Questions and Answers

• What is Clostridium difficile (C.difficile)?
• What is Clostridium difficile-associated disease (CDI)?
• What causes Clostridium difficile infection?
• What are the risk factors for CDI?
• How is C. difficile transmitted?
• Why is C. difficile such a serious hospital-acquired infection?
• Why is it important to look at hospital-acquired infections?
• Why are hospitals adopting a monitoring and reporting system for hospital-acquired infections?
• If the number of C. difficile cases in high in my hospital, does this mean that my chance of catching C. difficile or other hospital-acquired infection is higher? Is the hospital unsafe?
• Should patients make decisions about where to seek care based on this information?
• How will I know if my hospital has a C. difficile outbreak?
• What has the Ministry of Health and Long-Term Care done to ensure that hospitals have the tools necessary to fight C. difficile?

C. difficile is just one of the many types of bacteria that can be found in the environment and the bowel. C-difficile is the most common cause of infectious diarrhea in hospitals and long-term care homes. It has been a known cause of healthcare-associated diarrhea for about 30 years.

When C. difficile bacteria grows in the bowel, it produces toxins. These toxins can cause a disease known as Clostridium difficile-associated Disease (CDI). CDI can damage the bowel and cause diarrhea. The effects of CDI are usually mild but sometimes can be more severe. Symptoms can range from mild diarrhea to high fever, abdominal cramping, abdominal pain and dehydration. In severe cases, surgery may be needed, and in extreme cases CDI may cause death.

Clostridium difficile infection (CDI) can sometimes occur when antibiotics are prescribed. Antibiotics work by killing off bacteria – the bad bacteria – but also good bacteria. Without the presence of the typical “good” bowel bacteria, the C. difficile bacteria may start to grow and produce toxins that can cause CDI. CDI can damage the bowel and may cause diarrhea.

Certain people are at increased risk for acquiring CDI. These risk factors include :

• History of antibiotic usage
• Bowel surgery
• Chemotherapy
• Prolonged hospitalization
• Being elderly
• Serious underlying illness or debilitation

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, i.e. cleaning hands thoroughly and often, is the single-most effective way to prevent the spread of infectious diseases like C. difficile.

There are a number of strains of C. difficile that have become extremely toxic in recent times. This is a problem in a number of countries around the world, including the UK and the United States.

In the case of C. difficile, it is thought that over-use or inappropriate use of certain types of antibiotics has played a role in the increasing toxicity of the bacteria.

A hospital-acquired infection is an infection that a patient contracts while hospitalized. At the time of admission, the infection would not have been either present or developing. Hospital-acquired infections have a direct impact on patient safety and health care quality. They may be life-threatening and are costly to the healthcare system.

The main objective of the monitoring and reporting system is to track trends in CDI in each of the province’s hospitals in order to adopt control measures appropriate to each hospital facility. Reporting allows a hospital to measure its performance.

The number of cases of CDI in a hospital does not mean that the hospital is unsafe. A number of factors should be always considered, such as the size of the hospital, the population that the hospital serves and whether the cases were acquired within the hospital or in another facility of the community. In addition, compliance with excellent infection control practice, available facilities, appropriate use of antibiotics and surveillance systems are among other factors.

A patient’s decision regarding where to seek care should be based on the availability of the best resources to provide them the highest quality of care.

Hospitals are strongly encouraged to post on their web sites when their hospital is in an outbreak, the exact units and when the outbreak is over.

Starting October 31, the ministry will post on this website the list of hospitals that have been in outbreak for the previous month (i.e., September). The public is encouraged to contact the hospital directly for additional information.

The ministry has taken action through work on a number of initiatives :

• A multifaceted hand-hygiene program for hospitals, called Just Clean Your Hands, launched in March 2008. Improving hand hygiene is the single most effective way of reducing the spread of infections.
• 166 infection control practitioners in hospitals to help ensure that the necessary capacity and expertise is in place to prevent and control infections and infectious diseases in hospitals;
• 14 regional infection control networks (RICNs) across the province to promote a common approach to infection prevention and control and the use of best practices; and
• A standardized educational program -- Infection Prevention and Control Core Competency Education -- for front-line health-care providers in acute care, long-term care and public health