Scarborough Hospital shows remarkable improvement in C. difficile cases

A massive hospital-wide initiative to improve patient safety has resulted in an unprecedented 94 per cent decline in the number of C. difficile cases at The Scarborough Hospital, General campus.
“Before public reporting began, we recognized that we had a problem. So we hired an expert to assess our situation at the General campus and give us recommendations,” says Dr. John Wright, President and CEO of The Scarborough Hospital. “We took his advice, implementing all of his recommendations. I am proud of the incredible improvement we have made.”
Dr. Wright said he knew tackling the C. difficile problem was a major undertaking, but one that was necessary to improve patient safety. “One might have said you can’t fix it, it’s not worth throwing hundreds of thousands of dollars away. The lesson learned here is that it is worth it and it can be fixed,” says Dr. Wright. “Financially, it was the right thing to do. Not as many people are requiring isolation. Fixing the problem has a positive long-term impact on the cost of delivering care.”
Last month, the Ministry of Health and Long-Term Care released the numbers and rates of C. difficile cases in hospitals throughout the province, reporting an overall decline of 33 per cent since public reporting began a year ago. Last year, The Scarborough Hospital’s General campus was among the worst, reporting 17 cases in August 2008. The Birchmount campus (formerly the Grace campus) reported zero cases.
One year later, the General campus is down to just one case and is continuing efforts to reach its goal of zero. “We didn’t take last year’s C. difficile results lightly. We had all the excuses – an old building, no room for storage, very few private rooms and many shared bathrooms – but we didn’t use those excuses. We recognized the need for significant change and we worked very hard to tackle this problem,” explains Dr. Wright.
C. difficile – or Clostridium difficile – is a type of bacteria that can be found in the environment and in the bowel and is the most common cause of infectious diarrhea in hospitals. Elderly people and those with pre-existing health conditions are more vulnerable to C. difficile. It is one of eight patient safety indicators that all Ontario hospitals are required to publicly report.
“C. difficile is a stubborn spore. You can’t remove it easily. Ridding a hospital of this takes a significant effort,” says Bryan Morales, The Scarborough Hospital’s Manager of Infection Prevention and Control.
The Scarborough Hospital serves close to one million people at its two acute care hospitals. Canada’s largest urban community hospital, it is situated in one of the most diverse neighbourhoods in the country and tends to treat more patients who have pre-existing conditions.
Dr. Wright hired Dr. Michael Gardam, the province’s Director of Infectious Disease Prevention and Control, because the hospital needed an expert’s advice. Following Dr. Gardam’s recommendations, The Scarborough Hospital implemented new cleaning practices, changed its cleaning products and hired additional cleaners to do a surge cleaning, explains Ester Lipnicki, Executive Director of Patient Services and Quality Care at The Scarborough Hospital.
“We also did an inventory of furniture and threw out anything that was cracked or ripped. We increased education for all staff and introduced Vernacares, a better system for disposing of waste,” says Ester. “We know, for whatever reason, we have a higher number of patients who come in with C. difficile. We’ve improved our screening process so we can take immediate precautions to reduce the chance of spreading the bacteria.”
“We filled dumpsters with cracked and torn furniture and mattresses. We threw out all soft covered furniture from nursing stations and lounges. You can’t clean a cracked mattress, so we threw them in the dumpster,” says Dr. Wright. “We also did a major exercise in de-cluttering.”
Although the hospital had policies about cleaning practices, some weren’t being carried out properly. Increasing education and awareness around these practices resulted in a dramatic turnaround.
Also key was putting greater emphasis on proper hand washing technique. In fact, earlier this year, The Scarborough Hospital topped the list in the province’s first-ever public reporting of hand hygiene compliance. The Scarborough Hospital’s overall compliance rate was 97 per cent, well above the provincial average of 61 per cent.
As the manager of infection control, Morales says getting the problem under control was a major step. But the work is not finished. “It took us a year to get to this point. We will continue to educate staff, to encourage proper hand hygiene, to monitor our rates very closely. We can’t just rest because we’ve come this far. One case is one more than we want,” says Morales. “The challenge now is to sustain it. That’s not going to be easy but I believe that with the hospital working collaboratively as a team, we can do it.”
“We are an example that it can be done. It is worth the investment. A surge cleaning works,” says Dr. Wright. “We’ve been able to sustain our rates even after we backed off substantially in all of our exercises. Our rates are continuing to drop.”