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Hospitals battle superbug

HSC pulls out all the stops to thwart VRE outbreak

By: Larry Kusch

Posted: 08/26/2011 1:00 AM | Comments: 0 | Last Modified: 08/26/2011 10:00 AM | Updates

Dr. John Embil and Lori Lamont introduce new signage for use in hospitals to try to stop the VRE outbreaks. (KEN GIGLIOTTI / WINNIPEG FREE PRESS) Photo Store

The FYI on VRE

Health Sciences Centre

Outbreak declared February 2010;

584 patients affected as of Aug. 12, 27 of whom have developed infections

St. Boniface General Hospital

Outbreak declared Jan. 24, 2011;

124 patients affected, with two developing infections

Grace General Hospital

Outbreak declared March 9, 2011;

92 patients affected, with nine developing infections

-- Source: Winnipeg Regional Health Authority

What is VRE?

VRE is the short form for vancomycin-resistant enterococci. Enterococci are common bacteria that are normally found in the bowel. Vancomycin is a powerful antibiotic used to treat serious infections. Vancomycin-resistant enterococci are a type of bacteria that no longer responds to treatment with vancomycin.

How does it spread?

Through bad hand hygiene. VRE are found in feces. If those infected with the bug use the toilet and don't wash their hands properly, they can contaminate a door knob or a bed rail and all sorts of surfaces. You can get VRE when you touch your mouth with contaminated hands; the bacteria are swallowed and then may live in your digestive tract.

How hardy are these germs?

They can survive outside the body on surfaces such as toilet seats and door knobs from five days to several weeks and on hands for several hours. A surface does not have to be visibly soiled to be contaminated. VRE bacteria are invisible to the naked eye. They are not spread through the air. The bacteria are relatively easy to kill, however, with disinfectants and good hand hygiene.

-- Sources: Winnipeg Regional Health Authority and the York Central Hospital website

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Superbugs are a growing problem for Canadian hospitals.

Health officials are battling an outbreak of the superbug VRE at three Winnipeg hospitals, including the Health Sciences Centre, where it's been a problem since early 2010.

No one has died as a result of the outbreaks, which have also occurred at the Grace and St. Boniface hospitals. However, a total of 38 patients have become infected. Another 762 have become carriers but not developed symptoms.

VRE is relatively mild as far as superbugs go, and it's a problem in hospitals across Canada. But health officials are concerned with the length of the outbreak at HSC -- 18 months and counting. It indicates the facility may be vulnerable to other, more virulent, organisms such as C. difficile or MRSA.

"This is like the canary in the coal mine for us. For whatever reasons this is not being contained at HSC," said Heidi Graham, a spokeswoman for the Winnipeg Regional Health Authority (WRHA).

VRE, short for vancomycin-resistant enterococci, are found in feces and spread through inadequate hand washing.

Those stricken with the bug will develop infections in the urinary tract, the blood stream OR in organs.

To finally wrestle this stubborn bug to the ground, the HSC is launching a new cleaning and disinfecting blitz on all affected wards. In many cases, patient rooms will be cleared to allow for more effective scrub-downs. The hospital will also beef up its housekeeping services, it said Thursday.

HSC will also boost staff monitoring to ensure hospital personnel wash their hands or use hand sanitizer, when appropriate, as they enter or leave patient rooms.

It will launch an awareness campaign, through signs and pamphlets, to encourage patients, volunteers, visitors and staff to wash their hands frequently and thoroughly. It will also make anti-bacterial towelettes available to patients, and it will stock all shared bathrooms with disinfecting wipes to wipe down toilets and other surfaces.

"We need to rein this in because it cannot go on any longer," said John Embil, director of the HSC's infection prevention and control unit. He hopes to have the situation in hand within three months.

Embil said a big concern is that a problem at Health Sciences Centre can quickly become a citywide hospital problem. It's believed, for instance, the outbreak at St. Boniface was initiated by infected patients who had been at HSC.

Large hospitals tend to be more prone to superbugs since they often deal with patients with multiple illnesses, who are moved from ward to ward and remain in the institution longer.

St. Boniface hospital did not experience its VRE outbreak until nearly a year after HSC was hit. Officials said Thursday the number of cases there has been gradually declining over the last few months.

The Grace was hit in March, but already 92 patients have been affected, with nine developing infections. "We're hoping that it won't become the same persistent situation (as at HSC), said Lori Lamont, the WRHA's chief nursing officer.

A relatively small number of patients who get VRE develop infections, usually in the urinary tract, the blood stream or in organs. People can carry the relatively innocuous organism for years without knowing it. "The vast majority of people with the disease don't even get sick; they're colonized, they're carriers," Graham said.

When an outbreak is declared in a hospital, a set of protocols mandated by the Public Health Agency of Canada is immediately put in place to control it.

Graham said that for a time some months ago, it looked as though the HSC had the problem licked. But then, soon afterwards, it came charging back.

"It's very unusual. We don't know why the precautions we've taken before haven't contained it and not ended it," she said.

The bug has not been a problem in HSC's surgical wards, the women's and children's hospitals, nor in its psychiatric health area.

larry.kusch@freepress.mb.ca

Republished from the Winnipeg Free Press print edition August 26, 2011 A4

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Updated on Friday, August 26, 2011 at 10:00 AM CDT: Description added.

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