A deadly outbreak of a highly contagious superbug has claimed the lives of 15 patients in Southern Ontario, raising questions about whether enough is being done to prevent and control the spread of hospital-acquired infections.
Niagara Health System, a sprawling network of seven hospitals serving 434,000 people in a dozen communities, has declared an outbreak of Clostridium difficile, commonly known as C. difficile, at three of its sites.
C. difficile is a particularly menacing infection that causes diarrhea and travels from person to person through hand contact. It is one of the most common infections in hospitals and long-term care homes.
The incidence of C. difficile has been lower in Ontario than in other jurisdictions, including Quebec, where a particularly virulent strain of the disease caused 2,000 deaths. But over the past year, the rate of infection in Ontario has climbed 33 per cent, to 0.40 per 1,000 patient days in May, 2011.
The provincial government introduced mandatory reporting in 2008 after a severe outbreak of the Quebec strain of the disease led to 62 deaths at Joseph Brant Memorial Hospital in Burlington. Good hand hygiene is the most effective way to prevent its spread.
Sue Matthews, interim chief executive officer of Niagara Health, said in an interview on Sunday that it is impossible to determine at this point how great a toll the infection will take on patients.
"Handwashing, handwashing, handwashing," Dr. Matthews said in an interview. "We can't say it enough. It's all about getting us out of outbreak and preventing any further spread [of the infection]"
Niagara Health declared an outbreak at its hospital in St. Catharines on May 28, and followed four weeks later at its hospitals in Niagara Falls and Welland. As of Sunday, 42 patients remain in hospital, including 26 who are known to have been infected while there.
Local politicians and community activists say this is just the latest crisis for Niagara Health, which has been embroiled in controversy over the closing of emergency departments in two of its hospitals. The chief executive officer abruptly resigned last January amid renewed calls for the appointment of an independent investigator to look into the hospital restructuring plan.
The Ontario government dispatched a team of infection control experts last Wednesday to Niagara Health amid concerns in the communities that hospital officials initially kept the public in the dark about the problem.
"People ended up taking their loved ones to the hospital, not knowing this was going on," said Wayne Gates, a Niagara Falls city councillor.
St. Catharines resident Joyce Western was one of them. Her 89-year-old mother, Marjorie Howse, was admitted to St. Catharines General Hospital on May 18 with pneumonia. Shortly after, she began showing symptoms of C. difficile.
Ms. Western said that, as her mother's medical proxy, she had to make the grim choice of which condition to fight. The antibiotics used to fight the pneumonia kill off the good bacteria, making her mother susceptible to C. difficile.
Ms. Western opted to have doctors keep treating the C. difficile. Her mother died on June 4.
"In my opinion," she said in an interview, "if they hadn't transferred her to the hospital, she would still be alive."
Local politicians said they find it unusual that an outbreak of C. difficile has struck hospitals in three separate communities. They wonder if the infection was transmitted through the transfer of patients from one hospital to another within the Niagara Health network. But Dr. Matthews denied that patient transfers played a role.
Mr. Gates is organizing a public demonstration outside the Greater Niagara General Hospital for Wednesday to call attention to the community's concerns about how the hospital is managed. Kim Craitor, the Liberal MPP for the riding of Niagara Falls, said he plans to attend. He has been inundated with questions from constituents, most of which he has been unable to answer because of a lack of information.
"All that did was instill more and more fear," Mr. Craitor said in an interview.
Niagara Health will begin providing daily briefings for the media on Tuesday.
Editor's note: The original newspaper version of this article and an earlier online version incorrectly said "Ms. Western opted to have doctors treat the pneumonia." This online version has been corrected.