The hospital is not in outbreak mode, but is tracking the super bug after three hospital patients died of it over the last five months.

"We are not in an outbreak situation, but still we are taking it very seriously," said Dr. Neil Rau, an infectious disease specialist who is Medical Director of Infection Prevention and Control at Halton Healthcare Services (HHS).

As OTMH continues to track the virulent NAP1 strain of C. difficile first identified in Quebec hospitals in 2005, which appears to arrived in the GTA full force last year, the hospital confirms three patients died as a direct result of the super bug in the last five months.

"We are responsible to the community to let them know we are trying our best to rid the hospital of C. difficile," said Trish Carlton, of HHS communications.

"We aren't sitting around counting numbers, we are being very proactive, but it is a challenge, a real challenge," said Carlton.

The three patients were among a total of 18 OTMH patients, who died between November 2007 and April 2008 -- all of whom had C. difficile.

Of the 18 OTMH patient deaths, three were directly related to the bacteria -- three too many, said Carlton.

Five other patients, who died had C. difficile, but it was deemed indirectly related to their death -- it may have played a role, but was not the direct cause of it.

Nine others died of their underlying medical condition, though they did have the super bug.

One other patient's death is still under review.

C. difficile is a bacteria commonly found in the large intestine. It is kept in check by the bacteria normally present in the intestine, according to Rau.

However, problems arise when antibiotics taken for other illnesses kill the bacteria that keeps C. difficile in check -- allowing the intestine to become an ideal place for it to thrive.

C. difficile is picked up from surfaces and ingested -- making hand hygiene and diligent cleaning practices essential.

Complicating the situation -- as C. difficile is not new in hospital settings -- is the particularly nasty strain that takes the form of spores resistant to normal cleaning procedures, which, when released into a potential growth environment become active, multiply more and produce greater amounts, and types, of toxins that attack the colon.

Symptoms include diarrhea, fever, loss of appetite, nausea and abdominal pain.

Part of OTMH's proactive approach against C. difficile is that any case of diarrhea in a patient is assumed to be C. difficile, until proved otherwise by a lab test, according to Rau.

Healthy people are not usually vulnerable to C. difficile. However, seniors and people, who have other illnesses or conditions being treated with antibiotics and certain other stomach medications -- like those that reduce stomach acids -- are at a greater risk of infection.

"C. difficile is all about antibiotics," said Carlton.

Rau said the hospital is not banning use of antibiotics, nor will it play "antibiotic cop" and micromanage physicians' treatment of patients.

Rau said there is debate over whether a new genre of antibiotic that has been used over the last decade or more has paved the way for such a super bug, but options like intravenous antibiotics are not that palatable in many cases. He believes much of the answer is in cleaning.

At OTMH, Roberta Silcock is manager of Housekeeping and Patient Assistant Liaison (PAL), under facilities director Melinda Gorgenyi, and no expense is being spared when it comes to cleaning -- and more.

"I expect the Province is going to face a massive bill for C. difficile," said Rau, noting it may outpace the SARS (Sudden Acute Respiratory Syndrome) tab, particularly as it is occurring more gradually.

Carlton said she had no estimate on how much C. difficile -- and the fight against it -- has cost HHS, but agreed it was substantial through both supplies and staff.

HHS began monitoring C. difficile in 2002.

Rau called 2003 "the golden era," when rates of the more common J strain of C. difficile were but a blip on the radar screen.

C. difficile didn't become so difficult until last year -- and even then, did so gradually. That coincided with the NAP1 strain's arrival in the GTA, after its identification in Québec hospitals in 2005.

At the same time, the province was updating its best practice cleaning guidelines near the end of 2007, OTMH was upgrading its own cleaning practices in regard to C. difficile.

Rau said incident rates began increasing in mid-2007.

Five hundred additional hand hygiene units were added to the units already present at the hospital.

All mattresses were replaced on hospital beds and the corded pull cords, used by patients to call nurses, were replaced with vinyl pull cords.

Last December, HHS issued a report that announced findings of an increased occurrence rate of C. difficile in 2007 -- and corresponding aggressive hospital hygiene programs at OTMH.

C. difficile has captured the public eye with reports of it at neighbouring Joseph Brant Memorial Hospital in Burlington. Ontario Conservative Leader John Tory is demanding the Ministry of Health launch a short, independent investigation to find out how many patients across the province have been infected with C. difficile, and whether hospitals have super bugs under control.

According to last December's OTMH report, the incidence rate of C. difficile at OTMH in 2007 was 5.1 per 1,000 admissions compared to 2.3 per 1,000 admissions the year before.

The 2007 numbers represented a total of 74 cases of C. difficile amongst the 14,894 patients admitted to OTMH and was below the provincial incidence rate of 5.53 per 1,000 admissions.

Reporting of C. difficile is not mandatory and numbers released are often misleading, according to Rau.

Hospitals of different sizes, communities and case complexities are being compared using numbers that are not often qualified or equalized properly -- and are judged against benchmarks that are often out of date, according to hospital officials.

Rau said the new strain of C. difficile is resistant to regular hospital cleaners.

Though common bleach should kill it, the hospital is not asking its cleaning staff to breathe the fumes of bleach, said Carleton. Instead, it is using tougher chemical cleaners, like Virox and more recently, a new chemical cleaner called Rescue that is effective against C. difficile.

But the hospital doesn't stop there.

Isolation cleaning teams -- 25 people in total -- were hired in mid February and trained by similar teams from Toronto's Sunnybrook Health Sciences Centre.

The teams wear personal protective gear, such as gloves and masks, and scour any room in which a patient has had C. difficile, using the chemical cleaners and microfibre tools.

According to Silcock, the microfibre tools will pick up the C. difficile bacterial spores whereas a regular rag will just push them around.

After a prescribed "kill" time, in which the chemical is left to do its work, the cleaning team then cleans the room and its contents again.

A checklist of items cleaned is then presented to a supervisor, who, in turn, goes into the room with a fluorescent indicator called Glo Germ, which when viewed under black light, will show if germs remain.

If so, the cleaning is repeated.

According to Rau, if C. difficile rates continue to increase, the entire hospital could be subjected to such cleaning methods.