C.difficile outbreak

How do you feel about how public health officials have so far dealt with the C.difficile outbreak at Joseph Brant Memorial Hospital?

Comments

[jane]

I am working in a care home and one of our resedents have c diff I ask one nurse shuld we wear a mask becouse of the spores she said no, could someone tell me if this is wright should i be wearing one?. I think we should have masks on and full apron to cover our clothing
as i know hand washing is inportant, dont think is all that we should do

[Earl]

It disturbs me that St. joe's in hamilton has a c-diff outbreak and they have no info on their web site and the Spec had only a couple of stories weeks back buried 5-6 pages in.

Why not the same daily coverage as joseph brant?

[Anonymous]

Shouldn't the community be informed which Long Term Care Centre the Jo Brant patient with scabies came from and was the patient admitted because of the scabies or something else. Dan Nolan reports its been around for a few weeks, CHML said the patient was admitted April - what's the truth. Either way it is ridiculous to move a patient who entered the hospital with scabies to three different floors .... its time the Health Minister took over the supervision of the hospital and the lack of confidence in Don Scott to properly run a hospital safely and effectively needs immediately addressing .

[Anonymous]

The last comment seems to think the issues that have affected so many of us are not really issues - its because they were elderly or superbugs are virulent and they could not do better. I met with the Assoc. Deputy Chief Coroner on Monday morning to present my reasons that an inquest into the death of my mother that occurred at Joseph Brant is a necessity particularly when numerous elderly go to the ER at Joseph Brant on a daily basis. Hopefully we will get our inquest and this writer will sit through it and then comment as to whether we cannot do any better.

amarsden2@cogeco.ca

[Anon]

Yes, some health care workers have become complacent with hygiene, and that is not excusable, but I think people are missing the larger picture.
- C. diff is a super bug... it's NOT easy to contain, and can't be contained with regular hygiene and sanitation
- Visitors move the infection along more than health care professionals; visit your loved ones, but wash your hands properly and often.
- The people most susceptible to C. diff are the elderly. The average age of mortality is 80.

I commend the health care field. No one else could do better. Health is delicate (especially in the elderly), superbugs are intensely virulent and more complicated than the public maybe realizes, and health care is not an easy thing to change.

[Patricia Anthony]

Politicians (ie:Joyce Savoline) are quick to point out that the c-diff virus is present in hospitals other than Jo Brant. But they miss the point. Jo Brant has been remiss in its patient care for years - years before the c-diff outbreak. Its reputation is poor as a caring, effective and efficient hospital. The Toronto Star's research this year indicated that Jo Brant rated among the highest in mortality in the GTA. What we have in Burlington is a hospital whose management right on down to its caregivers have been substandard for years. For anyone to have the good fortune of a positive experience there, is more the result of 1 or 2 individuals who just happen to be good at what they do, not the result of an effective hospital in general. I have a story to tell about my mother's death at Jo Brant - it is not related to c-diff, but it is just one more example of a hospital that doesn't do its job. Anyone with any such story is encouraged to contact me at my e-mail, panthony@cogeco.ca- my hope is to set up my own web page for sharing experiences and developing a strong patient advocate group.

[Anonymous]

I recently heard from Minister Bartolucci that he will not deal with a lack of confidence in the Office of the Chief Coroner of Ontario in terms of a death at Joseph Brant that was precipitated by severe diarrhea (a symptom of c-diff) when 22 other patients at the time were known to be suffering from the severe diarrhea symptoms and c-diff is known to have spiked the very next month at Joseph Brant.

The Minister claims a complaint before the College of Physicians and Surgeons of Ontario with regard to coroners involved in the death investigation who failed to mention the severe diarrhea in their death investigation reports or communication to the pathologist (see written submissions of Anne Marsden in the Goudge Inquiry that are posted on-line) relieves him of the responsibility to ensure the OCCO is operating within its mandate.

The public should be up in arms with the position of Minister Rick Bartolucci and the Chief Coroner who supports his position. If the Coroners, one of whom was Chief of Staff of Joseph Brant, had done the job the mandate requires them to do 62 plus deaths associated with c-diff may well have been avoided. Joseph Brant has proven taking the right steps in a c-diff outbreak can result in elimination of c-diff cases and there is now only one in the recovery phase at Joseph Brant. When coroners refuse to test for the cause of diarrhea, as did the first coroner involved who as Chief of Staff had a responsibility not only as coroner but as Chief of Staff to do so, and a serious outbreak such as has existed at Joseph Brant for over two years follows the refusal to test for the source of diarrhea when a patient died after suffering severe diarrhea (10 noted episodes in the chart in a 24 hr. period preceding the death) then the Minister has a responsibility to determine what role the OCCO and several coroners involved played in the c-diff outbreak that took far too many lives and took far too long to bring under control.

