Alliston, Ontario - Stevenson Memorial Hospital is currently conducting an outbreak investigation related to four confirmed cases of Clostridium Difficile Associated Diarrhea (CDAD).

Clostridium Difficile (C diff) is one of many germs or bacteria that can be found in feces, that in some cases produces a toxin that can cause an inflammation of the intestinal tract. These bacteria can be found in hospitals and long-term care facilities, as well as in the community. Persons receiving antibiotics may be at increased risk for acquiring an infection from C. diff. The risk increases in the elderly, people with weakened immune systems, and those undergoing gastrointestinal procedures. The usual symptoms are diarrhea, fever and abdominal pain. In some cases there may not be diarrhea. Blood may or may not be present in stools. Lab testing is only way to confirm the bacterium.

Of the four cases, it has been determined that one patient had the infection on admission, as per the definitions outlined in Provincial Infections Diseases Advisory Committee's (PIDAC) Best Practices Document for the Management of Clostridium Difficile in all Health Care Settings. One elderly patient has since passed away and the initial report of the coroner indicates that the cause of death was not related to C. Diff.

In order to prevent any further transmission of the organism to other patients on the floor and throughout the hospital, the following measures have been taken and will be strictly enforced until further notice:

1. An outbreak has been declared in accordance with the Public Health Act. Extensive consultation with the Simcoe Muskoka District Health Unit is ongoing.
2. All patients on the unit have been placed on Contact Precautions. This means visitors MUST perform proper hand hygiene, using alcohol based hand rub and wear isolation gowns and gloves before entering the Medical Surgical Unit.
3. Only immediate family members are permitted to visit.
4. Only one visitor at a time.
5. In addition to performing routine proper hand hygiene, all staff, physicians and volunteers MUST wear isolation gowns and gloves before entering the patient rooms and between each patient contact.
6. Enhanced cleaning protocol has been implemented according to PIDAC's Best Practice Guidelines.
7. The Infection and Prevention Control team at SMH is tracking C. diff patients on a daily basis and is making sure best practices are in place to reduce the risk of transmission.

The attached information has been made available on the unit to ensure all patients and their families are fully informed about Clostridium Difficile. It contains information on what we are doing at Stevenson to help prevent transmission and what they can do to prevent spread of the bacterium.

Information On

Clostridium Difficile -Toxin positive (C. Difficile)

What is Clostridium difficile (c. diff)?
Clostridium Difficile (C. diff.) is one of many germs or bacteria that can be found in feces (bowel movement).

What is C. diff disease?
C. diff. disease occurs when antibiotics kill your good bowel bacteria allowing C. diff. to grow and produce toxins. These toxins can damage the lining of the intestinal tract and may cause the person to get diarrhea that may or may not be bloody.

Who gets C. diff?
C. diff is the most common cause of infectious diarrhea in hospitals. Anyone receiving antibiotics may be at risk for acquiring C diff disease. The risk increases in the elderly, people with weakened immune systems and those undergoing gastrointestinal procedures. A stool specimen tested at the lab will detect the toxin.

How is it contracted?
C. diff. is often part of the normal bacteria that live in the large intestinal tract of health people, or it can also be acquired in hospital, long term care and in community settings. C. diff. has also been found on people's hands and in the environment surrounding infected patients.

C. diff. cannot be spread through the air, for example, from people talking to one another. It is spread when a person touches contaminated surfaces such as toilets, handles, bedpans, or commode chairs. When touching these items, hands can become contaminated. If the mouth is touched without washing the hands, infection can occur. Soiled hands can also spread the bacteria to other surfaces. Hand hygiene remains the best protection in preventing the spread of C. diff.

What is SMH doing to prevent the spread of the bacteria?
Stevenson Memorial Hospital has policies and procedures in place that require a patient immediately be placed on Contact Precautions if they have diarrhea upon hospital admission, or develop diarrhea after admission. A sample of their stool is also sent for testing.

Contact Precautions are designed to reduce the risk of spreading the infection which include: increased hand hygiene, the wearing of gloves and gowns by the heath care team and visitors when interacting with the patient, and increased housekeeping efforts. It is the practice of Stevenson that Contact Precautions remain in effect until the patient is diarrhea free for 48 hours, regardless of whether or not they test positive for C. diff.

What are the symptoms of C. Diff.?

• The usual symptoms are diarrhea, fever and abdominal pain. In some cases there may not be diarrhea.
• Blood may or may not be present in stools.

How is C. Diff. treated?
Patients with mild symptoms will not require specific treatment and the symptoms will self-resolve with the discontinuation of the antibiotic that may have started the problem. For more severe or serious cases, special medications and treatment can be administered.

What is the best way to prevent the spread of C. Diff.?
Frequent hand hygiene, especially after using the washroom and before eating, is the best way to prevent the spread of all types of infections, including C. diff. In addition, all patients, visitors and staff are required to perform hand hygiene with alcohol gel each and every time they enter or exit the hospital. The alcohol gel is readily available at all hospital entrances. As well, a thorough cleaning of rooms and equipment has and will be done to prevent spread of the infection.

What do I need to do at home?
If you have C. diff. at the time of discharge from hospital, the chance of spreading the illness to healthy people, like your family and friends who are not taking antibiotics, is small. But, we do recommend you practice the following:

• Everyone who might help you with personal care should wash his or her hands for 15 seconds after contact with you.
• If you haven't completed your treatment, finish your treatment.
• As long as you are having formed, non-bloody stools, there is no need for follow-up testing for C. diff.
• No special handling of trash/garbage is required.
• No special precautions are required for visitors to your home.

Where can I find additional information?
Your health care provider or the Public Health Unit can provide further information. In addition, the Ministry of Health and Long Term Care website has valuable information. The website is listed below.

www.health.gov.on.ca/english/public/pub/disease/cdifficile.html