Niagara superbug report makes important recommendations

The new expert report from an Infection Control Resource Team (ICRT) on the C. Difficile outbreak at the Niagara Health System (NHS) makes a number of significant recommendations, including 11 concerning environmental cleaning at the NHS.  

The report notes that additional "housekeeping resources" have been brought in during the outbreak to increase the frequency of cleaning and that unit aides have been brought in to assist with environmental cleaning.  It adds: "These aides, in addition to increased and dedicated housekeeping staff, play a fundamental role in maintaining environmental cleanliness and both of these enhanced resources should be maintained over the long term." 

The report makes three recommendations on housekeeping staffing:

  • Increases in housekeeping resources put into place during the outbreak should be maintained permanently so that high risk units can maintain twice daily cleaning and dedicated housekeeping staff. 
  • Additional unit aides put into place on the medicine units during the outbreak should be retained permanently. 
  • One additional FTE housekeeper should be recruited for the night shift at the SCG site, so that the emergency department can retain a dedicated nighttime housekeeper and to ensure that there are sufficient resources to address environmental cleaning issues overnight.
The report notes: "C. difficile is a particularly difficult hospital-acquired infection to deal with as C. difficile spores readily contaminate the patient environment and are very difficult to remove and destroy. In managing a CDI outbreak, particularly one of the magnitude experienced by the NHS, it is imperative to use a sporicidal agent broadly as it can be assumed in a facility wide outbreak that gross spore contamination has occurred."

The report also notes the importance of a proactive approach:

"Given that environmental contamination is an important underlying cause of nosocomial transmission of antibiotic resistant organisms, and that environmental contamination can occur whenever there is an isolation burden on a given unit or in a facility, an important concept to keep in mind is that housekeeping and environmental cleaning should be proactive rather than reactive to maximize its benefit in preventing outbreaks."

The report recommends that "Outbreak measures such as enhanced cleaning can be implemented in advance of declaring a formal outbreak and when nosocomial activity is noted to be increasing. This should be considered as part of a proactive approach to outbreak avoidance."

The report recognizes that "housekeeping staff exhibited good cleaning techniques and applied excellent infection control practices."

The report also reflects on the infection control challenges created by a hospital operating over-capacity and overcrowded:

"As is the case for many Ontario hospitals, the NHS is frequently over census and therefore has issues of overcrowding and overstretched staff. In addition, most sites at the NHS have a chronically high isolation burden, due to high regional rates of antibiotic-resistant organisms. There are no hand hygiene sinks present in many clinical areas and certain facilities do not have patient bathrooms in every room. The ICRT acknowledges that these factors create a challenging patient care environment.

"The ICRT understands that at times the NHS would cohort suspect and confirmed CDI patients together. This practice should be discontinued immediately.... 

"Prior to declaration of the outbreak, it appears that transfer of both patients and patient care equipment between units was common. Increased movement of patients with actual or possible CDI increases the risk of spreading C. difficile and its spores, through environmental contamination and unwashed hands. During the outbreak, these transfers were minimized and this practice should be continued as part of outbreak management and prevention."

Infection Prevention and Control Staff
The report also makes important recommendations on increases in physician and managerial infection control and prevention staff. 

This report is a step forward in the battle against superbugs.  

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