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An elderly patient is slowly manoeuvring her wheelchair out of her hospital room, towing her lunch tray along in her journey down the corridor. Her fingers caress the walls, explore a cart that is parked in the hall - it's all more interesting than the lonely single-bed room where she has been cooped up at Saanich Peninsula Hospital near Victoria.

When a nurse notices the escape, the patient is wheeled back, her bare feet skidding on the linoleum. Outside her door, a bright orange card marks her as one of the hospital's patients infected with potentially deadly Clostridium difficile bacteria.

Everything she's just touched is now contaminated. The human factor strikes again in the battle against an unseen enemy.

Standing about two metres from the patient's door as this scene unfolds, Bev Dobbyn, director of infection prevention and control, is explaining the systems in place to handle the outbreak. In the last five weeks, the hospital has had 14 cases of C. difficile infection and one death attributed to the bacterium.

Ms. Dobbyn and infection control officer Kelly MacDonald are taking a reporter through the hospital to demonstrate their new and improved practices for handling a wave of contagion. We are standing in the epicentre of the current outbreak, centre unit, where the average patient is 84 years old and especially vulnerable.

The new sanitation and surveillance protocols are the products of a scathing report from the B.C. Centre for Disease Control on a similar outbreak of C. difficile at Nanaimo Regional General Hospital last summer.

But as the province's health authorities are being pressured to cut hundreds of millions of dollars from this year's budgets, critics worry that a critical component of infection control, hospital housekeeping, will be compromised.

Unlike previous outbreaks, the response here is obvious from the moment you set foot in the facility. Large red signs warn visitors of the outbreak. Dispensers of foaming hand sanitizer are prominently stationed throughout the facility.

Less obvious, but more costly, is the intense cleaning regime. The Centre for Disease Control cited Nanaimo General for insufficient numbers of cleaning staff and lack of adequate training. It's a scenario critics say is mirrored in hospitals across the province.

Ms. MacDonald won't say if inadequate cleaning led to the outbreak at Saanich Peninsula, but she has ordered 125 hours per week of additional cleaning services to manage it. The extra cleaning hours cost nearly $3,000 a week, at a time when the Vancouver Island Health Authority is trying to find $50-million in savings.

But it's hard to determine if the bacteria are contained.

B.C. hospitals are subject to an independent cleaning audit, and they conduct their own in-house infection audits. These are largely visual tests - great for spotting dust bunnies, but not terribly informative if you want to know if the cart that was surreptitiously handled by an infected patient is now harbouring C. difficile .

"We recognize how difficult it is to eradicate," Ms. MacDonald said. "We are way more vigilant."

At one point during the tour, Ms. Dobbyn described how one could determine if the new hygiene protocols are working. High-touch surfaces such as bedrails can be coated with a gel called GloGerm. After a cleaner is finished, the area is bathed in ultraviolet rays. If anything glows, the job wasn't done right.

Do they do that test here at Saanich Peninsula? No.

This week, Health Minister Kevin Falcon chastised hospital management for the slow response to the outbreak at Nanaimo. He said it "demonstrated we are not up to the job at this point" on battling bugs in hospitals and care homes.

He concedes that the cleanliness audits don't reveal much about infection control. "It is really a visual inspection of housekeeping standards," he said this week. "You could have the cleanest hospital around and still have an outbreak."

But he's not about to cut the health authorities any slack on their budgets: "We can't just keep throwing new money at them."

That response is cold comfort to Jeremy Tate, who buried his mother last month.

Margaret Tate was 89 when she went into Royal Jubilee Hospital on March 14 for an infection that she picked up during a medical procedure. Then in April, she was infected with C. difficile . The resulting diarrhea stayed with her until she died on May 18.

Mr. Tate is angry - not with the hospital staff, but with a system that was stretched too thin to protect a fragile old woman.

Mrs. Tate spent five days in the emergency ward until the hospital could free up a bed. "It was a zoo," he said. "She pleaded with me to get her out of there." But the infections proved unresponsive to treatment.

"Mother was 89 and not doing well, but her death was exacerbated by infections that perhaps could have been prevented."

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