:

  • The outbreak at St. Catharines General was first declared on May 28, 2011. That site has had a total number of 40 cases declared. 19 of those confirmed cases are currently in-patients, 11 are hospital-acquired and 8 are community-acquired.
  • The Greater Niagara General Site has had 14 cases since its outbreak was declared on June 23, 2011. 12 of those cases are currently in-patients; 8 are hospital-acquired, and 4 are community-acquired.
  • The Welland site had its outbreak declaration on June 23, 2011. It has had 12 cases declared, 9 are in-patients, 7 were hospital-acquired, and 2 were community-acquired.
  • As of July 4, 2011, there have been 16 patient deaths associated with the outbreak. Ten deaths have occurred at St. Catharines General and two deaths were associated with the Welland Site outbreak. Four patients deaths have been blamed for the Greater Niagara General site outbreak.
Today, July 12, 2011, a new report has been issued by Public Health Ontario about a visit on June 29, 2011 of the Infection Resource Team to the Niagara Health System St. Catharine’s General Site.  The report contains the following executive summary:

The Ontario Agency for Health Protection and Promotion received a request from the Niagara Health System (NHS) for an Infection Control Resource Team (ICRT) to review the management of an outbreak of Clostridium difficile (CDI). The CDI outbreak in question was declared at the St. Catharine’s site only on May 28, 2011.  Subsequently, CDI outbreaks were declared at both the Niagara and Welland sites. The ICRT review focused specifically on the St. Catharine’s outbreak, although many of the recommendations made are applicable to the subsequent two outbreaks.

Requested information was received from the NHS infection prevention and control (IPAC) manager and the NHS administrative director responsible for IPAC on June 27, 2011. On June 29, 2011 the ICRT team was deployed to conduct interviews and perform an on-site assessment of the events involved in the outbreak. A number of preliminary recommendations were given verbally to NHS at the end of the site visit. These key recommendations and others generated from the review are outlined below.

The report provides extensive recommendations that will certainly be helpful and important in preventing Clostridium difficile infections in Canada and elsewhere.  The recommendations address key issues related to the following:

  • Infection Prevention and Control Programs
  • Outbreak Management/Clinical Practice
  • Hand Hygiene
  • Environmental Cleaning
  • Antibiotic Utilization
  • Communication
  • Laboratory Support
Source:  Public Health Ontario.  Report on the Visit of the Infection Control Resource Team to the Niagara Health System (St. Catharine’s General Site) June 29, 2011.  Report submitted: July 12, 2011.Click to download the Report.


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