Those interested in ensuring Minister Rick Bartolucci lives up to his responsibilities as Minister of Community Safety responsible for the Office of the Chief Coroner of Ontario should contact Anne Marsden 905-639-5684 and watching@cogeco.ca to determine how contacting the Minister in this matter may well make a difference to their loved ones living or dying if for whatever reason or whatever age (c-diff was contracted by a young child at McMaster) they need to go in to Joseph Brant, or indeed any hospital.

[Joanne]

I read with interest that Hamilton General is only now telling us that they have C. Difficule in the hospital. Only thing is, I know a patient currently in the General that was diagnosed Sunday, May 11 and has been in isolation ever since. When I spoke to a IC nurse from Henderson, she informed me that all of the hospitals are dealing with it.

[Bob H]

I have met MANY visitors that REFUSE to wear isolation "garb" and disobey many of the infection control regulations ie: NOT washing their hands, exiting the isolation room with gown and gloves ON and COMING to the NURSING station with their PPE ON!! Hello.......... how hard can it be???

[Anonymous]

Dear Barb, You wrote:
"One of the most reasonable things to do when there is an outbreak of any kind of infection is to STOP visitors entering the hospital until the infection is under control;" the reason that does not work is the visitors in the main care for their family members and if they stop so does the care and the problem gets worse. The Public Meeting last Wed. saw family members report that they were being stopped going into visit as they had normally done because they were speaking out about what they were finding when they went into visit. Visitors have to take all precautions necessary but they need to be there to protect their family members, without them caring for their family member and speaking out this will get much, much, worse.

[Anonymous]

Dear Anonymous Nurse, many of us want to care for our families and in fact are refused the opportunity. I wanted private care for my mother to help keep her hydrated and mobile - nursing administration refused to allow us to bring this care in. My mother was out of bed once in six days and she died after 10 severe diarrhea episodes when untested, untreated and unreported to a doctor. No-one is trying to say its all the nurses fault but there are significant issues at Joseph Brant which until they are addressed and corrected will mean our elderly family members do not stand a chance.

[Barb.]

I have been following this story about C.dif in the media for several years now. One of the most reasonable things to do when there is an outbreak of any kind of infection is to STOP visitors entering the hospital until the infection is under control; Washing hands should be insisted upon, as one can carry all sorts of bugs from door handles or phones from one room to another.
To have the hospital cleaned from top to bottom may sound extreme and expensive but much cheaper than some of the other ideas I have heard and seen written about. And may I say more practical. C.diff is a spore that can lie around in the dust in corridors and cupboards; so clean and disinfect from top to bottom. Any patient that can go home be sent home. Everyone has to be gowned and masked until the source of the infection is found. To heck with all the cover ups, why cover it up? No one wants to take he blame for anything anymore do they? Lets be honest, tht is really the problem! One thing I do know, when the hospitals employed their own cleaning staff, there was a loyalty and an understanding between the nursing staff and the lab staff and when asked to clean something they did'nt say 'no that is not in my job description!' which is what you hear all the time from the "groups" who have been hired to do the work instead. Those people cared and wanted to help wherever they could, just as any family member would go the extra mile. Now the Nurses or the Lab staff have to take time out of their day to do it instead, thus making their jobs more hectic, adding to the burnout rate of an already short staffed over extended group. I know at one time you could almost eat off the floors at St.Joseph's Hospital, but not any more.
I think some common sense would go a long way to help in controlling this monster. Throw that at it before wasting more megabucks and use them for something really useful like finding ways to cut down waiting lists for OR's

[Anonymous]

Would all of you people take the time to REALIZE how stressful it is to be a nurse in the midst of a shortage and the burnout of many staff?? I don't think you realize how difficult it can be to be a nurse. Sometimes a more critical patient demands more of our time while another is left laying in feces. THAT IS never our intent to inflict suffering on our patients, remember .... we chose this profession for a reason! It is not something that we ENJOY doing, believe me, I go home sometimes and fall asleep thinking of all of the things I never got to accomplish during a 12hr shift! And it all cannot possibly be done! I myself, have a family member in an institution so I can empathsize with many of you here, however, this remains one-sided. Yes, errors have been made, but most of my colleagues and nurses do not neglect patients on purpose. We are human too, and yes we make errors, and it is what we make of it in the after-math of such a crisis that matters. I strongly recommend that if Families have issues with quality of care then how about you come in and sit with your family member and help out a little with their care??

