C. difficile Rates

The C. difficile infection rate is calculated as a rate per 1,000 patient days. The "total patient days" represents the sum of the number of days during which services were provided to all inpatients during the given time period. The rate is calculated as follows:

( Number of new hospital acquired cases of C. difficile in our facility x 1000 ) / ( Total number of patient days in the month )

For smaller sites such as HGMH, C. difficile infection rate may vary from month to month. The smaller the hospital, the greater the rates will vary-this is because a change in even one case in a small site will cause the rate to up or down considerably.

Clostridium difficile Associated Disease (CDAD) Rates

Measuring Clostridium difficile (C. difficile) rates

HGMH posts its infection rates online on a monthly basis. On this webpage, you can find information about hospital-acquired infection rates for C. difficile.

What are hospital-acquired infections?

Sometimes when patients are admitted to the hospital, they can get infections. These are called hospital-acquired infections. In the case of C. difficile, this may mean that symptoms began 72 hours after admission to the hospital; or that the infection was present at the time of admission but was related to a previous admission to that hospital within the last four weeks.

What is C. difficile?

C. difficile (Clostridium difficile) is a bacteria. C. difficile can be a part of the normal bacteria in the large intestine and is one of the many bacteria that can be found in stool (a bowel movement).

A C. difficile infection occurs when other good bacteria in the bowel are eliminated or decreased allowing the C. difficile bacteria to grow and produce toxin. The toxin produced can damage the bowel and cause diarrhea. C. difficile is one example of a hospital-acquired infection and is one of the most common infections found in hospitals and long-term care facilities. C. difficile has been a known cause of health care associated diarrhea for about 30 years.

Who is at risk for C. difficile?

Healthy people are not usually susceptible to C. difficile. Seniors, and people who have other illnesses or conditions being treated with antibiotics and certain other stomach medications, are at greater risk of an infection from C. difficile.

What are the symptoms of C. difficile?

The usual symptoms are mild but can be severe. Main symptoms are watery diarrhea, fever, abdominal pain/tenderness. In some cases there may not be diarrhea. Blood may or may not be present in the stools.

How do you get C. difficile?

When a person has C. difficile, the germs in the stool can soil surfaces such as toilets, handles, bedpans, or commode chairs. When touching these items, your hands can become soiled. If you then touch your mouth, you can swallow the germ. Your soiled hands can spread germs that survive for a long time on other surfaces if not properly cleaned.

The spread of C. difficile occurs due to inadequate hand hygiene and environmental cleaning; therefore, proper control is achieved through consistent hand hygiene and thorough cleaning of the patient environment. Good hand hygiene i.e. washing hands thoroughly and often is the single-most effective way to prevent the spread of infectious diseases like C. difficile.

At HGMH we are committed to promoting hand hygiene for patient care. We provide access to alcohol-based hand products as well as soap and water throughout the facility for staff, patients and visitors to use. We have a process to audit the hand hygiene of staff members and provide feedback. We follow the advice and practices in the Ontario "Just Clean Your Hands" campaign to help us provide best practices in hand hygiene in caring for our patients.

How is C. difficile diagnosed?

C. difficile is usually diagnosed by sending a specimen of diarrhea to the laboratory where it is tested for the presence of C. difficile toxin.

How is C. difficile treated?

Treatment depends on how sick you are. People with mild symptoms may not need treatment. For more severe disease, antibiotics are required.

What precautions are used to prevent the spread of C. difficile in the hospital?

If you are in the hospital and have C. difficile diarrhea, you will be put on precautions until you are free from diarrhea for at least two days. Your activities outside the room may be restricted. All health care staff who enter your room will wear a gown and gloves. Everyone MUST clean their hands when leaving you room.

How does HGMH control the spread of C. difficile?

In order to prevent the spread of C. difficile, we engage our housekeeping team to ensure that they are following the best practices for cleaning in situations where patients are identified with C. difficile. As well, we are strongly encouraging our staff to enhance their hand hygiene practices. We ensure that patients who are suspected or proven to have C. difficile receive appropriate treatment as soon as possible. Once diarrhea has stopped in a patient with C. difficile, there is a much lower risk of contamination that might cause further cases.

Does HGMH track C. difficile cases?

Looking closely at the C. difficile cases is an important step in making sure you are safe. This is called surveillance, and it allows us to know whether there is a problem in the hospital and to understand how big the problem is. We track all C. difficile cases in our hospital, and as soon as any case is identified, we bring in the resources needed to stop the possibility that it might spread to others.

What is HGMH doing to improve patient safety?

We have a patient safety program in the hospital to make sure that all practices are at the highest level possible to keep you safe. This includes:

• ensuring that our housekeeping practices are in line with the best practices in healthcare.
• following the "Just Clean Your Hands" program for excellence in hand hygiene.
• conducting audits on various practices to verify that patient care is as safe as possible.
• implementing programs such as "fall prevention", "medication safety" and "Safer Healthcare Now" initiatives.

What is a C. Difficile outbreak?

Definitions have been developed to assist hospitals and public health units in determining when there is an outbreak.

Outbreak: Six or more new nosocomial cases of C. difficile infection within a 30-day period on a single ward or unit.

Hospital Acquired Infection: Infection acquired during the delivery of health care within a particular health care facility. See also, Nosocomial.

Infection Risk: The probability that a patient/client will acquire an infection based on the characteristics of the individual, the inherent risks associated with a procedure, or other factors that might put the individual at risk for a health care-associated infection.

Nosocomial Infection: Infection acquired during the delivery of health care within a particular health care facility. See also. Hospital-Acquired Infection.

Surveillance: The systematic ongoing collection, collation and analysis of data with timely dissemination of information to those who require it in order to take action.

Cluster: Three or more new nosocomial cases of C. difficile infection associated with a single ward or unit within a seven-day period.

(From the Provincial Infectious Disease Advisory Committee)