Essence of the Search; When and When to look for C-diff
C-diff is here
C-diff is there
Hiding in plain sight
"Identifying the sources of C Difficile and how transmission occurs is complicated and remains poorly understood"
Dr. J. Scott Weese, Canadian Journal of Infection Control, Fall 2019
"Environmental reservoirs have been implicated in transmission of Clostridium difficile infections. Scent detection by canines has demonstrated promising ability to rapidly triage hospital surfaces and equipment. 18 months of data collected post-implementation of the canine scent detection project at Vancouver Coastal Health were used to identify key environmental reservoirs for C. difficile and possible mitigation strategies." Elizabeth Bryce, MD, FRCPC, Vancouver Coastal Health, Vancouver, BC, Canada
In general, reservoirs of C-diff have been found on all kinds of surfaces
- We find it in clinical and administrative areas, but it is not everywhere.
Finding C-diff is a science and art
We train by following specific guidelines and by placing the odour enhanced tips in a series of scent boxes. We choose to use cotton tips in a small aluminum tin with a slide cover because it’s safe to use and not usually seen in a hospital.
Locating the source with nose and brains
This door to this closet was closed. Finley showed strong interest. When opened, he tried to crawl under the bottom shelf, then dove onto the left corner and did his classic “I found it” thing.
We know that odour is transient and gets pushed into corners, so it is reasonable to conclude that the reservoir might not be on the bottom shelf. Maybe it's on the wood door, or on a glass vase.
The hospital's ICP witnessed this alert, recognized a gap in procedures and initiated a policy change.
The K9 C-diff detection project is a discovery process. It's a first for any Ontario Hospital and we are honoured to have had the training time and support of Southlake Regional Health Centre. With practice, we developed and refined the required protocols.
Things We Know
- In scent box exercises and in clinical areas he strongly alerts hides of 027 positive 027 negative.
- He develops a ‘scent picture’ and can tell us that a room is clean - in seconds.
- There is no mistaking his change in body language when he first encounters the scent cone. This behaviour change can be subtle,
and sometimes very dynamic.
We were leaving ICU and Finley exhibited classic signs of being ‘on odour’. His head was quickly moving left and right and he was rapidly sniffing. He closed in on the blue equipment cart and put his front feet up on the top level and continued to sniff rapidly. He moved to the yellow isolation cart on the left and pawed at the lower corner and completed his alert.
Where is the reservoir?
Finley has walked by this cabinet six times in the last few weeks, but he alerted today. Is it a new source or recently disturbed?
The solution here was to remove the contents and disinfect the entire cabinet.