RokStories The Nose Knows; Dog to Sniff Out C. Difficile at Canadian Hospital
By P.J. Heller
Vancouver General Hospital’s newest staff addition has his work cut out for him: nosing around to track down potentially deadly bacterium in the medical facility.

But Angus, a 2-year-old English springer spaniel, is up to the task, according to his trainer, Teresa Zurberg. The cute floppy-eared dog is expected to start work sniffing out Clostridium difficile (also called C. difficile or C. diff) at Vancouver General, Canada’s second largest hospital, before the end of September.

“We strive to continue to find ways to provide better care, and sometimes the answer is not more technology, but instead, man’s best friend,” said Terry Lake, the British Columbia health minister.

Angus will be the only active dog in the world to be used to sniff out reservoirs of C. diff and the first in Canada. A 2-year-old beagle named Cliff was previously used in a 2012 study to identify C. diff on 300 patients in two large Dutch teaching hospitals.

C. diff is a highly contagious bacteria that cannot be seen with the naked eye. It causes diarrhea and other intestinal conditions and can be life-threatening.

The number of C. diff infections in Canada has risen over the last decade — particularly among those who are taking antibiotics, the elderly in hospitals and nursing homes and those undergoing chemotherapy for cancer — and is linked with an increase in illnesses and sometimes death, according to HealthLink BC. An estimated 700 cases a year are treated by hospitals in the Vancouver area; 70 percent of the cases are related to healthcare facilities.

The Centers for Disease Control and Prevention estimates that in the United States there are some 453,000 cases of C. diff annually resulting in 29,300 deaths. About two-thirds of the cases were linked to a stay in a hospital or nursing home. Most of those who died were 65 or older and died within 30 days of their diagnosis.

Zurberg, who had been training bomb- and drug-detecting dogs, contracted C. diff in 2013 after being treated with antibiotics for a gash on her leg.

“I was on heavy duty antibiotics and ended up getting C. diff and almost died,” she says.

Her husband, Markus Zurberg, a quality and patient safety coordinator for Vancouver Coastal Health, recalled seeing an article about Cliff the beagle and suggested she consider training a dog to detect the superbug. He also approached officials at Vancouver Coastal Health, which serves more than 1 million people in British Columbia and operates 13 hospitals including Vancouver General, who encouraged the effort.

“The Vancouver Coastal Health administration was really quite open to the idea and quite curious to see what we could do with it and what would happen,” Teresa Zurberg says.

That led Zurberg in 2014 to Angus, a field-bred springer spaniel. She got him when he was 10 weeks old. Between working at her other job as a cardiologist technologist and other issues, it took Zurberg a year to train Angus to sniff out C. diff. The training, based on a reward system, included the use of food, toys and C. diff scent pads, which did not contain actual bacteria spores.

Eventually, “we take away the food or toy and he learns that just finding C. diff all by itself gets him what he really wants,” Zurberg says. “We used the same methods that we use with bomb dogs and drug dogs. Basically it’s a game to them. They honestly in the end don't care about C. diff or ammonia nitrates or cocaine . . . to them it’s just a way to get what they want, which is their toy or their food.”

Angus started clinical training in the hospital in July 2015 and finished his last validation in late spring of this year with a 95 percent to 100 percent success rate. Zurberg is waiting for a contract to be signed before Angus formally begins working at the hospital sniffing out environmental C. diff. He has already been issued his hospital ID and was the star in a PR rollout at the hospital in July.

“We’re thrilled to have Angus join our infection fighting team in the battle against C. diff,” says Dr. Elizabeth Bryce, regional medical director infection control at Vancouver Coastal Health. “We recognize Angus is still young and building up his stamina, so we’re exploring several options for his deployment.”

Zurberg says she expects Angus will initially work two days a week at the hospital and will eventually work full time there and at other Vancouver Coastal Health facilities.

Angus will search for environmental C. diff, as opposed to testing patients. He will check sites including common areas, waiting rooms, hallways and rooms where C. diff patients were located and were subsequently cleaned to ensure there were no remaining hidden reservoirs of C. diff.

Although C. diff in some cases can be smelled by humans, “by then it it’s way too late,” Zurberg says. “Just because you can smell C. diff doesn’t mean you can tell me where it’s coming from. When the dog comes in, it can find those reservoirs of C. diff before they become a big issue.

“You can test patients. You cannot test the environment,” she adds. “It’s just logistically impossible. You can’t go around and swab and culture absolutely everything. It’s just logistically impossible to test everything and the cost would be incredible, you’d have to swab and culture everything and by the time you got the results back, it’s days later.

“The beauty of having a dog is you can do a very large area very quickly and I can get my findings back to the cleaning team,” she says. “It’s just an easier way for them to triage their resources.”

When Angus finds C. diff, he signals by either sitting down or laying down in the area. If bacterium is detected, the area will then be disinfected by a robot using ultraviolet-light that removes 99.9 percent of the C. diff spores, according to hospital officials.

Zurberg says that while some people have expressed concern about Angus’ health while sniffing out the bacteria, there is little risk of him contracting C. diff.

“First of all, he’s my best friend,” she says. “You really think I’m going to put my best friend at a high risk?

“Because he’s not auto-immune compromised and he’s young and healthy, the chance of him getting C. diff is very, very minimal,” she adds. “It’s the same as when you’re working in the ER and you have unknown patients come in and you don't know what they have and they haven’t put isolation precautions on them. Medical staff are exposed to C. diff all the time and very rarely do they ever get sick. It’s the same sort of thing with Angus.”

Dogs like Angus are well-suited to such search tasks, whether sniffing out drugs, explosives, cadavers, people trapped in rubble or even cancers before they can be detected through clinical testing.

“Their sense of smell is beyond anything that we can comprehend,” Zurberg says. “What we can use a dog for is just limited by our imagination.”

Depending on who you ask, a dog’s sense of smell is said to be hundreds, thousands or even a million times better than that of a human. A dog has as many as 300 million olfactory receptors in its nose, while humans have about 6 million.

“We might notice if our coffee’s been sweetened with a teaspoon of sugar; a dog can detect a teaspoon of sugar diluted in a million gallons of water: two Olympic-sized pools full,” says Alexandra Horowitz in her book Inside of a Dog: What Dogs See, Smell, and Know. Horowitz heads the Dog Cognition Lab at Barnard College.

An oft-cited study by Dr. James Walker, former director of the Sensory Research Institute at Florida State University, puts it another way: “If you make the analogy to vision, what you and I can see at a third of a mile, a dog could see more than 3,000 miles away and still see as well.”

Angus is already attracting attention and interest worldwide and Zurberg says she is willing to work with other hospitals to set up their own programs. She is already working to train another springer spaniel, Dodger, to detect C. diff.

“I’m happy to share Angus’ story especially if it starts to help save lives,” she says.

Selecting a good detection dog is key; maybe one out of 100 dogs will be selected for training. Zurberg says she is partial to springer spaniels because of their size and agility.

“He (Angus) has to get into some tight places sometimes, where a bigger dog would have a little more trouble doing that. He can go under the beds. He doesn’t get tangled up in the equipment so much because he is so agile. It comes down to the individual dog.

“When you pick a detection dog, you pick one that’s high drive, that just wants to work and that’s what kind of differentiates them from a companion dog,” she says. “Angus, if it was up to him, he’d be like, ‘You go sit in the waiting room. I’ll go to work. I’ll let you know if I find something.”

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