Ontario hospitals to post C. difficile rates online
The Canadian Press
Published Thursday, September 25, 2008 6:24PM EDT
Ontario will begin public online posting Friday of hospital rates of infection with the potentially deadly bacterium Clostridium difficile, but critics are already criticizing the new surveillance program as inadequate because the number of deaths won't be included.
The reporting system will initially show how many patients were sickened by C. difficile during the month of August in each of the province's 157 hospitals.
Each institution will be required to provide monthly updates of its case count and rate of infection per 1,000 patient days, to allow comparison of how well centres of a similar size are faring in preventing incursions of the infection and its spread among patients.
Starting next month, hospitals will also be required to report on outbreaks and clusters of C. difficile cases, said Dr. Michael Baker, who is leading the patient safety effort for Ontario's Ministry of Health and Long-Term Care. An outbreak is defined as six cases of C. difficile-associated disease in any single hospital unit, while a cluster is three cases in a week.
C. difficile is widespread in the environment, with up to five per cent of the population carrying it without ill-effect. But for some patients, taking certain antibiotics or other drugs can allow the bacterium to flourish in the intestines, leading to diarrhea that can cause serious bowel disease or potentially fatal blood poisoning.
One virulent strain, called NAP-1, has killed more than 2,000 hospital patients in Quebec in the last several years.
Ontario Health Minister David Caplan said Thursday that infection rates began dropping in Quebec after the province began reporting its cases -- and he hopes a similar reduction now will occur in Ontario.
Caplan wouldn't comment on whether he thinks the public will find the numbers alarming.
"I think what you're going to find is there are hospitals that have been very concerned for a long time and have taken (infection-control) steps," he said. "There are others that have probably been struggling with this, and others still that have not taken the steps."
But a day before the figures were to be posted live on Ontario's website, opposition critics were already slamming the disease-tracking program for the paucity of data it would provide to the public, particularly the number of deaths at each institution.
"It is not complete and full reporting," said Tory critic Elizabeth Witmer. "This government is not transparent. They seem to be focused on hiding information from the public."
Opposition wants full review
New Democrat Andrea Horwath said the data should go back several months, if not years, to uncover how many people have been sickened by the bacterium and how many have died.
"We need to have a full review so we can see what's happening over time and not just a snapshot of the last month," she said. "The government did not act in a proactive way for many, many, many months and it's their obligation and responsibility to make sure that our health-care system is top of the line and transparent."
But Baker told a media briefing Thursday that no provincial standards have been developed for determining whether a death was caused by C. difficile or by another concurrent illness.
He said the website may eventually include death rates, but he needs to hear from a range of infectious disease experts before making a recommendation to Caplan on how fatality rates can be accurately determined so they can be posted.
"My prediction is that we will have this, but we want to hold a standard that we are doing with the actual cases themselves and the rates themselves," he said. "We want to have a uniform provincewide, reproducible, valid and comparable standard of deaths or death rates."
"And we're not ready for that tomorrow," Baker said of Friday's launch date.
Dr. Michael Gardam, director of infection prevention and control for Toronto's three-hospital University Health Network, said determining whether a patient has died from C. difficile "is always going to be fraught with difficulty" because of the nature of the organism and the type of patient in which it tends to cause disease.
Many patients made ill by C. difficile typically already have a number of health conditions for which they are being treated.
"It starts to get murky in terms of trying to figure it out," Gardam said. "And so if you're going to study patient mortality, given that murkiness in particular, you really can't do as accurate a job as you possibly can. And it's going to take a while to sort out how we want to do that."
"Realistically, we're talking many months before we try to figure this out. It's not that we don't want to figure it out, it's that we want to do it well."
Getting a handle on C. difficile is the first step in the program to track certain infectious diseases that seriously threaten public health. By the end of this year, hospitals will also be required to post rates of two so-called superbugs -- Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE).
Data on several other hospital-related infections will follow by the end of next April, as well as health-care centres' progress in improving hand-washing hygiene to prevent disease transmission by care providers between patients.
The Ontario Patient Safety Initiative website will be available after 1 p.m. Friday at www.ontario.ca/patientsafety.