Clostridium difficile (C. difficile) infection (CDI) occurs most frequently in hospitals and nursing or assisted living homes, but still occurs at home, within the community. Several antibiotics that are good at treating bacterial infections have the side effect of also killing the good bacteria normally residing in the gut, resulting in an imbalance in the microbiome and allowing for overgrowth of bad bacteria such as C. difficile. This bacterium’s spores also spread through the environment and contaminate surfaces in washrooms, hallways, and patient rooms, potentially infecting others and re-infecting a patient. The main symptom of CDI is watery, sometimes explosive, diarrhea, which can be fatal for vulnerable groups, such as seniors and those with weakened immune systems.

Family members and caregivers who have lost loved ones due to complications associated with CDI often report that they were previously unaware of the dangers of this devastating infection and that they felt helpless while watching their friend or family member suffer with CDI – often with recurrent bouts – while trying to manage other health issues. After losing a loved one, caregivers say they are again left feeling powerless to prevent this from happening to someone else and angry that it happened in the first place. One such family member, Ian Knowles of Peterborough, Ontario, transformed his frustration into something extraordinary: positive change.


A Caregiver’s Story

A day after returning home from the hospital following antibiotic treatment for pneumonia in 2009, Ian Knowles’ 83-year-old father, Eric Knowles, developed severe diarrhea. Knowing that diarrhea is a common side effect of antibiotics, no one in the family was immediately alarmed. About a week later, when Mr. Knowles’ general health condition had weakened considerably, they returned to the hospital and learned that he had CDI. A physician admitted him to hospital and placed him in isolation, but he died a short time later due to a combination of the CDI and other ailments from which he had been suffering.


What Could Have Been Different

Ian set out to help others who might experience something similar. He conducted a number of informal observations at the hospital. In one, he sat at the entrance to the hospital and kept track of how many individuals used the hand sanitizer when they entered or exited the hospital and witnessed only about 25% doing so. He took his findings directly to the Infection Control Department at the hospital, who listened to his concerns, considered the observations he had made, and responded by making changes. (It’s important to note that hand sanitizer, while it is valuable and protects against many types of infectious pathogens, does not kill C. difficile spores. It is crucial to practice good hand-washing techniques with soap and water to reduce the risk of spreading C. difficile.)

The Patient Relations Department asked Ian to write a story for the hospital’s Board of Directors and management teams, not to complain, but to suggest improvements. For example, Ian says his dad was a rule-follower, so had his health team sent him home with instructions to return if he experienced symptoms of CDI – ongoing diarrhea and abdominal pain – then he would have returned, perhaps in time to save his life. The hospital has since improved its knowledge transfer to patients and caregivers around CDI symptoms.


Lean on Me

A short time later, the hospital called on Ian as a caregiver/consumer consultant, when they began implementing a management strategy called Lean. This involves all members of the team, regardless of rank, to improve the (in this case) hospital system by gathering input on ways of eliminating waste while focussing on the needs of the consumer/patient.1 The carmaker Toyota had popularized the Lean strategy after it showed success using it for its production systems in the 1950s, but now many types of companies and organizations employ Lean, including health care facilities. Waste could comprise material/physical waste, but it also includes wasted time, energy, or procedures that are out of date or don’t work. In this case, the Lean strategy helped the hospital improve patient care.

Ian extends the key concepts of Lean to the fight against Clostridium difficile infection across the country. He explained how an individual might recover from CDI in hospital but return home to an environment with infected surfaces, which could lead to recurrences or spread to others. If Lean were adopted as a national strategy, it would include improved awareness of CDI and prevention behaviour among health professionals, patients, caregivers, family members, and the community at large. Everyone should know what symptoms to look out for and learn effective methods for disinfecting surfaces that could become contaminated with C. difficile spores. Each of us has an important role to play in limiting the spread of C. difficile.

The Public Health Agency of Canada has guidelines on its website regarding Infection Prevention and Control Guidance for Management in Long-term Care Facilities. When individuals enter these facilities visiting family and friends, it is very important to exercise precautions to ensure better health outcomes for everyone.


TRU-D – Prevention Starts With Proper Cleaning and Effective Disinfection

Hospitals employ rigorous cleaning protocols in order to prevent the spread of infectious disease, and many Canadian hospitals have begun supplementing these disinfection processes with some high-tech tools. The Vancouver General Hospital’s contracted cleaning company, ARAMARK Healthcare, recently acquired a robot that uses ultraviolet (UV) light to kill harmful microorganisms left on hospital surfaces, including C. difficile spores.2 TRU-D SmartUVC™ stands five foot five inches tall, has an outer surface lined with specialized UV lamps, and looks like it could have escaped from an episode of the science fiction television program, Doctor Who. It works by flooding a room with ultraviolet light. The germicidal light energy emitted from TRU-D’s long lamps disrupts the DNA structure of infectious cells, rendering them unable to replicate and therefore harmless. The hospital is using TRU-D in some patient rooms and in bronchoscopy, endoscopy, and surgery suites.

Staff members clean and disinfect using standard protocols and then roll TRU-D into the centre of the room, close the door, and control the disinfection process with a remote device. Once activated, TRU-D can detect the size of the room it is in and accurately gauge how much time and what dose of UV light is required. Disinfection normally takes 20-35 minutes and the robot shuts down automatically with a loud auditory signal. Canadian hospitals have employed similar UV disinfectant technologies, but this is the first TRU-D robot in Canada. The hospital hopes this new tool will help prevent outbreaks of superbugs such as Clostridium difficile and may consider acquiring additional units in the future.

First published in the Inside Tract® newsletter issue 186 – 2013
1. Graban M. Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction. New York, NY: Productivity Press; 2008.
2. Media Release. Vancouver General Hospital Deploys TRU-D ‘Superbug Slayer’ to Battle Worst Season of Flu in Recent Memory. PR Newswire. 2013-02-20.