As of October1, 2018, there are no outbreaks of C. difficile at Bruyère.
At Bruyère, we always take our patient care and safety very seriously and are particularly vigilant in the area of C. difficile infections. We are committed to both transparency and regular reporting. On a monthly basis, we report the rates of C. difficile at both our hospitals – Élisabeth Bruyère Hospital and Saint-Vincent Hospital on our website. The analysis of our rates over time provides us with valuable information that we will use to improve quality of care in our organization.
Infection rates are influenced by many different factors unique to each organization, such as patient risk profile and intensity of surveillance. As such, infection rate data may not always be comparable between organizations. Hospital-acquired cases exclude those patients who are admitted with the infection.
Rates of C. difficile are the first of a number of patient safety indicators that all Ontario hospitals publicly report. Since September 2008, these indicators have been posted on the Health Quality Ontario website. Public reporting of C. difficile rates is not intended to serve as a measure to compare hospitals against each other. First of all, it is important to remember that rates at most hospitals will vary from month to month. Furthermore, it is important to take into account the specialty care within the various facilities, implying different risk factors. Thus, when considering hospital performance, it is essential that C. difficile rates be viewed in the context of other performance indicators.
C. difficile Q&A
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Q: What is C. difficile?
A: C. difficile (Clostridium difficile) is a bacteria. C. difficile can be part of the normal bacteria in the large intestine and is one of the many bacteria that can be found in stool (a bowel movement).
C. difficile infection occurs when other good bacteria in the bowel are eliminated or decreased allowing the C. difficile bacteria to grow and produce toxin. The toxin produced can damage the bowel and cause diarrhea. C. difficile is one example of a hospital-acquired infection and is one of the most common infections found in hospitals and long-term care facilities. C. difficile has been a known cause of health care associated to diarrhea for about 30 years.
Q: What are healthcare-associated infections?
A: Sometimes when patients are admitted to the hospital, they can get infections. These are called healthcare-associated infections.
In the case of C. difficile, this may mean that symptoms began 72 hours after admission to the hospital; or that the infection was present at the time of admission but was related to a previous admission to that hospital within the last four weeks.
Q: Who is at risk for C. difficile?
A: Healthy people are not usually susceptible to C. difficile. Seniors, and people who have other illnesses or conditions being treated with antibiotics and certain other stomach medications, are at greater risk of an infection from C. difficile.
Q: What are the symptoms of C. difficile?
A: The usual symptoms are mild but can be severe. Main symptoms are watery diarrhea, fever, abdominal pain/tenderness. In some cases there may not be diarrhea. Blood may or may not be present in the stools.
Q: How do you get C. difficile?
A: C. difficile is the most common cause of healthcare-associated infectious diarrhea. Since it can be part of the normal bacteria that live in the large intestine, taking antibiotics can change the normal balance of bacteria in your large intestine making it easier for C. difficile to grow and cause an infection. Old age and the presence of other serious illnesses may increase the risk of C. difficile disease.
Q: How does C. difficile spread?
A: When a person has C. difficile, the germs in the stool can soil surfaces such as toilets, handles, bedpans, or commode chairs. When touching these items, your hands can become soiled. If you then touch your mouth, you can swallow the germ. Your soiled hands can spread germs that can survive for a long time on other surfaces if not properly cleaned.
The spread of C. difficile occurs due to inadequate hand hygiene and environmental cleaning; therefore, proper control is achieved through consistent hand hygiene and thorough cleaning of the patient environment. Good hand hygiene (washing hands thoroughly and often) is the single-most effective way to prevent the spread of infectious diseases like C. difficile.
At Bruyère, we are committed to promoting hand hygiene for patient care. We provide access to alcohol-based hand products as well as soap and water throughout the facility for staff, patients and visitors to use. Using the guidelines of the Ministry of Health and Long-term Care's "Just Clean Your Hands" Campaign, we are developing a process where we will audit hand hygiene techniques of staff members. The results of this initiative will be incorporated into our hand hygiene program.
Q: How is C. difficile diagnosed?
A: C. difficile is usually diagnosed by sending a specimen of diarrhea to the laboratory where it is tested for the presence of the C. difficile toxin.
Q: How is C. difficile treated?
A: Treatment depends on how sick the patient is. People with mild symptoms may not need treatment. For more severe disease, antibiotics are required.
Q: What precautions are used to prevent the spread of C. difficile in the hospital?
A: If you are in the hospital and have C. difficile diarrhea, you will be put on precautions until you are free from diarrhea for at least two days. Your activities outside the room may be restricted. All health care staff who enter your room will wear a gown and gloves. Everyone MUST clean their hands when leaving your room.
Q: How does Bruyère control the spread of C. difficile?
A: In order to prevent the spread of C. difficile, we engage our housekeeping team to ensure that they are following the best practices for cleaning in situations where patients are identified with C. difficile. As well, we strongly encourage our staff to enhance their hand hygiene practices. We ensure that patients who are suspected or proven to have C. difficile receive appropriate treatment as soon as possible. Once diarrhea has stopped in a patient with C. difficile, there is a much lower risk of contamination that might cause further cases.
In following the best practice standards Bruyère has also established the following procedures to control and manage C. difficile outbreaks when they occur. These procedures include:
- Ensuring that patients with C. difficile get the appropriate treatment;
- Placing individuals identified or suspected to have C. difficile on contact precautions (which means gowns and gloves are used when we go into their space);
- Enhancing cleaning of the outbreak unit;
- Involving all necessary services in the hospital to assist in outbreak management; and
- Notifying Public Health and get their advice.
Even when a hospital is not in an outbreak situation, we:
- Remind all staff of the importance of hand washing;
- Ensure that visitors are instructed in hand washing and other control measures (Information can be obtained from the hospital staff); and
- Provide education to staff, so that all members of our team are up-to-date with current management strategies.
Q: Does Bruyère track C. difficile cases?
A: Looking closely at the C. difficile cases is an important step in making sure you are safe. It allows us to know whether there is a problem in the hospital and to understand how big the problem is. We track all C. difficile cases in our hospital, and as soon as any case is identified, we bring in the resources needed to stop the possibility that it might spread to others.
Q: What is Bruyère is doing to improve patient safety?
A: Bruyère has a patient safety program in the hospital to make sure that all practices are at the highest level possible to keep you safe. This includes:
- Ensuring that our housekeeping practices are in line with the best practices in healthcare
- Developing a program for excellence in hand hygiene
- Conducting audits on various practices to verify that patient care is as safe as possible