Reporting - C-Difficile

On September 26, 2008, all Ontario hospitals are required to publicly report on C. difficile rates in their facilities through a public website using a new, standard set of reporting criteria.

On a daily basis, TDMH conducts surveillance and tracks C. difficile in the facility. Now, using the new standardized criteria, TDMH will take a further step and share its findings formally – on a monthly basis.
 
FACTS at A Glance

  • On Friday, September 26, the first province-wide, public release of C. difficile rates for all Ontario hospitals occurs.
  • Hospitals post their own number of C. difficile cases and rates on their own websites. At the same time, the Ministry of Health and Long Term Care posts the numbers and rates for all hospitals on a public website. ( www.health.gov.on.ca\patientsafety)
  • TDMH believes the reporting of C. difficile rates is a beneficial step and is in full support of this initiative.

Questions and Answers – C. difficile and strategies at TDMH
What is C. difficile?
C. difficile (also known as Clostridium difficile, C. diff or C. difficile Associated Disease) is one of 
the many types of bacteria that can be found in feces (bowel movement), and has been a known common cause of health care-associated diarrhea for about 30 years.

What are the symptoms of C. difficile?
The usual symptoms are mild but can be severe.  Main symptoms are watery diarrhea, fever, abdominal pain and tenderness. 

Where does C. difficile come from?
C. difficile is not new. Although people may lately associate it with health care settings, it doesn’t come from hospitals, long-term care homes or laboratories. It is widely distributed in the environment and can be found in the human intestine, occurring naturally in 3-5% of adults (more commonly in the elderly) without causing symptoms.

What causes C. difficile?
C. difficile can be picked up on the hands from exposure in the environment and can get into the stomach once the mouth is touched, or if food is handled and then swallowed. Once in the stomach, the bacteria usually will not cause any problems unless the other bowel bacteria are disturbed, which can happen when antibiotics are taken. The use of antibiotics increases the chances of developing C. difficile diarrhea as it alters the normal level of good bacteria found in the intestines and colon. Without the presence of the normal bowel bacteria, the C. difficile bacteria may start to grow and produce a toxin that can damage the bowel and lead to watery diarrhea, fever and abdominal pain or tenderness.

How does C. difficile spread?
When a person has C. difficile, the bacteria in their feces can contaminate surfaces such as toilets, bedpans, commode chairs, and door handles (if feces is on hands). Other healthy individuals can contaminate their hands if they touch these items. If these individuals then touch their mouths without washing their hands, they can become infected. C. difficile produces spores that survive for long periods and are resistant to destruction by many environmental factors (e.g. temperature, humidity). Good hand washing by everyone, healthcare providers, physicians, volunteers, patients and visitors, is the single-most effective way to prevent the spread of infectious diseases like C. difficile.

How is C. difficile treated?
Treatment depends on how sick the patient is.  Patients with mild symptoms may not need treatment.  For more severe illness, specific antibiotics may be required.

How is TDMH working to manage the spread of C. difficile?
TDMH’s Infection Control Committee comprised of Physicians, team members from Clinical, Laboratory and Environmental Services, Administration and Public Health representatives has had discussions regarding recommendations for strategies to minimize risk. These include placing patients with C. difficile on precautions, implementing special cleaning procedures and developing an Antibiotic Stewardship Program.  In addition, the Provincial Infectious Disease Advisory Committee’s (PIDAC) best practice document for the management of C. difficile is reflected in TDMH’s policies and procedures.  Plans are also underway for the implementation of the “Just Clean Your Hands” program. Education sessions have been provided for our team regarding C. difficile and the importance of hand hygiene.  Continuous promotion of hand hygiene for visitors, patients and team members is ongoing.

Our commitment to our patients is one of safety and continuous improvement. If our rates rise above our baseline, then we will: look internally at our hospital’s processes, consult externally with experts; identify areas for improvement, and implement strategies to reduce C. difficile in our organization.

Questions & Answers  - the Ontario Release of Patient Safety Indicators including C. difficile
What exactly will all Hospitals report on September 26th?
On the last day of each month, beginning September 26, 2008, TDMH, along with all of Ontario’s hospitals, will be required to publicly report on their own websites:

  1. The number of new hospital-acquired C. difficile cases associated with the reporting facility.  
  2. The rates of new hospital-acquired C. difficile cases associated with the reporting facility.

The Ministry of Health and Long Term Care will also report the same information on its own website.

How are the rates calculated?
The rate associated with TDMH =
# of new cases      x 1000
# of patient days

This rate represents the incidence rate of hospital-acquired C. difficile associated with the reporting facility per 1000 patient days.

What is the rate at TDMH?

The TDMH rate for June 2018  is 0  per 1000 patient days.  This represents 0 cases.
The TDMH rate for May 2018  is  0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for April 2018 is 0  per 1000 patient days.  This represents 0 cases.
The TDMH rate for Mar 2018  is 0.67 per 1000 patient days.  This represents less than 5 cases.
The TDMH rate for February 2018  is  0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for December 2017 is 0.67 per 1000 patient days.  This represents 0 cases.
The TDMH rate for November 2017 is 0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for October 2017 is 0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for September 2017 is 0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for August 2017 is 0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for July 2017 is 0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for June 2017 is 0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for May 2017 is 0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for April 2017 is 0 per 1000 patient days.  This represents 0 cases. 
The TDMH rate for March 2017 is 0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for February 2017 is 0 per 1000 patient days.  This represents 0 cases.
The TDMH rate for January  2017 is 0 per 1000 patient days.  This represents 0 cases.