In late July, a patient at Southlake Regional Health Centre in Newmarket died from a Clostridium difficile infection, the same bacteria responsible for the deaths of 79 hospital patients in Montreal and 10 in Calgary. Now, 100 more deaths at the University Hospital in Sherbrooke, Que., are being blamed on the "superbug."

Unless the Ontario government takes quick action, people will lose their lives to C. difficile because the same conditions that led to the bacteria spreading throughout Quebec hospitals, exist in our hospitals and long-term care facilities.

Government overconfidence and failure to heed warning signals were the first systems failures during last year's SARS crisis.

We are now being told that C. difficile is not a concern to Queen's Park because of new safety standards. That response is frightening.

The infection control failures that led to the spread of SARS have not been corrected and no new resources have been dedicated to keeping hospitals and long-term care facilities clean. Quebec doctors now blame hospital sanitation as the main culprit in spreading C. difficile.

In Montreal hospitals, the number contracting C. difficile is at least four times higher than it was seven years ago, attributable to reduced housekeeping staff and eroded cleaning standards.

Dr. Mark Miller, the head of infection control at Montreal's Jewish General Hospital, told reporters, "It is the general sanitation in the hospitals that is under the microscope right now. You've got fewer housekeepers. You've got less cleaning of patient rooms and less intensive cleaning." The situation is as bad in Ontario.

Dr. Allison McGeer of Mount Sinai Hospital told the Canadian Medical Association Journal: "Listening to stories from Montreal is, frankly, scary. It could happen in Toronto tomorrow."

Ontario's hospitals and long-term care facilities are very vulnerable to "superbug" epidemics because of 15 years of cuts to cleaning budgets.

Provincial governments and hospital administrators have devalued the importance of housekeeping and cleaning services and treated them as peripheral to patient care.

Some health-care facilities are using cleaning agencies instead of hospital staff, which was cited by a Hong Kong study as a factor that accelerated the spread of SARS because of poor training and high staff turnover.

Cleanliness practices have been dangerously eroded and hospitals are overcrowded. "We have a big problem in terms of infection control," Dr. Karl Weiss, an infectious disease specialist at Montreal's Maisonneuve-Rosemont Hospital, told the medical association journal. "We are practising 21st-century medicine in a 19th-century environment."

The problem is compounded by traffic among health-care institutions. Every day, thousands of patients are transferred between hospitals and from hospitals to long-term care centres or home.

With 50 per cent of the hospital workforce part-time, many health-care workers are forced to work at more than one institution in order to make a living. The government must convene a meeting, urgently, of hospital managers, public health officials, physicians, and unions representing health-care workers, to prepare a comprehensive action plan for dealing with hospital-based infectious diseases like C. difficile.

The Ontario government also must make special resources available for hospital cleaning.

Its recent budget gave Sunnybrook hospital, as an example, a 1 per cent increase. Hamilton Health Sciences Centre received a 1.3 per cent increase. Inflation is 3 per cent. How are these institutions to cope with demands for higher standards of cleanliness without additional targeted resources?

C. difficile is spread through the environment or by fecal-oral transmission. The germs can survive for long periods outside the body on walls, doorknobs, and furniture. The organisms can spread quickly throughout an institution from patient to patient, or from caregivers to patients.No one is necessarily safe.

The medical association journal has reported that at least two healthy people, in hospital for joint surgery, died of C. difficile and Montreal hospitals are reporting younger patients with the infection.

Superbugs are not the only microbes we should be concerned about. An estimated 250,000 people a year contract infections in hospitals and between 8,000 and 10,000 die.

Clean institutions will reduce these numbers.

Having lived through SARS, the people of Ontario have a right to demand leadership and action from government. Once was enough.

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Michael Hurley is the president of the Ontario Council of Hospital Unions, part of the Canadian Union of Public Employees.