UPDATE: Fraser Health CEO commits to more resources to address high rates of C. difficile

Fraser Health Authority CEO Dr. Nigel Murray announced Friday that all 13 recommendations in an independent review will be implemented to address the issue of high rates of Clostridium difficile infection at Burnaby and Royal Columbian hospitals.

A senior medical director for Fraser Health will also be hired to be in charge of efforts to reduce rates of infection which, with regards to C. difficile, are the highest in B.C. at Burnaby Hospital. The new position will report to Fraser Health's senior executive and have direct access to its board.

The move comes almost two months after several senior doctors at Burnaby Hospital wrote to Murray, on Jan. 9, warning of the problem. And it comes two days after New Democrats, including Burnaby-Deer Lake MLA Kathy Corrigan, raised the issue in the Legislature.

C. difficile is a highly contagious bacteria that infects the intestines and can cause illnesses ranging from diarrhea, nausea, vomiting, fever and colitis and in some cases, result in death.

The rates of C. difficile infection at Burnaby Hospital have ranged from two to three times the national and provincial averages for over two years, said the letter. From 2008 to mid-2011, the hospital saw 473 serious cases, of which there were 84 patient deaths.

"We would characterize current CDAD infection control management at Burnaby Hospital, at best, as a serious hazard to the patient population served by the Fraser Health Authority and describe the coordination of this activity at both the local and regional levels, at best, as chaotic.

"Such is the degree of the CDAD problem and the ineffectual response to it, that we believe it could objectively be considered medical negligence," it said, noting it believes FHA has "placed itself at significant risk of medical-legal action."

On Thursday, Dr. Andrew Webb, Fraser Health's vice-president of medicine, said in an interview that not all 84 deaths would have been directly related to the C. difficile infection. In 2010-2011, only 13 patients could be identified as having died from C. difficile, of which eight were over age 80 and all had other complicating medical conditions.

"Even times two-and-a-half years you don't get anywhere near 84," Webb said.

The C. difficile infection rate has decreased by 40 per cent between 2008-2009 and 2011-2012, although it continues to be above the Canadian average, he said.

Webb said of the 13 recommendations by Dr. Michael Gardam—an international authority on infection prevention and control practices who conducted a review of Burnaby and Royal Columbian hospitals in November—implementation had already started on 10 within the past six weeks.

The remaining three were still being considered—until Friday, when Murray announced all 13 would be implemented.

One of those originally in question was the hiring of additional trained infection control practitioners (ICP). Gardam's review stated Fraser Health's regional infection prevention and control program "is considerably under resourced compared to other jurisdictions in Canada and the United States" and that the number of ICPs "is less than half what would be considered acceptable by current standards."

Burnaby Hospital and Royal Columbian have a total of four ICPs for about 800 inpatient beds.

"My impression after speaking with the ICPs at these sites was that they are clearly dedicated to their roles, but also overwhelmed," Gardam wrote in his report. "Their days are spent 'putting out fires' and they are unable to work on more preventative activities."

Murray stressed that infection control in modern hospitals is "everyone's accountability," involving all health care providers following steps such as proper handwashing and good antibiotic stewardship in which antibiotics are not overused.

Nevertheless, "I am committed to increasing our resources in infection control and by definition there will be the funds to do that," he said.

"I as CEO am determined in this public statement to make sure that people know that this will be achieved by attending to those 13 recommendations and all the other aspects that are involved with infection control in a busy hospital."

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