TORONTO - When Sarah heard last week that more than a dozen patients were infected with C. difficile in a Toronto-area hospital -- and four had died -- she knew more than most the suffering caused by this all-too-common bug.
Her independent, 84-year-old mother went into a Hamilton hospital last fall for treatment of a bladder infection and contracted Clostridium difficile, said Sarah, who asked that her full name not be used.
The C. diff wasn't detected until after her mother was discharged for the bladder infection, which was treated with antibiotics. (The drugs kill off so-called good bacteria in the large intestine, allowing C. difficile to flourish.)
But within a week, her once-vibrant mother was "so incredibly ill,'' she had to be readmitted, said Sarah. "She wasn't eating, she was sleeping a lot, she was in pain in her lower abdomen and she was having very bad diarrhea.''
"The whole time she was at home, she just kept saying: `I want to die, I want to die.' And this is quite unlike my mother. My mother is a very sociable, outgoing person who had a great zest for life.''
Her mother's apparent "death wish'' led doctors to admit her to the psychiatric ward, where she continued to decline -- until they realized her problem was not mental but physical.
"But when you saw her in this place, she was like a skeleton with skin,'' Sarah recalled. "Her eyes were sunken and she had this pallor of death about her.''
Her mother had lost 25 pounds from her under five-foot frame and had to spend weeks in rehab regaining her strength.
In all, she was in hospital for more than three months, and by the time she had recovered from the ravages of C. diff, she could no longer manage living alone in her condo and had to go into a nursing home.
"The change that has come over her is devastating,'' said Sarah, fighting back tears. "It's heartbreaking.''
Miriam's story
Miriam, who doesn't want her real name used, also contracted C. difficile in a Hamilton hospital last summer. She was being treated with antibiotics for pneumonia, developed while in the midst of chemotherapy for breast cancer.
Like Sarah's mother, Miriam was sent home, then became increasingly ill with severe diarrhea. She was readmitted and eventually placed in the only isolation unit available -- in the hospital's physical rehab section, where nurses weren't used to dealing with infectious disease.
When her husband Harvey (not his real name) came in the next day, Miriam was on oxygen because her abdomen was filling up with fluid and she couldn't breathe. But because of her infection, she had to wait until after regular hospital hours to go to a special lab to have the fluid drained and for insertion of an X-ray-guided feeding tube.
They had to wait three days for those procedures, said Harvey. "She was getting weaker, and I was getting progressively frantic.''
Miriam was moved to the oncology ward -- and was bunked in with three other cancer patients, some seriously ill -- even though she was still infectious.
"Then finally, as if they had woken up to the reality of the situation, they said we're now moving you to an isolation room,'' Harvey said, adding that he doesn't know if any of those other three patients ended up contracting C. diff.
Miriam, 67, was in hospital for 3� weeks and lost 30 pounds. It took weeks to regain her strength and the lost weight, and her cancer appears to be in remission.
And while she has nothing but praise for the nurses and doctors, whom she believes did their best in less-than-optimal conditions, Miriam said cleaning services for hospital rooms and bathrooms was hit and miss (C. difficile produces spores which can spread infection from surfaces)
"It makes me feel that I would want to stay out of hospitals, and I find myself saying that to people.''
The Hamilton hospitals aren't the only ones trying to control the spread of C. diff within their walls. The bacterium is common in health-care settings across the country.
"But the statistics don't matter to the person who gets it,'' acknowledged Dr. Mark Loeb, an infectious disease specialist at Hamilton's McMaster University.
The key to halting its transmission is good infection control, including regular handwashing by health providers between patients. Yet a recent study Loeb helped conduct at 15 hospitals across Ontario showed that less than one-third of doctors and nurses regularly wash their hands.
"The bottom line is no one's been able to develop a foolproof system to get health-care workers to wash their hands. That's really the holy grail of infection control.''
Dr. Denise Gravel of the Public Health Agency of Canada, senior epidemiologist for the agency's Nosocomial (hospital-acquired) Infection Program, said prevention also "boils down to basic housekeeping, and it's a matter of frequent cleaning, using the old elbow grease.''
The Public Health Agency began tracking cases of C. diff in November 2004. Of most concern is a hypervirulent strain dubbed NAP1 that produces at least 10 times the amount of toxin of more garden-variety strains.
NAP1 was identified in one of the patients who died in the Toronto-area Trillium Health Centre late week and has been linked to the deaths of 2,000 patients in Quebec since 2003.
"And this particular strain, we have found it in every province except P.E.I., which does not participate in our surveillance, so we don't know if it's in P.E.I. or not,'' Gravel said Gravel, said from Ottawa.
What they do know is that deaths from C. difficile of all strains are on the rise -- up 400 times, to 5.7 per cent of patients between November 2004 and April 2005 from 1.5 per cent in 1997.
Still, Gravel said it's important to put the infection in perspective.
"The message to get across to people is that C. difficile is not a new disease, it's something that has been around for decades,'' she said. "It's just that people need to be reminded that proper hygiene -- handwashing and so forth -- basically control and stop the disease in its tracks.''
But obviously, said Sarah, strict infection control isn't always being practised, or her mother would not have ended up so desperately ill. And she is furious that a medical system meant to heal ended up making her mother sicker and put her in a nursing home before her time.
"She changed forever,'' said Sarah. "If you said would she be like that at some time in her life, maybe. But every member of my family truly believes that this horrible disease hastened it.''
