Prioritizing C. Diff Infection Prevention

In 2008, my grandmother was admitted to a hospital in Ohio for a heart condition and contracted a Clostridium difficile (also known as “C. diff”) infection, which ultimately ended her life. I witnessed hospital staff subscribing her antibiotics without administering probiotics, washing with alcohol-based sanitizers rather than soap and water, and failing to disinfect her room.

The elderly and individuals taking antibiotics are extremely vulnerable to contracting C. diff in the healthcare settings such as nursing homes and hospitals. Individuals older than 65 account for approximately 90 percent of all deaths from CDIs. This is a deadly and costly epidemic, which may be avoided with proper precautions.

 Clostridium difficile are bacteria that produce toxins that destroy the lining of the intestine and cause mild diarrhea to life-threatening colitis. The vast majority of all C. diff infections (CDIs) take place in healthcare settings, where antibiotics are prescribed and patients with C. diff are concentrated.

Although many healthcare-associated infections declined in the 2000s, C. diff infections are at historic highs. From 2000 to 2009, the number of hospitalized patients with CDI discharge diagnoses more than doubled from approximately 139,000 to 336,600. In addition, during these 9 years, the number of patients with a primary CDI diagnosis more than tripled from 33,000 to 111,000.

C. diff kills 14,000 Americans each year and adds an estimated $1 billion in extra costs to the healthcare system. The Agency for Healthcare Research and Quality has collected billing data that reflects more than 9% of hospitalizations related to C. diff end in death, which is approximately five times the rate for other hospitalization stays. CDIs take place not only in hospitals, but current statistics show that approximately 75 percent of these infections begin in medical settings outside hospitals, such as nursing homes and outpatient clinics.

C. diff is easily passed from person to person, but may be avoided. Measures for preventing C. diff include:

∙ Healthcare employees washing their hands with soap and warm water (as opposed to using alcohol-based sanitizers).

∙ Healthcare employees and visitors wearing disposable gloves and gowns.

∙ Healthcare employees disinfecting surfaces in patient rooms with chlorine bleach.

∙ Patients avoiding taking unnecessary antibiotics.

∙ Patients consuming probiotics or yogurt during and after antibiotic treatment.

The U.S. Department of Health and Human Services Steering Committee for the Prevention of Healthcare-Associated Infections intends to review on an annual basis progress toward achieving nine 5-year goals or targets in a HHS Action Plan to Prevent Healthcare-Associated Infections. This Action Plan is designed to reduce the incidence of specific healthcare-associated infections and increase adherence to sets of recommended prevention practices by December 31, 2013. The national 5-year prevention target for C. diff is its reduction by 30 percent. Unfortunately, according to HHS, this target will not likely be achieved by 2013.

However, health systems are having significant success with their infection control programs. In 2009, Jewish Hospital-Mercy Health in Cincinnati implemented a high-priority initiative to lower its skyrocketing C. diff rate, which took less money and time than expected and had a dramatic result. In six months, this hospital cut its C. diff infection rate by 50 percent—by using betting controls on antibiotics, better employee training on disinfecting and hygiene, new room-cleaning strategies, and revised standards of care. This hospital’s initiative continued to drop C. diff infection rates by nearly 80% since the implementation of the program.

Hospitals, long-term care providers, and other healthcare facilities are spread thin with the volumes of regulations, policies and procedures that must be followed for patient quality and safety purposes. In addition, their margins are squeezed with perpetual cuts to their reimbursement from government and private payors. However, if more healthcare providers could make a priority the strict adherence to the above-described measures for avoiding C. diff, then there should be a significant reduction in healthcare costs and increase in the life expectancy and quality of health of their patients.

— Cheryl Camin Murray is a shareholder in Winstead’s healthcare industry group.