Quebec strikes committee on Clostridium difficile

Laura Eggertson

doi:10.1503/cmaj.1041033

The Quebec government has struck an expert committee to assess the extent of a Clostridium difficile outbreak affecting hospitals in the province and to recommend infection control strategies.

Figure. Quebec Health Minister Philippe Couillard: waiting for the results. Photo by: Canapress

The committee, announced June 10, is an offshoot of the Committee on Nosocomial Infections in Quebec. It will report through the Ministry of Public Health to Health Minister Philippe Couillard.

The committee of microbiologists, infection control officers, public health officials and infectious disease specialists has already issued recommendations advising hospitals to strengthen their infection control procedures, says Dr. Charles Frenette, the chair. He did not provide a date for a final report.

To facilitate increased surveillance and reporting of C. difficile, the National Institute of Public Health of Quebec (INSPQ) will set up a specific computer monitoring database.

When surveillance data are available, the committee will forward them to public health and the ministry, says Frenette. He anticipates the government will release that data.

“I would expect that there will be pressure to make it public,” he says.

Quebec hospitals will now have to track and report cases of C. difficile, says Dr. John Carsley of the Montreal public health department.

The additional surveillance and expert committee follow a CMAJ investigation, as reported online June 4 and in the July 6 issue (CMAJ 2004;172[1]:19-21), into an outbreak of C. difficile diarrhea in at least 12 hospitals in Montréal over the past 18 months. Hospitals in Calgary are also seeing increased cases of the infection. CMAJ elicited reports of at least 83 deaths in the 2 cities — the vast majority in Montréal — in 2003 and the first quarter of 2004.

Also in response to the news reports, the McGill University Health Centre set up a hotline at its 5 member hospitals. In the first 2 days, nurses staffing the phones received 150 calls from concerned patients. About half wondered if they should postpone tests or elective surgery at the MUHC for fear of contracting the infection; the other half were calls from patients at other Montréal hospitals looking for information about C. difficile, its symptoms and treatment, says Christine Zeindler, communications coordinator for the MUHC.

Nurses told patients they should keep their appointments for all tests, but should discuss elective surgeries and potential risks of contracting C. difficile with their physicians, Zeindler says.

The MUHC saw 780 patients with C. difficile in the fiscal year 2003/04, 84% of whom contracted the infection in hospital, according to an advisory they issued the day CMAJ released its story online. Of those patients, 36 died from C. difficile related complications and another 12 required colorectal surgery, according to the institution. — Laura Eggertson, CMAJ