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Handwashing alone won't stop C. difficile, experts warn Add to ...

Public outrage was mounting over dozens of deaths and illnesses linked to superbug C. difficile, and politicians and health officials were under fire for failing to act sooner to contain deadly outbreaks.

That was back in 2008, when hospitals across Ontario were either struggling to contain the spread of the superbug or manage the fallout from recent disease outbreaks. But it could just as easily be today, as at least seven hospitals across the province continue to battle C. difficile outbreaks.

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Although many improvements have been made in Ontario and across the country as officials learn from experience, infectious disease experts warn that much more needs to be done to stop future outbreaks of virulent superbugs.

"This could happen to anybody at any time," said Gerald Evans, medical director of infection prevention and control and infectious diseases consultant at Kingston General Hospital.

One of the biggest mistakes politicians and health officials are making, experts say, is to focus too much effort on one particular prevention strategy while neglecting others.

The campaigns to encourage handwashing in health-care facilities have received the lion's share of attention in the ongoing battle to fight hospital-acquired infections. But handwashing won't stop future outbreaks if health officials fail to implement a host of other equally important prevention strategies, experts say.

"There's no doubt handwashing is unbelievably important, but it's a one-trick pony," said Dr. Evans. "There are other factors."

Other important prevention strategies include limiting the use of antibiotics, eliminating shared hospital rooms and implementing rigorous, evidence-based cleaning policies in order to get rid of stubborn bacteria.

Clostridium difficile is the name of one type of highly contagious, antibiotic-resistant bacteria that pose a serious threat in health-care organizations. Estimates suggest that superbugs such as C. difficile and methicillin-resistant Staphylococcus aureus (MRSA) kill up to 12,000 Canadians a year, while more than 200,000 fall ill from infections.

C. difficile, which is found in feces and causes diarrhea, and can lead to serious illness or death, spreads easily in a hospital setting. For instance, if an infected person touches a surface while their hands are contaminated with feces, the bacteria can produce spores that are able to survive for weeks, even after being cleaned. The spores can then be transmitted to another person.

The elderly, and people with underlying conditions that require antibiotics, are vulnerable to contracting these infections. Virtually all patients who contract superbug infections are on antibiotics.

Infectious disease experts say reining in the use of antibiotics is one of the most important steps. Antibiotics change normal levels of "good" bacteria in the colon and intestines, which allows C. difficile to thrive and produce potentially deadly toxins, according to the Public Health Agency of Canada.

Although some patients require antibiotics to battle infections, Michael Gardam, medical director of infection prevention and control for the University Health Network in Toronto, said they continue to be prescribed to patients who probably won't benefit from them.

"We have absolutely rampant misuse of antibiotics in health care," he said. "We typically estimate that probably 50 per cent of patients we see on antibiotics don't need them."

Reducing antibiotic use is not simple, however, as it can be difficult to determine which patients actually need them. Doctors may fear withholding antibiotics could put some patients at risk, said Christine Lee, an infectious disease specialist at McMaster University.

"Physicians will have to be educated," said Dr. Lee, who is also medical director of infection prevention and control at St. Joseph's Healthcare Hamilton. "It's more challenging than it sounds."

Cramming multiple patients into a single room also contributes to superbug outbreaks. A Queen's University-led study published last year found that each hospital roommate a patient is exposed to boosts the chances of acquiring a superbug infection by 10 per cent.

Despite mounting evidence and a push toward single-patient rooms in hospitals across Britain and the United States, many new hospitals being built in Canada continue to have shared patient rooms.

Cleaning is also a significant issue. As superbugs such as C. difficile are resistant to cleaning, health-care organizations must ensure they are using sound, evidence-based guidelines in order to properly remove spores and decontaminate surfaces, Dr. Gardam said.

Although experts know these prevention strategies can go a long way toward reducing the number of superbug outbreaks, the cost, time and effort involved explains why they have yet to be fully implemented in many organizations, Dr. Gardam said.

"No one wants to bite the bullet."

Follow on Twitter: @carlyweeks

 

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