Bacterium plagues hospitals

Despite its danger, no statewide plan to investigate C-diff is in place.
CLEVELAND (AP) -- Cases of a deadly bacterial illness at hospitals and nursing homes appear to be on the rise in Ohio, but the state has not pursued a plan to study the bacteria or require hospitals to report it, a newspaper reported Sunday.
Ohio Department of Health officials are reluctant to require reporting on the spread of Clostridium difficile, also known as C-diff, despite urging from federal authorities, according to departmental e-mails obtained by The Plain Dealer.
The bacterium has been most prevalent among hospitals and nursing homes, and some surveillance advocates worry that patient transfers among facilities contribute to its spread. C-diff is a bacterium that resides in the colon and can cause diarrhea and colitis. U.S. public health officials warned this month that a more virulent strain has grown resistant to antibiotics. The germ was blamed last year for 100 deaths over 18 months at a hospital in Quebec, Canada.
Cases, concerns
The Plain Dealer said it had confirmed 21 deaths related to C-diff in the Cleveland area, most in 2005. The number is based on coroner records, which capture only some C-diff deaths, and other cases brought to the newspaper's attention and confirmed through death certificates.
In addition, several hospitals have implored the state for guidance on how to handle it, e-mails show.
Barbara Bradley, chief of infectious diseases at the state health department, told the newspaper in November that she had no reason to suspect outbreaks have occurred in Ohio since no hospitals have reported outbreaks.
But in an e-mail a week earlier to a colleague at the state health department, Bradley acknowledged the problem in Cleveland hospitals.
"The fact that they suspect a 'problem' indicates that this may be an outbreak," she wrote.
And in July, when a federal health official requested information on cases in nursing homes, the state Health Department said it knew of 3,550 cases in 2004, up from 2,072 in 2002.
Limited communication
State law does not require C-diff to be reported, as it does other diseases, such as Legionnaires' disease or meningitis.
Some hospital officials said they feel stuck in a semantics trap.
The state Health Department hasn't defined "outbreak," so hospitals can't report it, said Bill Ryan, chief of the Center for Health Affairs, the Cleveland-area hospital association, and a former state health director.
Representatives from the U.S. Centers for Disease Control and Prevention urged Ohio last summer to study recent hospital cases of C-diff.
But an investigation didn't happen because the CDC backed off its plans and got busy with other matters, Bradley said.
Cleveland hospitals have since agreed to track C-diff cases locally.
Patients and their families in the Cleveland area said they had never heard of the bug before encountering it in hospitals and nursing homes.