I think it's official: I've taken as much shit from Paul Wells for a single column about nosocomial clostridium in Quebec as, well, the average Quebec hospital patient does from his caregivers. Wells doesn't think the persistent crisis has anything to do with unique conditions there, which suggests he hasn't studied the literature too closely—this passage from a CMAJ study of the problem written by Quebecois researchers pretty much sums it up. I'll put the important parts in bold (you don't need the help, but some might):
A lingering question that remains unanswered is why this strain of C. difficile spread so extensively within and between hospitals in Quebec, while dissemination of the same hypervirulent, and presumably highly infectious, strain seems to have been more limited in the rest of Canada and the United States. There is no evidence that Quebec differs from other jurisdictions in North America with regard to the size of its population of elderly inpatients or to the use of antibiotics. In 2003 and 2004, respectively, 686 and 663 prescriptions of antibiotics per 1000 inhabitants were delivered in retail pharmacies of Quebec, compared with 763 and 737 in the rest of Canada. Assuming a mean duration of 10 days per prescription, use of antibiotics in Quebec corresponded to 18.5 defined daily doses per 1000 inhabitants-days, a figure similar to that in British Columbia and to the median in 26 European countries. The lack of investment in our hospitals infrastructure over several decades, with shared bathrooms being the rule rather than the exception, may have facilitated the transmission of this spore-forming pathogen, which can survive on environmental surfaces for months. Providing modern medical care within hospitals built a century ago is no longer acceptable.
This finding is damning enough (and there is abundant testimony from Quebec healthcare workers on every tier that they do think the province has a unique problem with hospital design and funding for maintenance), but other researchers who've tackled the outbreak have argued specifically that the bigger issue is probably the infection-control procedures amongst frontline workers in Quebec's hospitals. An excerpt from my column [supporting material here]:
The theoretical debate over why Quebec might have been hit especially hard is continuing. Relatively little attention has been paid to a presentation given to Quebec's expert panel on C. difficile in October, 2005, in which American epidemiologist Dale Gerding tackled the important question of whether the hospital environment or poor handwashing practices are more likely to be the originating cause of such an outbreak. The data, Gerding told the panel, suggest that the hands of healthcare workers are the most important factor in the transmission of C. difficile. Several studies have suggested that a patient is more likely to get the disease from another patient treated by the same people than he is from a roommate, and the only proven precautions against transmission are the mandatory use of gloves, frequent disinfection of patient rooms, and the adoption of disposable rectal thermometers. To put the matter in plain English, Gerding advised Quebec that it needed, if at all possible, to stop doctors and nurses from carrying diarrhea from bed to bed.
Lest I be accused of singling out Quebec as singularly filthy for political or racial reasons—oops, Paul already pretty much did that, didn't he?—I'd like to note that I also discussed Alberta's own homegrown nosocomial infection/instrument sterilization scandal in that same column. (Funny thing, but an outbreak of serious iatrogenic disease in the hospital closest to where my retired parents live managed to grab and secure my attention, despite my obvious anti-Quebec bias.) An inquiry by the Health Quality Council of Alberta has just been completed, and I'd love to reassure you that the whole ugly mess had nothing at all to do with issues of institutional politics or employee carelessness, but alas, it seems like those are pretty much what was behind it. Never have I argued that hospitals in other countries don't face similar challenges, though I did make one wisecrack about whether Canadian doctors are taught the germ theory of disease. Is this sort of public shaming perhaps too harsh a penalty to be imposed on some unreconstructed brute who would perform a gynecological exam in the 21st century with nonsterile implements? My concern was with highlighting especial outrages, ones that utterly defy understanding to the layman, in the Canadian system. I guess I can see why Wells has a potential beef with Mark Steyn, who was much more ambitious in his political conclusion-drawing than I would be, but I cannot for the life of me perceive why anyone would look at what happened in Alberta and Quebec and think "Nope, nothing of interest to a public-affairs columnist there." What's the matter, don't I write about Nicolas Sarkozy enough?