C. difficile is just one of the many types of bacteria that can be found in the environment and the intestines. For most people, it does not pose a health risk. However, C. difficile associated disease (CDAD) can sometimes occur when antibiotics are prescribed. Antibiotics work by killing off bacteria – the bad bacteria – but also good bacteria. This can allow the C. difficile bacteria to multiply, which may cause diarrhea and can damage the bowel.
CDAD is the most common cause of infectious diarrhea in healthcare facilities. The effects of CDAD are usually mild but can sometimes be more severe. In severe cases, surgery may be needed, and in extreme cases CDAD may cause death.
Rates of C. difficile are the first of eight patient safety indicators that hospitals will be required to publicly report. All of these indicators will be posted on the Ministry of Health and Long-Term website and also on each hospital’s own website.
It’s important to understand that the reporting of these rates is not the overall solution to reducing the rates of healthcare associated infections. They are tools which will provide hospitals with good information to assist them in understanding where patient safety issues exist and help them to take action to improve their safety standards.
The public reporting builds on other initiatives such as Just Clean Your Hands – a hand hygiene program for all Ontario Hospitals that was launched in March 2008 and the creation of 14 Regional Infection Control Networks across the province.
Rates of C. difficile
It is important to note that C. difficile rates, as is the case for all infections, can fluctuate over the course of a year for a number of reasons. For example in winter, we admit more patients with respiratory infection than at other times of the year. An increase of respiratory infections often results in more antibiotics being prescribed, a leading factor in new cases of C. difficile.
An increase in the rates of C. difficile may also be related to periods of increased occupancy levels. An increased number of patients mean that more patients are being cared for closer together. Close physical proximity can result in C. difficile being spread more easily.
When we experience cases of C. difficile, they are usually contained in a limited geographic area or unit of the hospital. Also, patients and families should know that compared to the overall number of patients admitted each year, these cases are relatively low in number.
That said, TADH pays close attention and follows a number of procedures to control and manage new cases of C. difficile. As described in the provincial best practice standards for managing C. difficile, we are:
- Isolating individuals identified or suspected to have C. difficile, wearing gowns and gloves to enter their rooms.
- Ensuring that all patients suspected of having C. difficile in hospital are tested.
- Reminding all staff of the importance of proper hand hygiene.
- Ensuring proper cleaning of all patient rooms, including rooms of C. difficile cases.
- Ensuring that visitors are instructed in hand washing and other control measures.
- Providing education where needed so that all members of our team are up-to-date with current management strategies.
- Ensuring that all patients with C. difficile infection are appropriately treated.
Measuring compliance 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 (for one month)
C-difficile Rates at TADH as of July 2019:
CDiff = 0.67