Sniffing out killer bugs

 

Cliff the beagle detects 'Clostridium difficile' as he 'does his rounds' of the wards in a leading Dutch hospital, writes ISABEL CONWAY

WHEN “DR CLIFF” first appeared on the wards of a leading Dutch teaching hospital, some patients assumed they were experiencing strange side effects from their drugs or were seeing things.

But “Dr Cliff” happens to be a two-year-old bacteria-busting beagle, trained at Amsterdam Free University Medical Centre to detect the virulent and highly contagious bacteria, Clostridium difficile, which besets hospitals, closes wards and has been known to kill.

As we set off on the rounds with Cliff, accompanied by his owner Hotsche Luik, a renowned sniffer dog trainer and canine psychologist, and Marije Bomers, a member of the hospital medical staff, Luik comments: “Patients say, ‘Here’s Dr Cliff again’.”

Like the star of a reality hospital series, he poses for photographs in the restaurant of one of the Dutch capital’s busiest hospitals and has even been on TV.

Cliff enjoys having his ears stroked and sneaks a few crumbs of cake from under a table. But once he goes on duty, he is a true professional.

On the wards, Cliff, wearing his smart yellow coat and badge which reads “Zoek en zocht hond” (search and find dog), is on duty, a sign for Luik to switch the leash clip from his neck to the shoulder harness. He is now on his own, even though she is holding the leash.

The beagle trots from bed to bed, having first investigated the sluice room and other service areas. He tries to keep his distance from patients when on duty. But his bedside manner is such that few can resist him and the hands of the frail and ill automatically reach out as he takes a long sniff at the side of their beds.

He spends some moments of concentration beneath the beds, pausing here and there, taking an extra snuffle in a pair of old slippers in another ward. The faces of sick patients, many of whom have little reason to smile, light up as he passes through the wards.

Few, however, are aware that if Dr Cliff’s ears and tail stand up straight, he pulls on his lead and he sits down beside a bed, he has just given a diagnosis. He is signalling that he has detected the presence of Clostridium difficilebacteria.

Months of training prepared the beagle, the son of a renowned forensic sniffer dog named “Ralph”, for sniffing out the bacteria to which he was introduced in smell tests. Now he can detect it in minute traces, even when it’s enclosed inside three separate sealed boxes.

Bomers, who is studying to become a consultant in internal medicine and infectious diseases, says that training a dog such as this one could open many more doors in the fast detection of other highly infectious hospital superbugs.

They are still in the research phase of the project, she stresses, but adds that Cliff has never been wrong yet. “The microbiology labs will always be there, we see Cliff as an additional tool, and in terms of speed and economy in the future he could prove vital.”

Other Dutch hospitals and also nursing homes who do not have laboratories on site could over time be visited by Cliff as a preventative measure. He could also be used to back up results already awaited or those which have proven inconclusive, speeding up isolation to prevent the spread of Clostridium difficileand so reduce hospital costs.

The idea of training a sniffer dog to provide an early alarm service in the detection of bacteria came from Prof Yvo Smulders, head of internal medicine at Amsterdam’s Free University Medical Centre.

“We hope the typical smell can be used to detect the bacteria before it spreads to other patients and wards need to be closed,” he says.

“Dogs are known to vastly outperform electronic smell detectors, so they are most suitable in our view. Outbreak management and even better prevention is the ultimate goal, and what we are doing here at our hospital may be particularly relevant in high prevalence countries such as the UK and the US.”

Apart from their proven expertise in detecting drugs, smuggled tobacco and explosives, dogs have been trained to detect various cancers including bladder and prostate, and ovarium carcinomas.

Seb, a German shepherd, has been able to identify mixed infections in faecal samples with a 92 per cent success rate, says Bomers. Cliff may yet be added to the roll call of canine super sniffers.

PET PROJECT: STOPPING THE SPREAD

The Netherlands is good at containing the spread of multi-resistant bacteria and superbugs such as MRSA and ESBL.

Patients transferred from other countries are always treated in isolation with extra hygiene precautions until hospitals are 100 per cent sure they are unaffected.

Resources are ploughed into keeping wards ultra clean and maintaining good hygiene.

Dutch doctors traditionally prescribe antibiotics only when absolutely necessary, helping to improve resistance to potentially deadly bacteria.