The Cape Breton District Health Authority has released its first progress report on recommendations made by Nova Scotia’s auditor general in the ongoing fight against C. difficile.

Two deadly outbreaks in Cape Breton hospitals within the past year led to an audit of the health authority, which produced 20 recommendations.

In his report, Auditor General Jacques Lapointe said the outbreaks could have been avoided if staff had used proper cleaning methods to prevent the spread of infections.

Health officials say 11 of the recommendations have been completed so far and that another four are in progress.

The health authority says the biggest change has been what it refers to as audits of staff handwashing practices.

“I won’t call them secret shoppers, but we do have individuals who were specifically hired to come in and help,” says health authority spokeswoman Dianne Calvert Simms.

“We’ve trained them in what they need to look at in terms of hand hygiene. They literally go up onto units, observe what’s being met or not met, and give real-time results to the unit. “

The health authority admitted earlier this year that improper handwashing played a part in the deadly outbreaks at the Cape Breton Regional Hospital in Sydney and at the hospital in Glace Bay last year.

Four patients died due to the illness in the first outbreak, and one death occurred during the second outbreak.

There are now three active cases of C. difficile in the district.

With files from CTV Atlantic's Ryan MacDonald and The Canadian Press