Ontario is preparing a hospital program aimed at determining the rates of infection for Clostridium difficile, a superbug that poses a growing threat to patients across Canada.

At the end of September, the province's 157 hospitals will be required to report monthly C. difficile infection rates to the Ministry of Health and Long-term Care. The numbers will be posted on the websites of the government and the hospitals.

The aim of the program is to give the government, hospital administrators, infection-control experts and the public a clearer picture of just how much of a threat the disease presents and ultimately to reduce the number of patients sickened or killed by the organism.

"There seems to be an increasing incidence of C. difficile disease in health-care settings and also there seem to be more people getting sick," Dr. Mary Vearncombe, chair of the provincial infectious disease advisory committee (PIDAC), said Thursday during a briefing.

"And the illness in the people who are getting sick seems to be more severe," said Vearncombe, who is also medical director of infection prevention and control at Toronto's Sunnybrook Health Sciences Centre.

"There seems to be more bad outcomes in more people requiring bowel surgery and more people dying from the illness," she said.

"So there's a real impetus right now to find out exactly what the situation is in our Ontario hospitals and that's related to the reporting. But more importantly is to control the spread of the organism as much as we humanly can within health-care settings."

2 other superbugs will be reported

C. difficile reporting is the first step in the program to track certain infectious diseases that seriously threaten public health.

By the end of this year, Ontario's hospitals will also be required to post rates of two other superbugs — methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Several other disease-fighting measures will follow by the end of April 2009.

Dr. Michael Baker, who is leading the patient safety effort for the ministry, said the public reporting of C. difficile-associated disease rates will also allow hospitals to recognize when a rise in cases constitutes an outbreak that may spread.

"We will have public information on outbreaks that we know are occurring but are not yet clearly reported to the public," said Baker, physician-in-chief for Toronto's University Health Network.

C. difficile very common

C. difficile is widespread in the environment. About three to five per cent of the population carry it in the bowel without ill effects.

But certain circumstances that affect the immune system — taking particular types of antibiotics, undergoing chemotherapy for cancer or taking anti-rejection drugs after an organ transplant — can allow C. difficile to grow and cause illness.

Infected patients develop diarrhea that in severe cases can lead to serious bowel disease or potentially fatal blood poisoning.

About six years ago, a virulent strain of the bacterium appeared and has since killed more than 2,000 hospital patients in Quebec alone. Known as NAP-1, the organism produces far greater amounts of toxin than regular strains and the infection-spreading spores it produces are far more difficult to kill.

This beefed-up C. difficile has led to more severe illness in patients, said Dr. Michael Gardam, director of infection prevention and control at the University Health Network, who has helped a number of Ontario hospitals deal with outbreaks.

"Essentially the on-off switch for the toxin is permanently broken `on,' so it's always producing toxin," he said.

"So it tends to make patients sicker, they tend to have more relapses, which means they're all having more diarrhea, which means it's contaminating the environment more and it spreads to other patients."

"There's been a couple of things with this strain that have given it the right stuff to be able to become very prevalent and it's now prevalent throughout Canada, the U.S. and Europe. So clearly it has legs. It has the right genetic makeup to be able to make a name for itself."

Washing hands fights bug

Vulnerable patients become infected when spores are transferred, most often by the hands of health providers who move from bedside to bedside and from contaminated equipment like bedpans and bed rails.

"Clostridium is ubiquitous in the environment," said Vearncombe.

"It's not something you can eradicate. So I would predict that every single hospital in Ontario has the organism. How many people are getting sick with it is going to vary from institution to institution."

Many Canadian hospitals are battling the bug, primarily with stricter infection-control measures.

Ontario's efforts include education programs to improve hand hygiene by care providers and other hospital staff, more rigorous housekeeping to disinfect hospital rooms and equipment, and campaigns to encourage doctors to eliminate unnecessary or inappropriate antibiotic use.

One other thing that infection-control specialists and government would like to know is just how many people have been sickened by C. difficile and how many have died from infection with the superbug.

It's a question that is being asked by provinces and health-care providers across Canada.

The Public Health Agency of Canada does an annual snapshot of C. difficile infections and outcomes in 41 sentinel hospitals across the country, but there is no ongoing national surveillance program yet.

Baker said the purpose of Ontario's program is, in part, to fill in the blanks for numbers of C. difficile-related illnesses and deaths.

"And by doing a careful set of definitions of what the disease is and developing uniform ways to measure and report the rate of disease with C. diff and by publicly reporting … we'll be able to answer that question," he predicted.

"It's a major part of why we want to do this."