Via The Globe and Mail, a report by Wendy Stueck: 'Outbreak' or not? How superbugs test a hospital's practices on informing the public. Excerpt:
In the global cast of drug-resistant bacteria, carbapenemase-producing enterobacteriaceae – more commonly known as CPE – can be thought of as the brooding villains. They are resistant to nearly all antibiotics, they can spread resistant traits to other organisms, and as many as 50 per cent of people who get a serious CPE infection die.
Yet when Fraser Health Authority detected 41 patients carrying the potentially lethal bug in its hospitals in the last half of 2013, it was under no obligation to report that to the public. The reason? In Canada, individual health facilities to determine what constitutes an outbreak. Fraser Health has called the incidents a “cluster,” saying B.C. hospitals and infection control practitioners are still discussing guidelines on what determines an outbreak.
The question of when a cluster becomes an outbreak – and whether and when the public should be told – is pertinent not only to Fraser Health, which serves more than 1.6-million people in the Fraser Valley east of Vancouver. It highlights the challenges for Canadian hospitals when it comes to getting ahead of CPE, which began to show up in Canada around 2010.
Health facilities are grappling with questions around the best ways to screen and test for the bacteria, the costs associated with increased testing and even whether screening can do harm. A June conference on antimicrobial-resistant organisms in Calgary, for example, includes a session that will discuss whether screening can result in patients receiving reduced care due to “leperization” and isolation.
Fraser Health, meanwhile, is dealing with a new reality – asking patients admitted to its sites whether they have traveled outside Canada within the last six months. Those who answer yes are tested for CPE. The authority currently has about a dozen cases and expects CPE to be an ongoing issue.
“We have not provincially decided on the definition of what an outbreak means,” Elizabeth Brodkin, Fraser Health’s medical director of infection prevention and control, said last week in discussing the cases. “So I wouldn’t use the term outbreak. We saw a cluster, which clearly we needed to respond to. And the measures we put in place were very satisfactory in bringing the numbers down.”
