Source: http://www.thespec.com/News/Local/article/437071
How other countries fight C. diff
September 18, 2008
Joan Walters
The Hamilton Spectator
(Sep 18, 2008)
Outside Ontario, rising death and infection rates from a vicious new strain of the superbug C. difficile have prompted governments to call inquiries, impose fines, offer incentives and take other action to bring the disease under control.
In the United States, Medicare officials asked this summer for public comment on a plan to hold back payments to hospitals for the extra care required for patients harmed by certain preventable infections -- including C. diff.
The U.K. has imposed fines of up to $100,000 and warned of reduced funding for hospitals that cannot hit government-imposed targets to bring C. diff infection rates down.
Around the world, rising public anxiety and warnings from health watchdogs have led other jurisdictions to act aggressively.
In Ontario -- where hundreds of infected hospital patients have died in just the past two years -- the government takes its first formal steps against the bug next week with the launch of mandatory reporting on hospital C. diff infection rates.
But Ontario's C. diff death rate, which went up 50 per cent from 2005 to 2007, indicates more is needed, critics of the government say.
A tally by The Spectator shows at least 460 patients infected with C. diff have died at just 22 of Ontario's 157 hospitals since 2006. In the worst of those outbreaks, 91 patients died at Joseph Brant Memorial Hospital.
But the Ontario government has declined to find out on its own how many patients have died provincewide. It has also rejected calls for any investigation or inquiry into what went wrong with the province's infection controls.
"Family after family after family went through hell and back in dealing with these outbreaks and the government pretty much tried to have an arm's-length approach," says New Democrat Andrea Horwath, MPP for Hamilton Centre.
"That is absolutely unacceptable when people were dying."
And the new C. diff reporting system that launches Sept. 26 will only look at what happens from this point forward, not what occurred in the past. It will not count deaths, either, meaning the public will not be able to see whether C. diff fatalities rise -- as they have in other countries.
Investigations into the circumstances surrounding as few as 20 deaths from C. diff have been called in England, Scotland, Wales and Northern Ireland.
Other initiatives include:
* Notice of fines of up to $100,000 has been posted by Britain's National Health Service for hospitals that breach hygiene regulations. The fines also cover infractions such as obstructing a government inspector and failing to provide requested documents.
* British inspectors will now have the power to prosecute hospitals and clinics -- for example, if they fail to take requested action after an outbreak of C. diff.
* Doctors and other health workers in Britain have a "bare-below-the-elbows" dress code: no ties, shirt cuffs, rings or watches. C. diff spores can survive on clothing and other surfaces.
* U.K. hospitals with declining C. diff rates can apply to an incentive fund for up to $500,000 for new hygiene initiatives, such as extra handwashing basins.
* Earlier this year in Northern Ireland, the health minister took less than a month to order a review and set in motion an action plan after 51 patients in one hospital district died of C. diff. An expert panel was retained for a three-month investigation of what went wrong, and $18 million was found for special infection-fighting measures, including unannounced hygiene inspections of hospitals.
Northern Ireland has also set a target of a 20 per cent reduction in C. diff in the elderly by mid-2009.
* The European Centre for Disease Prevention and Control called this summer for a review of existing guidelines for C. diff control, after outbreaks of the epidemic strain in 16 countries there.
* A symposium of clinical microbiologists in Europe called this spring for strong efforts to find new therapies for the bacterium.
Here is a recent report on C diff from the Netherlands. Number of infected patients is not known exactly, RIVM (Nat. Inst. Infectious Diseases) says "several dozens". Anti-biotics and fecal therapy are used.
Below you can find a link leading to a document with protocols how to prevent and fight C diff in your hospital. Document is in Dutch, via Google Translation Tool you can translate it.
September 12, 2008
Clostridium difficile ribotype 027 remains present and a new type 078 is emerging
Since the last report in summer 2007, Clostridium difficile infections (CDI) caused by PCRribotype 027 (type 027) have caused only a few epidemics. In six hospitals that regularly submitted samples for typing, type 027 has not been found in the last 9 to 12 months.
However, type 027 was recently found again in two of these hospitals. It is not yet clear whether this has led to new epidemics. Since last summer there has been one new hospital which was affected by type 027-associated outbreaks. This hospital had an outbreak at the end of 2007, which is controlled by now. The peak incidence was 67/10,000 admissions.
The figure shows the mean incidence for 2005, 2006 and 2007. For all but three (among which the two most recently affected) of the hospitals where type 027 has caused epidemics, the incidence in 2007 was lower than or comparable with the incidence in 2006. The mean incidence in 2007 was 20/10,000 admissions or less in 8 hospitals.
The mean incidence of most hospitals was higher in 2007 than before the epidemics started.
This is (partly) the consequence of more methodical testing, which many institutions introduced at the discovery of the outbreaks.
Another new ribotype, 078, is emerging. This type has the same virulence characteristics as type 027. Since 2007 it has been increasingly reported in Belgium, Ireland, Germany and Spain. In the Netherlands this type was also found in piglets with diarrhea but a direct transmission to humans is improbable.
By now many hospitals have detected type 078 and this type led to a small outbreak in one institution.
It can be concluded that type 027 continues to be present in the Dutch Clostridium difficile population. New serious epidemics fortunately remain at bay, partly thanks to increased attention for prevention and treatment. The emergence of the new type 078 is monitored closely.
Publications
More information on Clostridium difficile in the Netherlands and Europe and the studies there into can be found in following publications:
Goorhuis A, et al. Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands. Clin Infect Dis 2007;45:695-703.
- Kuijper EJ, et al. Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe. Euro Surveill Monthly 2007;12(6)E1-2.
www.eurosurveillance.org/em/v12n06/1206-221.asp.
- Goorhuis A, et al. Clostridium difficile PCR Ribotype 078: an emerging strain in humans and in pigs? J Clin Microbiol 2008;46:1157-8.
- van der Kooi TII, et al. Antibiotic use and other risk factors at hospital level for outbreaks with Clostridium difficile PCR ribotype 027. J Med Microbiol 2008;57(6):709-16.
- Vonberg RP, et al. Infection control measures to limit the spread of Clostridium difficile. Clin Microbiol Inf 2008;14(Suppl. 5):2-20.
- Kuijper EJ, et al. Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe. Euro Surveill 2008;13(31):pii=18942.
www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18942
And appearing soon:
- Notermans DW, et al. De epidemiologie van Clostridium difficile PCR-ribotype
027 in Nederland sinds 2005 en de opkomst van andere typen. Ned Tijdschr Geneeskd .
- Goorhuis A, et al. Emergence of Clostridium difficile infection due to a new hypervirulent strain, PCR-ribotype 078. Clin Infect Dis [in press]
http://www.rivm.nl/cib/binaries/20080912%20CDI%20surveillance%20report_tcm92-54418.pdf# class=
Protocols:
http://64.233.183.104/search?q=cache:on8R4nuba4QJ:www.wip.nl/free_content/Richtlijnen/Clostridium.pdf+clostridium+difficile&hl=nl&ct=clnk&cd=2&gl=nl
[I]Same in PDF: http://www.wip.nl/free_content/Richtlijnen/Clostridium.pdf
More: RIVM website: http://www.rivm.nl/cib/
 I could use some help again...
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How other countries fight C. diff