[Anne Marsden]

Will someone not hear my story? In the meantime, I would like to offer support to the c-difficile families because the underlying issue is the lack of quality of health care at Jo Brant - doesn't seem to matter if it is c-difficile, palliative care, or having your tonsils out. Please contact me - I also have a story to tell.

Posted by: patricia anthony | June 05, 2008 at 10:58 AM

How do we contact you Patricia you are going to have to post an e-mail address.

[Anne Marsden]

Posted by: Outsource | May 13, 2008 at 08:05 AM

So with 62 deaths caused by C difficile and 14 others where it was a contributing factor, what action did the Coroner's Office take to protect the public? Their twenty months of inaction surely contributed to additional needless fatalities.

I think you may be interested in reading my written submissions posted on the Goudge Inquiry site:

Submission by Mrs. Anne Marsden (May 21, 2008) (452Kb / 15 pages)

http://www.goudgeinquiry.ca/submissions/index.html

[patricia anthony]

I am looking for a consumer contact re: the c-difficile advocate group. At the time of the outbreak and cover-up at Jo Brant, my mother was dying of lung cancer. I was her caregiver for 11 mo. The one day she spent at Jo Brant caused her unnecessary suffering due to nurse neglect before she took her last breath. I have letters of apology, but that is not going to effect real change in the level of health care at Jo Brant. I have sent my store to numerous media sources with no success. I have a story to tell also, and so do many others, that don't even involve c-difficile. There is great neglect at Jo Brant concerning palliative care. Will someone not hear my story? In the meantime, I would like to offer support to the c-difficile families because the underlying issue is the lack of quality of health care at Jo Brant - doesn't seem to matter if it is c-difficile, palliative care, or having your tonsils out. Please contact me - I also have a story to tell.

[Earl]

IMPORTANT INFORMATION FOR OUR VISITORS AND PATIENTS
St. Michael's Hospital has declared a small outbreak of Clostridium difficile (C. difficile) that is impacting cardiovascular surgery patients. The situation is confined to this area of the Hospital. No other inpatient or outpatient areas are affected.

Our top priority is the safety of our patients and our staff. We are taking precautionary measures to protect our patients, staff and physicians, while ensuring that we provide the best possible care. The small number of patients involved have been isolated and put under contact precautions with visitor limitations (see Visitor Information below). As an extra precaution, the small number of unaffected patients on the unit have also been put under contact precautions with visitor limitations and the Hospital has cancelled elective cardiovascular surgeries only at this time. Patients scheduled for elective cardiovascular surgery are being contacted directly by their surgeon.

If you are scheduled for any other type of surgery or if you have an appointment at a clinic, please proceed to your appointment as planned.

As always, please take precautions to guard against spread by practicing good hand hygiene, which includes washing hands and using the alcohol gel that is available at Hospital entrances, in clinics and on inpatient units.

We will continue to work vigilantly with staff to curb further spread of this outbreak of infection.

VISITOR INFORMATION
Visitors coming to see patients in the cardiovascular surgery area are required to wear gowns and gloves. Visitors are limited to one per bed. Please check in with the nursing station upon arrival at the unit to receive your gown and gloves and to speak to the staff about any questions you have about the situation.

[Sue B]

In Dec 2006, my father was admited to JBMH with pneumonia. Yes, he was treated with high doses of antibiotics. He was in a ward with 3 other gentlemen. After a few days, a man was brought in to the room who had c-dif.
We didn't know anything about it at the time, there was no notices warning of the outbreak at the time. In the days following, the notice was posted outside the ward about wearing gloves and gowns in the room. As I arrived for a visit with my Dad, I stopped to suit up and was told by a nurse that we didn't need to , only the people visiting on THE OTHER SIDE OF THE WARD had to do wear the protective garb. It was laughable, watching the nurses go from bed to bed with NO gloves on. Every man in that ward died within weeks. I can't say if it was from C-dif or not. We even had a man that we called the 'phantom pooper' who roamed the halls and used the washroom in my Dad's ward room. My brother ran into him and asked why he didn't use his own bathroom and he said there was C-Dif in his room and he wasn't allowed to use it. So he randomly looked for an empty washroom. My Dad was eventually moved to the 5th floor where he had a notice on the door about an infection and protective wear. I asked the nurse what he had and she said she didn't know but she'd check. She came back and said the results were not back and not to worry about wearing the gowns and gloves...just not to touch his cath bag.
This is getting way too long but the end of the story is about 3 days before my Dad passed away, I was sitting by his bed and a nurse I hadn't seen before, came in and gave me what-for for not wearing the gear. I still do not know what infectous disease my Dad had. My mother did not get a letter from JB concerning the c-dif outbreak.
I also have to add that the housekeeping was disgusting, we cleaned Dads tray every day or it wouldn't be done. My feet stuck to the floor by his bed.
My Dad was hospitalized for 4 months and died April 2007.

