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Hospitals must report superbugs by next year
Institutions will be required to provide information on rates of deadly infections
LISA PRIEST

Two superbugs sweeping through Canadian hospitals, striking the sick and killing thousands in their path, will soon have to be reported if institutions want accreditation.

The move highlights the potential dangers lurking in hospitals, where as many as 12,000 patients die each year from all types of infections.

"Hospitals are like a breeding ground for some of these infections," said Phil Hassen, chief executive officer of the Canadian Patient Safety Institute, who said studies show tone in nine patients will acquire an infection in hospital.

Starting in January, 2008, the Canadian Council on Health Services Accreditation will compel virtually all acute-care hospitals -- in addition to those nursing homes and other institutions seeking a stamp of approval -- to provide the rates of methicillen-resistant Staphylococcus aureus (MRSA) or Clostrodium difficile (C. difficile).

Currently, all health-care institutions seeking accreditation must monitor infection rates and share the results throughout their organizations.

The new requirement will compel those organizations to also track the rate of either MRSA or C. difficile as part of the accreditation process.

"When you look at SARS and you look at concerns of pandemic flu, it's important we put a stronger emphasis on infection prevention and control," said Wendy Nicklin, president and chief executive officer of the Canadian Council on Health Services Accreditation, a non-profit, independent organization.

Although accreditation is voluntary, 99 per cent of Canada's acute-care hospitals participate, as do many nursing homes, some community health centres, home-care organizations and other health-care facilities.

The council accredits the 3,750 sites of 923 organizations.

This new reporting mechanism comes as the two bacteria, MRSA and C. difficile, have become a health-care nightmare. This is because institutions that care for premature infants, the immune-suppressed and the frail elderly have inadvertently created the perfect biological environment for the bugs to spawn.

In all, said Dick Zoutman, physician director of the Community and Hospital Infection Control Association of Canada, "we have between 8,000 and 12,000 Canadians who will die from a hospital infection each year. . . . That's more than traffic accidents, breast cancer and many other things we care deeply about."

In the case of MRSA, thousands of patients have been killed in the United States and Britain -- two countries that have found out the hard way that, once the bacterium has colonized in a hospital, it can be difficult to control.

This week, Sunnybrook Health Sciences Centre's neonatal intensive-care unit, located at Women's College Hospital in Toronto, was shut down because of an outbreak of methicillen-sensitive Staphylococcus aureus. The hospital has assured the public that no other services have been affected.

MRSA can hide inside a nostril, survive on a hand or stay embedded in a piece of soiled clothing. It may show up as a blotch of reddened skin, or a painful, swollen pimple. The damage it inflicts can be minor and treated with a topical antibiotic, or it can be swift and merciless, resulting in septicemia, pneumonia, deep wound infections and decayed lungs.

Equally formidable is the Nap 1 strain of C. difficile. It creates a toxin factory that can damage the lining of the bowel, in some cases even perforating it. The strain has caused 2,000 deaths in Quebec since 2003.

Four patients who died at a large Ontario hospital over the past month tested positive for C. difficile. But Mississauga's Trillium Health Centre spokesman Larry Roberts stressed that C. difficile has not been established as the cause.

C. difficile is such a formidable hospital superbug that the Public Health Agency of Canada has called for all cases to be reported nationally. However, the agency's recommendation is not binding, and only Manitoba and Quebec compel institutions to report MRSA and C. difficile to provincial health bodies.

According to Michael Mulvey, chief of antimicrobial resistance and hospital-acquired infections at the National Microbiology Laboratory, those stricken by the Nap 1 strain are two times more likely than others with C. difficile to have a serious outcome, defined as an admission to a hospital intensive care unit, a colectomy -- an operation to remove part or all of the colon -- or death.

A Public Health Agency of Canada surveillance study of 34 hospitals found the Nap 1 strain was present in every province but Prince Edward Island -- and PEI does not have a hospital that participates in the program.

Moreover, the strain was present in about one-quarter of the 2,000 stool samples collected from Nov., 1, 2004, to April 30, 2005, a particularly troubling finding since that strain produces 10 times more toxins that other C. difficile strains.

"With over 300 strains of C. difficile, it can mutate continuously," said Denise Gravel, senior epidemiologist for the Canadian Nosocomial Infection Surveillance Program for the Public Health Agency of Canada. The agency is to embark on another surveillance study this month involving 50 hospitals.

Allison McGeer, director of infection control at Mount Sinai Hospital in Toronto, said although the goal should be to eradicate every infection, no hospital can prevent them all.

However, Dr. McGeer said, "there are lots of model programs from hospitals and evidence from studies showing that we can prevent a much larger fraction of them." In fact, Mr. Hassen notes that "only 40 per cent of hospital workers appropriately wash their hands."

When Quebec was hit with the strain of C. difficile that caused 2,000 deaths since 2003, the provincial government pulled out all health-care stops to contain it.

Millions were poured into new hygiene measures, including frequent hand-washing by hospital personnel, visitors and patients, as well as better cleaning to help prevent its spread. In addition, infected patients were isolated and antibiotics were used more intelligently to slow mutation of the bacteria, said Alain Poirier, national director of Quebec Public Health.

"We've done a lot of work since that outbreak," he said, noting that the number of cases is estimated to have dropped by half.

Dr. Zoutman said that he would like to see a $100-million research fund set up to study how hospital infection is transmitted, and how better to prevent it.

"We react once there has been a problem," Dr. Zoutman said. "I think we need to move well beyond reacting."

This month, 10 hospitals will participate in a pilot project of the Canadian Council on Health Services Accreditation, in which they will be asked to report either MRSA or C. difficile rates. The plan will be further refined, then rolled out to health-care institutions applying for accreditation this January.

The results will not be reported publicly, unless the institutions choose to release the information.

Online source:
http://www.theglobeandmail.com/servlet/story/LAC.20070310.CDIFFICILE10/TPStory/National