Winnipeg Free Press - PRINT EDITION

Ward Stories: Four case studies

They went in sick, got a lot sicker

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Dr. John Embil, director of infection control for the Winnipeg Regional Health Authority, responds to concerns some superbug patients about treatment of antibiotic-resistant infections.

Adam Janzen, 22, MRSA

Adam Janzen lifts up a pant leg and points to a raised scar at the back of his left calf -- the only physical reminder the 22-year-old basketball coach and business student nearly lost his leg six months ago.

After spending May long weekend at his cabin in Victoria Beach, a tiny mosquito bite on his leg became red and inflamed and filled with pus.

"I thought nothing of it," Janzen said. "By the end of the week I had a huge infection on my leg."

Janzen went to Concordia Hospital emergency, where he was referred to the Access clinic on Henderson to receive IV antibiotics to quell the infection.

One week later, Janzen couldn't put any weight on his leg and his calf was swollen, red, and "rock hard" to the touch.

He was taken by ambulance to Health Sciences Centre where doctors suspected Janzen may have a blot clot.

"He said if you don't act now you could lose your leg," Janzen said. "It was pretty scary."

Doctors inserted a large needle in Janzen's left leg and drained more than 200 millilitres of blood. A blood test later confirmed that MRSA, an antibiotic resistant strain of bacteria, was behind Janzen's nasty infection.

Doctors immediately switched his antibiotics, and isolated Janzen in a private room where all staff were required to wear gowns and masks.

Janzen said no one was sure whether he picked up MRSA in the community through body-to-body contact in basketball, or at Concordia Hospital where he had been visiting a relative before he got sick.

He was admitted to Seven Oaks for two days so a surgeon could make an incision in the back of his calf and install a surgical tube to drain the inside of his leg. Janzen laid in bed for two days while the open wound drained and healed, and he hoped the incision wasn't an invitation for further infection.

Ten days after surgery Janzen could finally walk on his leg and antibiotics helped clear the MRSA from his system.

"I didn't know anything about MRSA," he said. "It was bad luck and a combination of things that got pretty ugly."

The problem: Janzen wasn't tested for MRSA at Concordia emergency, and wasn't isolated until several weeks after he was initially infected.

The response: Embil said patients with skin lesions are not necessarily screened for MRSA when they present to hospital. He said skin lesions are caused by a variety of things, and patients are only automatically screened for MRSA if they've been admitted to hospital within the last six months for more than 24 hours, or has come into contact with a patient who tested positive for MRSA or VRE.

"Funny looking skin lesions could be psoriasis, could be Steven Johnson Syndrome, could be a number of things," he said.

Donna, 63, C. difficile

Tears well in Donna's eyes as she describes her five-month long battle with messy C. difficile that left her physically and emotionally exhausted.

Donna was admitted to Health Sciences Centre in March 2006, suffering from extreme abdominal pain from what doctors thought was a perforated ulcer.

After two weeks in hospital, Donna got a roommate who developed uncontrollable diarrhea. Although Donna was almost ready to be discharged, she started getting sick too.

"All of a sudden, I started having diarrhea," Donna said, noting her roommate tested positive for C. difficile and was isolated.

"You can't have someone who has C. difficile share a room with someone who doesn't."

Donna tested positive for the superbug and was immediately isolated.

She said at the time, at least seven other hospital rooms in the surgical ward had signs on the door warning staff and visitors to wash their hands and wear protective gloves and gowns. While doctors and nurses always made sure to wear the protective coverings, Donna said hospital orderlies usually didn't.

The diarrhea was so violent, Donna said she often couldn't make it to the washroom. To make matters worse, she was horrified at how hospital cleaning staff mopped up the problem.

"When they came to clean it up they just wiped it with a towel and threw it in the laundry bin," she said. "They'd just smear everything around."

The problem: Donna's roommate shared a washroom with Donna and potentially exposed her to C. difficile spores.

The response: Embil said diarrhea in a surgical ward could be a complication or surgery or a number of different things. When a person in hospital has diarrhea, a stool sample is done to determine the cause.

Embil said he couldn't comment on Donna's specific situation, but that anyone who tests positive for C. difficile is isolated with their own washroom.

Arnold Otto, 63, C. difficile

Less than two weeks after Arnold Otto was released from Health Sciences Centre in September after an emergency gallbladder surgery he started to get sick.

Otto was suffering from severe diarrhea but his family doctor told him it was likely a complication from surgery, and sent him home with antibiotics. Five days later, Otto said the pills weren't working and his doctor told him to take an over-the-counter drug instead.

"I spent four or five days chewing up Immodium like it was going out of style," he said.

Otto passed out and was rushed back to the emergency room at Concordia Hospital. He asked whether he could've picked up a bug at HSC, but no one could pinpoint the cause of his sickness.

"I said is this something I could have picked up at HSC?" he said. "Meantime, this C. difficile is raging in my body."

Otto's family doctor ran further tests which revealed he had C. difficile. He began taking aggressive antibiotics right away.

Although Otto is starting to feel better he said he's worried he exposed his entire family and friends to the infection over the Thanksgiving long weekend.

"My big concern is Hell, I didn't know this I have a family, my son lives at home my wife got really sick," he said.

"What you're looking at here is a possibility of contaminating your whole neighbourhood, your family, your friends."

The problem: The ER didn't test Otto even though his symptoms were consistent with C. difficile and he had recently been taking powerful antibiotics.

The response: Embil said hospitals don't screen patients for C. difficile when they present to hospital. Instead, they do diagnostic tests.

However, Embil said anyone who is admitted with diarrhea is isolated and proper precautions are taken.

"There is no routine screening (for C. difficile) as there is for other microorganisms," he said.

Tahir Diglisic, 78, C. difficile

After suffering a heart attack last December, Tahir Diglisic was admitted to Health Sciences Centre to await bypass surgery in January.

Diglisic had a successful bypass surgery at St. Boniface Hospital and didn't suffer any complications. But seven days later, Diglisic tested positive for C. difficile and everything began to unravel.

Diglisic's daughter, Katerina Diglisic, said her father's condition began to worsen and doctors told the family a severe bout of C. difficile could kill him.

Diglisic underwent a six hour emergency surgery to remove his colon.

Katerina said fighting C. difficile has aged her father "at least 10 years." He now has problems with his kidneys, is on dialysis, and has a colostomy bag.

She's upset staff told her infections like C. difficile are just a part of hospitals and that no one can be held responsible for causing a life-threatening complication to her father's health.

"I'd like to know what the hospital is going to do," Katerina said. "There's nothing we can do,' is their attitude."

The problem: Hospitals are not held accountable in cases where patients contract serious superbug infections.

The response: Embil said, "We're trying very very hard and to intimate negligence serves to undermine everyone who's working like fiends to make sure that our local health care facilities and our national health care facilities are actually safe for people."

"The intimation is there's been gross neglect and obvious non-adherence to basic infection control practices and that's incorrect."

Republished from the Winnipeg Free Press print edition December 2, 2007 $sourceSection$sourcePage

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