Earlier today, the Ministry of Health and Social Services released preliminary findings from its provincial surveillance on the incidence of Clostridium difficile in Quebec.
To supplement this information, the McGill University Health Centre (MUHC) is releasing data on the incidence of C. difficile at its institution with comparisons between this year and last for periods six through 10 (mid-August to mid-January). "The numbers are down significantly this year compared to this time last year," notes Ann Lynch, MUHC Director of Clinical Operations.
|Year-over-year comparisons of Clostridium difficile rates
at the McGill University Health Centre
|Year||Number of cases||Rate per 10,000 patient days|
|2004-05 (periods 6 to 10)||167||15.6|
|2003-04 (periods 6 to 10)||251||23.6|
|NOTE: The adult hospitals of the MUHC are the Royal Victoria, the Montreal Chest Institute, Montreal General and Montreal Neurological Hospitals.|
"The Ministry report for the province and our own institutional data indicate a downward trend and we are encouraged by this," she said, noting that the MUHC is taking a two-pronged approach to respond to the C. difficile outbreak — enhanced infection control measures and intensive research. "This is a very difficult situation for our patients and prospective patients," says Ms. Lynch. "We want to reassure them that we will continue to take every possible measure to prevent and treat this infection."
Infection control measures: The measures taken to combat this outbreak include: close monitoring of antibiotic use; reducing the number of patients per room on units that have experienced persistent outbreaks; providing more dedicated equipment for all patients; making C. difficile diagnostic tests available on a daily basis; immediately isolating patients exhibiting symptoms and initiating treatment even before a diagnosis is confirmed; isolation precautions for all intensive care patients; enhanced housekeeping activities; follow-up clinics for discharged patients; increased in-service support by infection control specialists on affected wards; and providing information pamphlets to all patients at admission and discharge.
"Everyone who works at the MUHC is making an extraordinary effort to meet the C. difficile challenge," says Ms. Lynch. "We have made significant resource investments above our operating budget. Additional funds recently received from the Ministry of Health and Social Services will help to support our efforts and we will continue to work with the government to meet this challenge."
Research: Epidemiological and microbiological studies are ongoing at the MUHC and in other institutions. "There are still many unanswered questions about the pathology of this infection and about effective preventative and treatment measures," says Dr. Vivian Loo, MUHC Chief of Microbiology and Director of Infection Control. "Together with our colleagues at other institutions, we are bringing the best expertise together to study this problem systematically."
In the summer of 2004, Dr. Loo sent C. difficile isolates to be analyzed at the Centers for Disease Control in Atlanta. These tests confirmed that we are dealing with a strain of C. difficile identified in Canada for the first time and identical to the strain causing recent outbreaks in the United States.
The MUHC has collected a bank of isolates of C. difficile samples from across the province that will allow further in-depth microbiological analyses. This work is ongoing at the MUHC and other hospitals to examine for specific antibiotic resistance patterns and to analyze toxin production and genetic mutations in the dominant strain that may explain the increased virulence of this microorganism. MUHC researchers are also conducting studies to examine risk factors for acquisition of C. difficile, analyzing the effectiveness of preventative measures such as probiotics, and evaluating various laboratory tests for rapid diagnosis.
About the McGill University Health Centre (MUHC)
The McGill University Health Centre (MUHC) is a comprehensive academic health institution with an international reputation for excellence in clinical programs, research and teaching. The MUHC is a merger of five teaching hospitals affiliated with the Faculty of Medicine at McGill University — the Montreal Children's, Montreal General, Royal Victoria and Montreal Neurological Hospitals, as well as the Montreal Chest Institute. Building on the tradition of medical leadership of the founding hospitals, the goal of the MUHC is to provide patient care based on the most advanced knowledge in the health care field, and to contribute to the development of new knowledge.