A hospital is experiencing a C. difficile outbreak and they’re starting to feel overwhelmed—patients are in isolation, sick or dying, wards are being closed, and their infection control resources are being stretched to the limit. What should they do?
They call Public Health Ontario (PHO) who stand ready to dispatch an expert team of infection control professionals in times of crises or outbreak. Free of charge, these Infection Control Resource Teams (ICRTs) will assess the situation and provide guidance to get the hospital back on track. PHO then determines the severity of the situation and, depending on geography and availability, deploys a team from either UHN or the Ottawa Hospital.
The ICRTs started in late 2008 when the Ministry of Health and Long-term Care (MOHLTC) made public reporting of C. difficile rates mandatory. Borrowing from the UHN model for infection control teams, the new rapid response teams consisted of at least one physician, one or more senior Infection Control Professionals (depending on the severity of the situation) and an epidemiologist when the situation warranted it.
These teams spin into action and are on site at the “outbreak” hospital within seven business days. The ICRTs embark on a day-long investigation that includes extensive staff interviewing – everyone from housekeeping to health care professional and from transportation to transplantation. They study the hospital’s policies and procedures and observe and assess hospital practices.
Shortly after their visit, the team submits a comprehensive report often making stringent recommendations on how to control the current outbreak and avoid future ones. Hospitals or local public health unit can request ICRT for many kinds of outbreaks, including MRSA and VRE. The ICRT teams from UHN have investigated many hospital outbreaks over the past few years and are finding some common trends amongst them.
“We are increasingly seeing problems with environmental cleaning practices and with the hospitals’ limited resources,” says Dr. Camille Lemieux, Associate Director of IPAC, UHN. “Because our teams are hospital-based we understand all aspects of an outbreak, from administration to cleaning to funding to program management, we leave no stone unturned. Heavy duty disinfectants are expensive and can destroy surfaces and equipment. This is a huge area where interpreting provincial guidelines and adapting cleaning procedures to suit the ‘outbreak’ hospital are key to reducing and eliminating infections. We are non-judgmental and are able to dig into all the issues across the board. That’s what makes us effective.”
These teams bring a fresh set of eyes to the problem, a benefit that even UHN took advantage of when it asked PHO for an ICRT visit to help manage rising C. difficile rates earlier this year. Lastly, ICRTs provide a forum for knowledge transmission between Ontario hospitals. “We’ve learned a lot by seeing other hospitals and their challenges and successes,” says Dr. Lemieux. “Every ICRT is a learning experience, and we collect tips that we bring back to UHN and then pass along to other hospitals.”
Independent of the ICRT program (and along with their daily rounds, educational sessions and special investigations) UHN’s infection control practitioners and physicians have also provided longer term support to hospitals across Ontario since 2006. “We’ve long recognized IPAC physician resources are very stretched,” says Dr. Lemeiux, “and we’ve found that we can provide a lot of help to smaller hospitals that otherwise would not have access to IPAC specialists.”
