Are Hospitals Doing Enough to Fight C. diff?

Survey Shows More Steps Are Needed to Curb the Spread of C. diff Infections

Medically Reviewed by Laura J. Martin, MD on May 20, 2010
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May 20, 2010 -- Hospitals and other health care facilities have been taking steps to stop the spread of C. diff, a potentially life-threatening bacterium, but a new survey concludes that more needs to be done.

The Association for Professionals in Infection Control and Epidemiology (APIC) says it is concerned about C. diff infection and worried that more isn't being done to fight it.

The APIC says a survey reveals that many "infection preventionists" -- people charged with fighting the disease -- feel that though steps have been taken, more intense efforts are needed.

In a new survey of its members, the APIC said a third of about 1,800 respondents believe their institutions ought to be doing more to prevent the spread C. diff, formally known as Clostridium difficile.

The bacterium causes diarrhea and sometimes more serious problems of the intestines, such as colitis, that can be life threatening. It is most common among the elderly who have been exposed to health care institutions, including hospitals and nursing homes. APIC officials say deaths have been rising.

The APIC's 2008 prevalence study found that 13 out of every 1,000 hospitalized patients were infected with C. diff.

According to the APIC's survey:

  • 53% of respondents say additional steps have been taken in the past 18 months to control the spread of C. diff infection.
  • Fewer than 25% say they have been able to add to their infection prevention staffs.
  • 45% indicated C. diff infection was not identified as a high-priority problem for their facility.
  • 34% said they have an infection control plan to increase prevention steps in case of an outbreak.
  • 30% said C. diff infection rates were declining within their facilities with their current practices

Strategies to Fight C. diff

Although the APIC survey shows that not enough is being done to combat C. diff, the survey points out some of the strategies now being used by health care facilities:

  • 83% of respondents say their institutions now have hospital-wide hand hygiene initiatives.
  • 90% perform surveillance or take other steps to quickly identify C. diff infection cases.
  • 94% always place C. diff infection patients on "contact precautions" -- meaning patients are isolated and health professionals use gowns and gloves when caring for them.
  • 86% have increased emphasis on environmental cleaning.

"We are pleased to see that many health care institutions have strengthened their efforts to combat CDI (C. diff infection) and that many have seen declines due to these added measures," says Kathy Wayne, chief executive officer of the APIC. "But we are concerned that three out of four respondents may not have adequate staff and resources to protect patients. We had hoped that the infection prevention positions and resources that were eliminated during the economic downturn would have been replaced by this time."

The APIC report says antimicrobial stewardship could be improved, and 40% of respondents said programs promoting the judicious use of antimicrobials are not in place. Only a third said monitoring and evaluation of antimicrobial use have increased in the past 18 months.

"Because up to 90% of patients with symptomatic C. diff infection have previously received antibiotics, stewardship programs that seek to limit inappropriate use of these agents play an important role in C. diff infection prevention efforts and are necessary to prevent antimicrobial resistance, which is a growing worldwide concern," Cathryn L. Murphy, PhD, RN, the APIC's 2010 president, says in a news release. "Further research is needed to develop effective stewardship programs."

The news release, citing the World Health Organization as its source, says that on any given day, more than 1.4 million people are affected by a health-care-associated infection. These are associated with an estimated 99,000 deaths per year in the U.S., and cost between $30 billion and $40 billion annually.

The online survey was made available to 13,000 members of the APIC; about 1,800 took the survey.

Show Sources


News release, Association for Professionals in Infection Control and Epidemiology.

Association for Professionals in Infection Control and Epidemiology: "2010 Clostridium difficile Pace of Progress."

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