Clostridium Difficle poses threat across medical facilities

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March 7, 2012

CDC: Life-threatening C.Difficle poses threat across medical facilities

A new CDC report released Tuesday highlights how Clostridium difficile infection (CDI) is a common and sometimes fatal healthcare-associated infection. The incidence, deaths, and excess healthcare costs resulting from CDIs in hospitalized patients are all at historic highs. Meanwhile, the contribution of nonhospital healthcare exposures to the overall burden of CDI, and the ability of programs to prevent CDIs by implementing CDC recommendations across a range of hospitals, have not been demonstrated previously.

Population-based data from the Emerging Infections Program were analyzed by location and antecedent healthcare exposures. Present-on-admission and hospital-onset, laboratory-identified CDIs reported to the National Healthcare Safety Network (NHSN) were analyzed. Rates of hospital-onset CDIs were compared between two 8-month periods near the beginning and end of three CDI prevention programs that focused primarily on measures to prevent intrahospital transmission of C. difficile in three states (Illinois, Massachusetts, and New York).

Among CDIs identified in Emerging Infections Program data in 2010, 94% were associated with receiving healthcare; of these, 75% had onset among persons not currently hospitalized, including recently discharged patients, outpatients, and nursing home residents. Among CDIs reported to NHSN in 2010, 52% were already present on hospital admission, although they were largely healthcare related. The pooled CDI rate declined 20% among 71 hospitals participating in the CDI prevention programs.

Nearly all CDIs are related to various healthcare settings where predisposing antibiotics are prescribed and C. difficile transmission occurs. Hospital-onset CDIs were prevented through an emphasis on infection control.

More needs to be done to prevent CDIs; major reductions will require antibiotic stewardship along with infection control applied to nursing homes and ambulatory-care settings as well as hospitals. State health departments and partner organizations have shown leadership in preventing CDIs in hospitals and can prevent more CDIs by extending their programs to cover other health-care settings.

CDC has issued a report that highlights six steps to prevent spread of deadly C. difficile bacteria, which impacts patients in nursing homes and outpatient care, not just hospitals:

1. Prescribe and use antibiotics carefully. About 50% of all antibiotics given are not needed, unnecessarily raising the risk of C. difficile infections.

2. Test for C. difficile when patients have diarrhea while on antibiotics or within several months of taking them.

3. Isolate patients with C. difficile immediately.

4. Wear gloves and gowns when treating patients with C. difficile, even during short visits. Hand sanitizer does not kill C. difficile, and hand washing may not be sufficient.

5. Clean room surfaces with bleach or another EPA-approved, spore-killing disinfectant after a patient with C. difficile has been treated there.

6. When a patient transfers, notify the new facility if the patient has a C. difficile infection.

C. difficile is linked to about 14,000 U.S. deaths every year. Those most at risk are people who take antibiotics and also receive care in any medical setting. Almost half of infections occur in people younger than 65, but more than 90 percent of deaths occur in people 65 and older. Previously released estimates based on billing data show that the number of U.S. hospital stays related to C. difficile remains at historically high levels of about 337,000 annually, adding at least $1 billion in extra costs to the healthcare system. However, the Vital Signs report shows that these hospital estimates may only represent one part of C. difficile's overall impact. Visit the CDC report here.
Statement by APIC about CDC Vital Signs report on Clostridium difficile

The Centers for Disease Control and Prevention (CDC) issued a Vital Signs report Tuesday that showed infections from Clostridium difficile (C. difficile) are a growing threat in all types of healthcare settings. This new report from the CDC is timely as despite successes against many healthcare-associated infections (HAIs), C. difficile continues to be a challenge at many healthcare facilities. It is one of the infections targeted in the U.S. Department of Health and Human Services Action Plan to Prevent Healthcare-Associated Infections.

In 2008, the Association for Professionals in Infection Control and Epidemiology (APIC) released a prevalence study showing that this intestinal infection is sickening significantly more hospital patients than once thought.

The CDC Vital Signs report shows that C. difficile is no longer just a hospital problem. According to the report, 75 percent of cases first appear in nursing homes or other places where care is delivered outside of hospitals. Prevention efforts must be coordinated across all care settings.

C. difficile is frequently associated with previous antibiotic use and is most commonly contracted by the elderly and those with recent exposure to hospitals, nursing homes, and other healthcare settings. Because any antimicrobial can potentially induce C. difficile infection, stewardship programs that promote judicious use of antimicrobials should be encouraged. APIC and the Society for Healthcare Epidemiology of America (SHEA) have just published a position paper on the important role that infection preventionists and healthcare epidemiologists play in successful antimicrobial stewardship efforts.

Since 1972, APIC has provided thought leadership on infection prevention to drive attention to the critical need to protect patients from HAIs and is an authority in the application of evidence-based, infection prevention measures. APIC offers resources to help all types of healthcare facilities implement infection prevention programs, including a "Guide to the Elimination of Clostridium difficile in Healthcare Settings."

Clean Spaces, Healthy Patients, a joint program between APIC and the Association for the Healthcare Environment offers free tools and resources to spread best practices for cleaning and disinfecting to help prevent transmission of infections from the healthcare environment.

APIC believes that every healthcare institution should be working toward HAI elimination. The CDC report highlights three programs showing success in reducing C. difficile rates. Continued progress is contingent upon sustained focus and resources. APIC believes that continued use and monitoring of these strategies will support ongoing reductions in C. difficile, both inside and outside the hospital. Visit APIC for more information.
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