Image of antibiotics courtesy of somegeekintn via Flickr
The U.S. Centers for Disease Control and Prevention reported in its March 6 issue of the Morbidity and Mortality Weekly Report that 75 percent of all C.difficile infections originated outside of a hospital setting, and that more than half of patients with C.diff infections treated by hospitals had the infection upon admission.
As nurses know, a C.diff infection can have life-threatening consequences, especially now. There has been a 400 percent increase in the number of deaths since 1999. From 1999 to 2000, an estimated 3,000 people died from the infection; from 2006 to 2007, the number jumped to 14,000 deaths, with 90 percent of the deaths occurring in the 65 and over population.
The numbers finally appear to be leveling off, according to research headed by L. Clifford McDonald, M.D., a medical epidemiologist with the CDC. In his team’s analysis of data from the Emerging Infections Program from 2010, and the number of C.diff cases reported to the National Healthcare Safety Network, the researchers concluded that although 94 percent of the outbreaks occurred in patients receiving healthcare, 75 percent of the C.diff cases occurred in non-hospitalized patients. The 52 percent of already infected patients coming into the hospital pose a significant intrahospital transmission risk to other patients.
The good news is that C.diff targeted prevention programs can be effective.
The researchers studied data from prevention programs in three states: Illinois, Massachusetts and New York. These programs were adopted by a total of 71 hospitals in those states, for eight months each. The data across the three prevention programs demonstrated a 20 percent decrease in infections during the study period. Dr. McDonald and his team concluded that better prevention programs, which begin with a more discerning approach to prescribing antibiotics, need to be implemented “in all health-care settings” including outside the hospital, since 75 percent of the infections are not, as previously believed, initiating in acute care facilities.
In a media briefing, Dr. McDonald outlined six steps endorsed by the CDC to prevent C.diff infections:
1. Prescribing antibiotics with care;
2. Testing for C.diff in patients who develop diarrhea while taking antibiotics or who develop diarrhea several months after an antibiotic protocol;
3. Isolating the patient;
4. Wearing gowns and gloves during patient care, even if the caregiver is only in the room for a short time;
5. Cleaning the room with bleach or another spore-killing disinfectant that has been approved by the Environmental Protection Agency after patient’s treatment has ended;
6. If a patient is transferred to a new facility, notifying that facility of the infection and treatment.
Dr. McDonald also stressed using prevention strategies “across the continuum of health-care,” not simply at one site where the patient is treated. The importance of prevention programs cannot be stressed enough as in addition to the implications for patients’ health, insurance companies have instituted non-reimbursement policies for nosocomial infections such as C.difficile.