[waiting for action]

Smitherman has been saying for months that we are prepared for a pandemic. One person dies on a train and ministry people descend on that train like locusts. So why have all of our hospitals been hushed? Where is the Chief Medical Officer of Health?

I commuted to Toronto during SARS, the subway was deserted, people wore masks in public, no one was shaking hands and purell was everywhere.

To top it off, we could tune in to the Chief Medical Officer of health several times a day to hear the latest update and be informed about emergency protocols.

It is sad when our nurses are having to spread disease control information on blogs - what is this world coming to?

Is it too much to ask for Smitherman to show some leadership here? Where are the infectious disease specialists supporting hospital staff, creating awareness campaigns, getting the message out?

I can not believe the power this government weilds to be able to hush a provincial outbreak.

[stef]

First off I want to say that as a healthcare professional we do everything in our power with the resources that we are given to protect and make our patients better. Clostridium difficile (cdiff)is a normal gut bacteria. If you are on an antibiotic for some kind of infection in some cases the antibiotic kills the normal "friendly" gut bacteria and an overgrowth of cdiff occurs. Cdiff is transmitted by the fecal (poop) to mouth route (ingestion) and mainly occurs in those who have a poor immune system (like the elderly). Death occurs from the dehydration from the diarrhea caused by cdiff. As a registered nurse I wash my hands and use alcohol rinse until they break out in a rash. I also have to tell 99% of my patients to wash their hands after they are finished in the bathroom. Catch visitors prior to entering these rooms and teach them how to use the protection gear and handwashing, I hate to think of the number of people we missed because of being short staffed and overwhelmed. I encourage everyone to, please take an interest in your own health wash your hands, be an informed patient, encourage your visitors to wash their hands and even ask hospital staff (esp. physicians) if they have washed their hands. Sometimes being in a rush with limited time and resources can cause such problems as cdiff to become out of control and can cause deaths. Research states that deaths may result if there is a higher patient to nurse ratio and with a shortage of nurses that will only get worse. Take care.

[Elle Dietrich]

The most effective way to deal with killer germs is Steam Vapour. High heat, low moisture steam vapour is proven to be thousands of times more effective than any chemical method to kill these viruses, with a 5 second contact. This system is effective on the C.diff endospores that are untouchable by traditional chemicals.

The SteamKing 1500 equipped with TANCS - Thermal Accelerated Nano Crystal Sanitation - is proven effective by independent labs.

This technology is very affordable, safe, accessable and easy - and in use in Europe and the US.

I would encourage you to ask why this lifesaving tool is not found in every hospital in Canada. I have tried to get hospitals to test this system, but they are, for the most part, uninterested.

[health care consumer]

What an abuse of power – refusing to give weekly updates on an issue that has killed so many people when it is still not over. You can bet that if the update they are now refusing to release had good news about the outbreak they would have made it public. Maybe they are hoping that by the time July comes there will be better news or the issue will no longer be in the spotlight.

Surely those who run the hospital work for and are paid by the public – when are they going to be made accountable to us?

[Charlie Schwartz]

The administration running Joe Brant & especially its CEO should all resign. All they do is pass the buck as to why they couldn't do this or that. They would not to this day even admit they was ever a problem there unless it had been forced out into the open! Its only common sense that people should wash their hands before handling anything especially in a hospital & the posturing by CEO Scott & the others who run the place that the lack of funding is responsible for this is bull.

[Elaine]

Earl...I don't consider an 8.5 X 11 piece of paper taped to the wall next to the elevator saying the hospital is experiencing a c.diff outbreak a public service announcement. It did not explain the health risks to patients or visitors. I live in Mississauga, did not read anything about this serious outbreak in my local papers...it is possible I missed an article or two. I strongly believe that hospitals have a responsibilty to their patients and their families to inform and educate them on risks that they are/will be exposed to. I am not a health care professional and I do rely on the professionals to educate me. I questioned the reasoning for having to gown and glove up when going in to visit my Mom, and was given a very non-chalent response that it was for my protection not hers...but nothing more detailed.

[DMB]

I believe Smitherman is being far too lax about this important issue and I also think he is contradicting himself. Neo-Libs/Neo-Con one and the same.