Laura A. Stokowski, RN, MS; L. Clifford McDonald, MD
No Getting Away From Clostridium difficile
Clostridium difficile (C difficile) is in the news again. This time, some of the news is good. In 3 state-led prevention programs, 71 hospitals that focused on prevention of C difficile infection (CDI) were able to cut their aggregate hospital-onset CDI rate by 20% in less than 2 years.
The bad news is that for most of the country, CDI rates are still at an all-time high and remain strongly associated with exposure to healthcare. According to Emerging Infections Program surveillance, in 2010, 94% of CDIs occurred in patients who had received healthcare as an inpatient, outpatient, or both in the preceding 12 weeks. C difficile infection is a rising cause of death in the most vulnerable patients. From 2000-2007, deaths from CDI increased 400% — to 14,000 annually, at a cost of more than $1 billion.
It’s time to reassess the way we think about C difficile.
C difficile infection is not just a frustratingly difficult-to-treat disease. It cannot be dismissed as a “hospital problem” or a “long-term care problem.” It is a healthcare-wide patient safety problem. Like other patient safety problems, resolving CDI requires a multifaceted approach and a commitment to action from both multiple stakeholders and the individuals at the “sharp end” of patient care.
With the conviction that transmission of C difficile is avoidable but that no single action will be sufficient, the Centers for Disease Control and Prevention (CDC) outlined the 6 strategies that have the best chance of eradicating C difficile from healthcare. These strategies involve elements of antibiotic stewardship, testing for C difficile, isolation and infection control procedures, environmental cleaning, and communication:
- Prescribe and use antibiotics carefully. About 50% of antibiotics that are given are not needed.
- Test for C difficile when patients have diarrhea while taking antibiotics or within several months of taking them.
- Isolate patients with C difficile immediately.
- Wear gloves and gown when treating patients with C difficile, even during short visits. Hand sanitizer does not kill C difficile, and handwashing may not be sufficient.
- Clean room surfaces with bleach or another Environmental Protection Agency (EPA)-approved spore-killing disinfectant after a patient with C difficile has been treated there.
- When a patient transfers to another facility, notify the new facility if the patient has CDI.