Association issues recommendations to fight C diff.

A recent study indicates that a killer microbe is more commonplace in U.S. hospitals than has been thought.

The survey of healthcare facilities, conducted in 2008 and reported in the American Journal of Infection Control, documents a higher Clostridium difficile prevalence rate than previous estimates. The rate is 6.5 to 20 times greater than previous incidence estimates, according to an Association for Professionals in Infection Control and Epidemiology news release.

Clostridium difficile -- commonly shortened to C diff -- is the most serious cause of antibiotic-associated diarrhea and can lead to a severe infection of the colon. The infection often results from eradication of the normal gut flora by antibiotics. The C diff bacteria, which naturally reside in the body, become the sole survivors of the antibiotics, overgrow and release toxins that cause bloating, constipation, and diarrhea with abdominal pain, which may become severe.

Most inpatient C diff appears to be healthcare associated. Not all patients with diarrhea are tested for C diff, and most facilities use enzyme immunoassays with limited sensitivity to detect C diff, the survey’s authors said. So their findings are “minimum estimates” of the U.S. healthcare-facility C diff burden.

Here are some of the study’s findings:

            • The overall C diff prevalence rate was 13.1 per 1,000 inpatients. The survey identified 1,443 C diff patients among the 648 participating hospitals;

            • 82 percent of facilities reported their C diff infection rate had not decreased in the past three years; and

            • 79 percent of patients with C diff had received antimicrobials within 30 days.

Outbreak Forced Policy Changes

A C diff outbreak is serious business; 91 infected patients died over 20 months that peaked in 2007 at a Burlington, Ontario, hospital.

The outbreak fueled government actions such as mandatory reporting of C. diff and other bugs, more money for infection control, and the creation of special teams to help hospitals when outbreaks occur, the Hamilton (Ont.) Spectator reported. Joseph Brant Memorial Hospital, where the outbreak occurred, still faces a $50-million class action lawsuit.

The most common way of transferring healthcare-associated infections is on the hands of healthcare providers, according to Ontario’s Ministry of Health and Long-Term Care. Jo Brant recently registered one of Ontario’s best rates for staff hand-washing and has lower rates of infection, the Spectator reported.

U.S. policy: People are most often infected with C. diff in hospitals, nursing homes, or institutions. In 2008, the Centers for Medicare & Medicaid Services proposed adding C. diff-associated disease to a no-pay rule. CMS backed off that proposal, but, combined with ventilator-associated pneumonia, C. diff cost Medicare a combined $10 billion to treat in 2007.

The American Medical Association and other organizations objected to including these infectious diseases in the no-pay rule because they were not “reasonably preventable,” as required by the Deficit Reduction Act of 2005, according to American Medical News, an AMA publication. That law instructed CMS to limit payment for avoidable hospital-acquired conditions.

APIC recommends healthcare facilities take these measures to fight C diff:

            • Identify high-risk areas within the institution;

            • Institute a surveillance program to identify C diff cases early;

            • Adhere to Centers for Disease Control hand-hygiene guidelines;

            • Use contact precautions (gloves, gowns, and separating C diff patients from other patients);

            • Clean and decontaminate environment and equipment, especially items that are close to patients such as bedrails and bedside equipment;