Jim McCarter, Auditor-General for Ontario, Canada, has criticised poor housekeeping and hand hygiene in the province's hospitals, saying they were instrumental in the spread of the recent C.difficile epidemic, during which 75 patients died because of the bug at one facility alone.

His report, which was released yesterday, reveals that hospitals do not always ensure that rooms occupied by patients with the infection are adequately cleaned and that surgical instruments are not always properly sterilised. It also finds that many physicians and nurses do not wash their hands often enough.

The Globe & Mail reports that a Ministry of Health hand-hygiene pilot programme initially exposed the hand washing problem. It says that amongst the 10 hospitals that participated, only 28% of physicians were complying by the end of the programme, up from just 18% at its start. Nurses performed better, with 60% complying by the end of the programme - up from 44% at the start.

The publication reports that Dr Michael Gardam, the Director of Infection Protection and Control at Toronto's University Health Network, said that nothing in the auditor's report came as a surprise to him. He said:

"We've known for quite a while that we need good housekeeping standards and guidelines to help hospitals know how much they're supposed to be cleaning and how often."

The Auditor-General's report comes after several months of negative publicity for the Ontario government over its handling of the C.difficile outbreak, says the Globe & Mail, during which government officials were forced to introduce mandatory reporting of the infection after admitting that it had no idea how many of the province's 157 hospitals were having to fight the C.difficile outbreak. Hospitals reported 319 cases of the infection during August.

The government is now being critisised for requesting that hospitals report the number of C.difficile cases, but not the number of deaths resulting from a patient becoming infected with the bug.

The report says that incidences of C.difficile may be slightly higher in Ontario than in Canada as a whole, as Ontario had 5.53 cases for every 1,000 hospital admissions during the first four months of 2007, compared with 4.74 cases for Canada overall. Dr. Gardam believes the rate is higher in Ontario because the province is one of the first in Canada where the bacterium arose.

2nd October 2008