Quebec hospital linked to C. difficile deaths cleaner now: officials

Families say coroner's report urging hospitals to adopt a 'culture of prevention' falls short

Last Updated: Tuesday, September 25, 2007 | 3:00 PM ET

CBC News

The interim director of a Quebec hospital under scrutiny after a deadly C. difficile outbreak has taken draconian measures to prevent any similar problems, but families of the victims continued Tuesday to place part of the blame on hospital personnel.

Mario Larivière of Honoré-Mercier Hospital in Saint-Hyacinthe was responding to the release of Quebec coroner Catherine Rudel-Tessier's report on 16 deaths at the institution last year.

Quebec coroner Catherine Rudel-Tessier says hospitals need to encourage a 'culture of prevention' to stem infection outbreaks.
(CBC)

Rudel-Tessier concluded the "principal" problem that fuelled the outbreak was management's need to save money — and its decision to skimp on appropriate prevention measures.

Larivière said superbugs pose tremendous challenges to institutions, but insisted Honoré-Mercier has changed its ways.

The institution east of Montreal now produces a daily report on infection rates, has hired new permanent cleaning staff and juggled its budget to allocate more funds for disinfection procedures, he said at a press conference in Saint-Hyacinthe.

"I can tell you that recommendations [the coroner] made in terms of the hospital are already in place."

The measures have taken well and are "effective," he continued, without providing precise figures about current infection rates.

Sixteen people died between May and November 2006 after they contracted C. difficile, a bacterium that can lead to chronic diarrhea, fever and vomiting.

The bacteria prey on the elderly and weak, and have morphed into hypervirulent strains in recent years due in part to the endemic use of antibiotics in hospital settings.

Rudel-Tessier said four of those deaths were directly caused by an antibiotic-resistant strain of Clostridium difficile that festered at the hospital over several months.

But even if the other deaths weren't directly caused by C. difficile, there was a flagrant lack of prevention and foresight at the institution east of Montreal that contributed to the bacteria's spread, Rudel-Tessier wrote in her report.

In particular, the hospital's emergency room was a breeding ground for bacteria.

The Honoré-Mercier Hospital in Saint-Hyacinthe says it has improved disinfection measures after 16 people died during a C. difficile outbreak.
(CBC)

"There are things to do in terms of triage in emergency rooms to understand that an [infected] person waiting there is susceptible of infecting others," she said.

"I remember at the inquiry someone said you should never touch magazines or books left in the waiting room. We have to take out all the papers lying around because they could be contaminated."

Hygiene in hospitals 'essential':coroner

Rudel-Tessier stressed the need for a "culture of prevention" in Quebec hospitals in order to contain bacterial outbreaks.

ER washrooms are another danger zone that must be kept clean and disinfected, she continued.

"As absolute priority, hygiene and salubriousness must be essential" in hospitals, Rudel-Tessier concluded.

The Quebec coroner also singled out the absence of pharmacists in many hospitals, and said there is a danger of using antibiotics as a blanket prophylactic.

"This question of control of antibiotics and the lack of pharmacists struck me in particular," Rudel-Tessier said. "They play a role" in maintaining an equilibrium in hospital environments.

Hospitals should consider creating more individual rooms to house highly infectious patients, she recommended.

Coroner's report short of the mark: families

Quebec lawyer Jean-Pierre Ménard, representing a group of victims' families, said that while Rudel-Tessier's recommendations are sound, they are incomplete given the serious situation at Honoré-Mercier Hospital.

The report fails to recognize C. difficile infections are a public health menace and require a vigorous provincial program to ensure hospitals are implementing appropriate disinfection measures, said

Details that emerged during the coroner hearings on the C. difficile deaths point to general negligence and a flagrant disregard for patients' security, he said in a written statement released Tuesday.

The hospital's former director who was in charge during the outbreak carries a heavy personal responsibility for the crisis that led to 16 deaths, the families said.

But other staff should assume blame as well, given what the health sector knows about C. difficile and its dangers in hospital settings, they charge.