Since the 1980s Clostridium difficile colitis had been recognized as a, generally manageable, adverse consequence of antibiotic therapy. Not surprisingly, outbreaks in hospital were associated with shared bathrooms. Patients usually responded well to therapy and infection control efforts focused on cleaning and providing a private room and bathroom to those affected. Most often outbreaks were relatively easily managed. It was a regularly recurring nuisance type of problem for infection control practitioners.
However, the evolution and spread of an extremely virulent strain of C. difficile (referred to as NAP1 in Canada) has changed the landscape. The likelihood of severe disease ending with colectomy or death has markedly increased. Overall incidence has increased and outbreaks sustained. Canadians are truly dying for the lack of a toilet. Primary prevention is essential.
Canadian hospitals are aging and a cycle of renewal is beginning. We must make sure that acute care hospitals are constructed with a one patient: one toilet ratio. The added capital costs will be recovered many fold in infection avoidance. We need standards that explicitly state the requirement for a toilet for each patient and a maximum of 2 patients per room – Provincial standards and National standards. Lets make it the law.