Ontario hospitals are bracing for an influx of a highly contagious superbug that has already claimed the lives of at least 18 elderly patients in the province.
One in 14 hospitals in Ontario were dealing with an outbreak of Clostridium difficile. commonly known as C. difficile, according to statistics collected by the Ministry of Health for the month of May. While some have since been taken off the list, several others have been hit with their own outbreaks in recent weeks.
Health-care practitioners say it is not just the spike in cases that is a concern. They are also worried about the virulence of the strain, the same one that killed 2,000 people in Quebec a few years ago and that Australia is now struggling to contain.
While officials scramble to contain the outbreaks in Ontario, an infectious-bacteria expert is warning that hospitals are going about tackling the problem the wrong way.
Andrew Morris, director of the joint anti-microbial stewardship program at University Health Network and Mount Sinai Hospital, is calling on the Ontario government to push doctors to prescribe fewer antibiotics, which leave the elderly particularly vulnerable to infection with C. difficile.
"We've been improving hand washing for the last few years, and all we've seen if anything is an increase in C. difficile," Dr. Morris said in an interview. "I don't believe this is only a hand-hygiene issue. It's an unnecessary-antibiotic issue."
C. difficile is one of the most common infections in hospitals and long-term-care homes. Antibiotics make the elderly in particular susceptible to the infection, because they kill off so-called good bacteria. But weaning the health-care system off the ubiquitous use of antibiotics would require a sea change in practices.
About 200 people in Ontario die every year from C. difficile, which causes severe diarrhea and travels from person to person through hand contact.
The outbreak has put health-care officials in other provinces on alert because C. difficile is an ongoing issue in institutional settings everywhere.
"We are always aware of the dangers these types of infections pose," said Andy Weiler, a spokesman for Alberta's Health Minister, "and we monitor situations when they arise in other jurisdictions."
Southern Ontario and the Greater Toronto Area have been hit particularly hard by the disease.
Guelph General Hospital declared an outbreak on Tuesday, following two months of unusually high C. difficile rates among patients. The hospital reported seven new cases in May and four in June - well above the monthly average of one or two cases. No new cases have been reported for July.
Guelph General said in a statement that C. difficile "may have contributed" to the death of an elderly patient who acquired the disease in the hospital.
Joanna Hope, interim chief of staff for the Niagara Health System, which is battling its own C. difficile outbreak, acknowledged to reporters on Wednesday that Ontario is dealing with the strain of the disease officially known as NAP 1, but less formally as the Quebec strain in that province and the Pittsburgh strain in the United States.
The mortality rate from C. difficile is unusually high in three Niagara Health System hospitals that have declared outbreaks. Out of 66 patients who have contracted the disease, 16 have died.
Local politicians and community activists held a protest on Wednesday outside the hospital in Niagara Falls.
In the Greater Toronto Area, two hospitals have declared outbreaks - William Osler Health Centre and Toronto East General Hospital.
James Downey, an infection control officer at Toronto East General, said it's normal to see C. difficile numbers rise every spring following flu season when more people are on antibiotics, but his hospital's spike was higher than usual. The hospital had 11 hospital-acquired cases in May and five in June, including one death in which C. difficile was a significant contributing factor.
"In most of the patients who pass away, the vast majority of them have significant medical issues that complicate their recovery. In fact, sometimes, C. diff isn't the main problem, it's just a contributor," Dr. Downey said.
The outbreak is back under control now and the hospital went off the list on Wednesday, he said.
A union that represents hospital workers in Ontario is blaming the C. difficile outbreak at Niagara Health on Aramark, the company contracted to manage cleaning of its seven hospitals.
Sharleen Stewart, president of the Service Employees International Union, Local 1, said she believes Aramark has cut corners with the cleaning products it uses.
"From what we're hearing [from hospital employees] the solutions weren't strong enough to kill infections in the hospital," Ms. Stewart said. "It's about cutting costs for the hospital and profit-making for the contractor."
Ms. Stewart said she wants the Niagara Health System to end its contract with Aramark.
Nicole Kennedy, a spokesperson for Aramark, called the union's accusation "irresponsible and flat-out wrong."
Dr. Sue Matthews, interim chief executive officer of Niagara Health System, said there's no evidence to suggest the cleaning standards have declined since Aramark began managing those services in 2002, adding cleaning products have only changed over the years based on best practices.
"We have, as the Niagara Health System, every say in any purchasing that we do," Dr. Matthews said.