Infection control a major struggle
Hospital’s rate of C. difficile is highest in city
A new study by the Quebec government shows that the Lakeshore General Hospital has reported the sharpest continuous increase in its rates of C. difficile-associated diarrhea of any hospital in the province since 2011, raising concerns about its infection-control practices.
Although the Pointe-Claire facility lowered its incidence rate of C. difficile infections for the first time last year, the decrease was smaller than at other hospitals. The Lakeshore’s rate is now the highest in the city and almost double the provincial one.
The Lakeshore is among three community hospitals in Montreal — the others being Santa Cabrini and Fleury — struggling to contain the spread of C. difficile and other superbugs.
Most health institutions have reported substantial decreases over the years.
Officials at the West Island health authority in charge of the Lakeshore defended its record, saying the “significant efforts of the hospital’s staff have paid off” in reducing its C. difficile incidence rate to 10.8 infections per 10,000 patient days in fiscal 2016-2017 from 12.3 the year before. The provincial rate is 5.9.
By comparison, Hôpital Fleury in the city’s north end slashed its C. difficile rate to 5.3 from 15.2. And Santa Cabrini, in the east end, cut its rate to 10 from 15.4 (at the time, the highest in the province).
Despite the progress at Fleury and Santa Cabrini, officials at those hospitals acknowledged in interviews with the Montreal Gazette much work remains to keep up good infection-control practices.
“We’re still above our target and that means we have to be more rigorous in our practices,” said Dr. Martine Leblanc, director of professional services at the eastend health authority that oversees Santa Cabrini.
Hugo Larouche, a spokesperson for the north-end health authority, noted that Fleury surpassed an objective set by the Montreal Public Health Department of a C. difficile rate of 7.6. Even though Fleury’s rate plunged to 5.3 last year, Larouche vowed the hospital will not let up in its infection-control practices, which include no longer having up to four patients share the same room.
Highly virulent strains of Clostridium difficile were responsible for a wave of epidemics in Quebec hospitals in 2003-2004, causing 1,270 deaths. Many patients who survived underwent emergency operations to remove parts of their colons. Since then, the government has repeatedly pressed hospitals to improve staff hand hygiene and room cleanliness.
The West Island authority concluded a “management and accountability agreement” with the government to make improvements to the Lakeshore. One of the areas that require improvement is making sure “infection rates are compliant with the established standards” for C. difficile.
In its most recent annual report made public, the one for 20152016, the West Island authority highlighted some results from the accountability agreement, but did not disclose its rates for C. difficile, stating they were not available.
In an email to the Gazette, officials pointed out the Lakeshore “is the only hospital in the West Island and serves a large number of patients from outside its territory, such as the Montérégie region. Moreover, the hospital has a particularly aging population, and a large proportion are transferred from various nursing homes surrounding it.”
Other hospitals — like the Jewish General — serve a large proportion of elderly patients, too, including those from Laval and the West Island. The Jewish General’s C. difficile rate plummeted last year to 5.1 from 15.7 in 2011. The rate at the Royal Victoria Hospital dropped from 14.6 in 2011 to 7.7 last year, despite the fact its new location at the Glen site was beset with sewage problems.
Dr. Jasmin Villeneuve, co-author of the report by the Institut national de santé publique du Québec, said he was surprised the provincial rate decreased by as much as did — to 5.9 from 7.3.
“We believe that this is due to more aggressive infection-control practices. The rates today are below what they were before the epidemics of 2003-2004.”
Still, Villeneuve was at a loss to explain why the Lakeshore, Santa Cabrini and Fleury reported increases until last year.
The report observes “the incidence rates were significantly higher in non-teaching facilities.” The Lakeshore, Santa Cabrini and Fleury are not affiliated with the medical faculties at McGill University or the Université de Montréal.
Dr. Renée Paré, an expert in infectious diseases at the Montreal Public Health Department, praised Fleury for its progress in reducing the number of C. difficile infections to below the provincial rate. Despite the challenges faced by Santa Cabrini and the Lakeshore, Paré added she still has confidence in those hospitals as they “redouble their efforts” to continue cutting their rates.
Lakeshore officials stressed they have “implemented the most efficient procedures, such as hand washing, as this is the best way to prevent any bacteria from spreading. We implement close monitoring by informing the various internal units — such as care units and maintenance units — about the importance of hand hygiene.”