As Fraser Health struggled to suppress an alarming C. difficile outbreak in Burnaby Hospital, there was never a discussion about warning the public, documents reveal.
Nearly 1,900 pages of reports and communications among health board and provincial government employees — obtained by The Sun through a freedom of information request — reveal how officials responded to the crisis in March 2012.
Emails flew internally about curbing the hospital’s rate of infections with the C. diff. bacteria — said then to be two to three times the national average — but there was no mention of steering patients away from the troubled hospital.
The FOI documents were provided to The Sun this month, around the same time as B.C.’s Privacy and Information Commissioner Elizabeth Denham released a report saying government agencies have a duty to inform the public when their health and safety is at risk.
“Only a small number of public bodies are making disclosures under (the Freedom of Information Act) about a risk of significant harm to the environment or to the health or safety of the public,” Denham wrote in her Dec. 2 report. “Public bodies do not fully understand their obligations under (the act) and are not always taking appropriate measures to ensure they meet these obligations.”
In an interview last week, a Fraser Health official said lessons have been learned since March 2012 and that if a C. difficile outbreak happens again, information would be shared publicly.
“I think perhaps the learnings from March 2012 is just the importance of transparent communication,” said Dr. Elizabeth Brodkin, Fraser Health’s executive medical director of infection control and prevention.
In early 2012, eight senior doctors at Burnaby Hospital wrote a letter to Fraser Health complaining that C. difficile infection rates were consistently too high at Burnaby Hospital and that 84 people who became infected there had died between 2009 and 2011.
The FOI documents reveal conditions were so unsanitary at the hospital during that time that disgusting photos taken in patients’ rooms were turned into warning posters for the staff.
The hospital’s C. difficile “champion” did audits in late 2011 and “discovered many cluttered unhygienic bedsides (e.g., full urinals sitting next to food items),” the documents reveal.
The champion hung posters entitled “How to give C-Diff to the Whole Hospital!” inside the facility to give staff advice about how to reduce the spread the bacteria. The posters included photos of a tube of rectal cleaning cream and a spray used to clean incontinent people sitting next to a full food tray at a patient’s bedside.
C. difficile is a bacteria typically contracted in a hospital, often passed from hand to hand, and most commonly affects seniors, with symptoms ranging from diarrhea to life-threatening inflammation of the colon.
The FOI documents show that Fraser Health officials were working hard behind the scenes to lower the number infections, through measures such as increased hand-washing by staff, and had also commissioned an external review from an infection control expert.
By early March 2012, however, the Burnaby Hospital infection rate was making front-page news, after the NDP opposition released the disgruntled doctors’ letter to the media.
Families of patients who contracted C. difficile told reporters they had never been advised about the dangers of becoming infected at Burnaby Hospital. The FOI documents show that, in response to journalists’ questions, a health authority spokesman revealed written warnings were only posted in the hospital units with the C. diff. outbreaks.
“We acknowledge that it could be more available, and that hearing appetite for more transparency we are moving toward posting infection rates and related info at all hospital sites,” former Fraser Health spokesman Roy Thorpe-Dorward said in a March 5, 2012 email.
These changes have been made, Brodkin said last week.
For the past year, C. difficile infection rates have been posted by the front doors of every Fraser Health hospital so people can see them as they walk into the facility. The information is not yet available online, Brodkin said, but the health authority hopes to coordinate that with the Health Ministry in the future.
“If you want the latest rates, you can call and ask for them and we are happy to share them, but they are publicly posted at all of our buildings,” she said.
In addition, for the past year, Fraser Health has been posting on its website a notice of any gastrointestinal outbreaks (including C. difficile) at its hospitals. Not all health authorities are doing this, she added.
Brodkin said C. difficile rates have fallen steadily at Burnaby Hospital and across Fraser Health in recent years. She attributed that to vastly improved hand-washing rates among staff, increased cleaning of infected units, having more infection control staff, and never putting someone with C. diff. in a room with an uninfected patient.
By contrast, back in July 2011, a Burnaby Hospital audit showed too many medical and hospital staff were not washing their hands (washing is one of the best defences against the spread of C. diff.) before and after seeing a patient. In one ward, the rate of handwashing was just 20 per cent. Audits for all Fraser Health hospitals showed only 35 per cent of staff and physicians were washing hands in 2011, and 56 per cent in early 2012 (then the lowest rate of all B.C. health authorities).
And, also by contrast, between January 2011 and February 2012, a Burnaby Hospital count showed that in only fives cases could it follow the policy of putting people with C. difficile infection in private rooms or with other infected patients to reduce the spread. In the other 32 cases, C. difficile patients ended up in a room with non-infected patients.
The FOI documents spell out how bad the C. diff. situation was from 2010 to 2012:
• A Feb. 14, 2012 memo indicated C. difficile infection rates “at some Fraser Health hospitals is twice the national average.” A Feb. 23, 2012 provincial memo said Fraser Health had the highest rates of any B.C. health authority.
• In March 2010, staff was told Burnaby Hospital’s C. difficile infection rate “is one of the highest in the province” and there was a target to reduce it by 75 per cent in the next nine months.
• A February 2012 memo noted hospitals with lower C. difficile rates used a different disinfectant to clean rooms, and that the one used by Fraser might actually increase the spread of the bacteria.
• An April 2011 internal report noted: “Fraser Health has some of the highest rates of CDI in Canada. For patients/clients/residents, this translates to increased length of stay, increased risk of further complications and increased risk of morbidity/mortality. ... There is also a heightened public awareness of super bugs and the risk of acquiring an illness in the hospital, which brings additional pressure to demonstrate our accountability to take visible action.”
Few of the actions taken at the time, though, were visible to the public.
One day after case blew up in the media in March 2012, a Health Ministry official warned in an email to colleagues that the NDP opposition could also raise alarm bells about the high C. difficile rates in other Fraser Health hospitals, such as Royal Columbian, Mount Saint Joseph, Langley and Eagle Ridge, “as they all seem to stand out above the provincial average.”
And yet, no public warnings were ever issued.
The FOI documents show, however, that Fraser Health did work internally to address the problems. And Brodkin said that work has paid off.
She said C. difficile rates have steadily fallen across Fraser Health. In Burnaby Hospital there were 15.2 cases per 10,000 patients days in 2011/2012, 8.5 cases in 2012/13 and 5.6 cases so far in 2013/14.
Hand washing by staff before and after contact with patients has also steadily increased across the region and in Burnaby Hospital, where there was a 44 per cent compliance in 2010/11, 59 per cent in 2011/12, 79 per cent in 2012/13 and 83 per cent year-to-date in 2013/14.
“Fraser Health takes all of our health care associated infections very seriously, including C. difficile, and we have made substantial efforts both prior to and since March 2012 to address them and bring the numbers down and get them where they needed to be,” Brodkin said.
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