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C. difficile outbreak linked to nine hospital deaths

Oct 29, 2006 | Montreal Gazette Public health authorities have yet to contain an outbreak of C. difficile-related diarrhea in a St. Hyacinthe hospital that has been linked to the deaths of nine patients since July.

At present, 22 patients most of them elderly are still sick with Clostridium difficile-associated disease at the Centre hospitalier Honore Mercier. The superbug is suspected to be lurking on five floors of the building, despite the fact housekeeping staff have twice washed down patient rooms with bleach.

The outbreak is baffling authorities because it comes as rates of C. difficile infections have been declining across Quebec, especially in the Montreal region.

Quebec's top public health officer, as well as a leading expert on C. difficile, dismissed claims yesterday by the hospital that an entirely new, hypervirulent strain has emerged in St. Hyacinthe, about 65 kilometres east of Montreal.

Rather, a lack of infection-control measures is probably to blame, suggested Mark Miller, head of a national surveillance group on C. difficile for the Public Health Agency of Canada. Miller said the hospital has probably been hit with a strain called NAP1/027 the same one that has circulated in Quebec since 2004.

That strain is 20 times more toxic than older strains of C. difficile and has directly or indirectly caused the deaths of 2,000 Quebecers.

"With the strain we have here in Quebec, there's no room for errors and no room for being lax," Miller said.

"You have to have excellent infection control all the time. You have to have great housekeeping all the time. If you become lax, the hospitals have shown that this strain causes outbreaks."

The infections started occurring in the 202-bed hospital on July 23 a couple of months after extensive renovations were undertaken to eliminate a fungus that was discovered in the walls.

Ghislaine Archambault, the hospital's communications director, said workers are in the process of disinfecting half the building. What's more, visits have been limited to one person per patient and children under 2 are not allowed in the hospital. Visitors are also advised to wash their hands before entering the hospital and after seeing patients.

"We want to ask the public to help us," Archambault said.

"We'll get through this."

Patients who are sick with C. difficile are being isolated. Certain pieces of equipment have been sterilized, curtains have been replaced and furniture is not being moved around.

Archambault said the hospital has faced two outbreaks the first in August and the second in recent weeks. Housekeeping staff scoured the hospital after the first outbreak.

Proper sanitation is good but is not enough, Miller said. Early diagnosis and treatment of C. difficile diarrhea must be made, and patients must be isolated without delay, he added. If those measures are not carried out immediately, an outbreak will occur, he said.

Across the province, the rate of C. difficile infections in large hospitals was eight per 1,000 admissions last month. That's down from a province-wide rate of 24 at the height of the epidemic in 2004.

At Montreal's Jewish General Hospital where Miller works as chief of infectious diseases the rate of infection dropped last month to its lowest level in 13 years.

For smaller hospitals, the average rate last month was four C. difficile cases per 1,000 admissions.

"It continues to improve every month," Miller said, the exception being St. Hyacinthe.

Horacio Arruda, provincial director of public health, said he doubts Honore Mercier has been beset by a new strain.

"It's clear that if you don't react fast to an outbreak, you'll get more cases," he said, adding he's satisfied with the hospital's measures.

"If you look at hospitals in Quebec, there are some that have seen increases and others that have seen decreases," said Jacques Bisson, of the Association to Defend Victims of Nosocomial Infections. "It all depends on how a hospital manages the problem of nosocomial infections and how they keep up with proper hygiene and prevention."

The provincial government is monitoring the situation at the hospital, said Isabelle Merizzi, an aide to Health Minister Philippe Couillard. "We have confidence in the rapid response by the hospital," Merizzi said.

It's doubtful the C. difficile bacterium was a direct cause of death in all nine patients at the hospital. Some of the patients were suffering from multiple illnesses, Archambault said, and C. difficile was a contributing factor in their deaths.

After initially playing down the C. difficile epidemic, the provincial government last year invested $25 million to fight hospital-acquired infections.

Similarly virulent strains of C. difficile have caused outbreaks in four U.S. states as well as in Britain and the Netherlands.

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