C-Difficile Infection Rates High In US Hospitals
Consumers Union called on hospitals today to take more aggressive steps to protect patients from Clostridium difficile (C.-diff.) infections in light of a new report showing that they are much more common than previous estimates had indicated. As the rate of hospital acquired C.-diff. infections has jumped in recent years, an increasing number of patients have developed antibiotic-resistant strains of the infection that are more difficult to treat and more deadly.
The report released by the Association for Professionals in Infection Control and Epidemiology (APIC) found that 13 out of every 1,000 patients or approximately 7,178 inpatients on any one given day were infected or colonized with C.-diff (94.4 percent were infected). The rate is 6.5 to 20 times higher than previous incidence estimates that were based on more limited data. The report estimated that on any given day these infections cost between $17.6 million to $51.5 million and kill between 165 and 438 patients.
The APIC report is based on a survey of infection control professionals from 648 health care facilities throughout the country who collected data about all of their patients with C.-diff. infections on one day between May and August 2008.
"C-diff. infections are much too common in our nation's hospitals and threaten the health of thousands of patients every year," said Lisa McGiffert, Director of Consumers Union's Stop Hospital Infections Campaign. "Most hospitals aren't doing enough to protect patients from these deadly, preventable infections."
C.-diff. bacteria is released into the hospital environment in feces. It is found on surfaces throughout hospitals and nursing homes and can be spread to patients through hand contact. In one study, C.-diff. was found on the hands of nearly 60 percent of doctors and nurses caring for infected patients. Studies have found C.-diff. contamination of almost all objects in the hospital environment, ranging from stethoscopes and blood pressure cuffs to mops.
When patients undergo antibiotic therapy, beneficial bacteria in the colon are killed off, but C.-diff. survives and multiplies. The bacteria release toxins that cause inflammation and damage the mucosal lining of the colon leading to severe diarrhea. An antibiotic-resistant strain of C.-diff. has developed in recent years that can result in colitis, sepsis, and death. Elderly patients, patients with severe underlying illness, and patients undergoing immunosuppressive therapy are at higher risk of becoming infected since their immune response to the bacteria and its toxins is diminished.
According to the federal Agency for Healthcare Improvement's Healthcare Cost and Utilization Project, the number of hospital patients with C.-diff. infections more than doubled between 2001 and 2005 to 301,200 patients. As infection rates have increased, so have mortality rates. According to data from death records and the National Inpatient Sample, fatality rates rose from 1.2% in 2000 to 2.2% in 2004, indicating that C.-diff. infections are becoming more dangerous and deadly.
APIC's survey found that 54.4 percent of patients with C.-diff. were identified within 48 hours of admission and that most were admitted to the hospital already infected. However, APIC estimates that 72.5 percent of the patients with C.-diff. infections developed them as a result of exposure to bacteria in a healthcare facility. In other words, many patients who were admitted with an infection picked it up during a previous stay at a hospital or nursing home.
The most basic way to prevent infections is to keep patients from being colonized by C.-diff. The Center for Disease Control and Prevention's (CDC) Guidelines for Infection Control in Health Care Facilities notes that proper hand hygiene is the single most important factor in protecting patients from C.-diff. and other hospital-acquired infections. To complicate matters, the CDC advises that hands must be washed with soap and water when caring for C.-diff patients, as the commonly used alcohol-based hand gel is ineffective against this bacteria. Unfortunately, studies have repeatedly shown that handwashing compliance rates in hospitals are generally less than 50 percent. Other key infection control strategies include using contact precautions, including gloves and gowns with C.-diff. patients and separating them from other patients.
Improved cleanliness in hospital wards is also necessary to limit the spread of C.-diff. Use of a hypochlorite (bleach) cleaning solution is the most effective way to eliminate the bacteria. Hospitals that have stepped up efforts to more thoroughly clean hospital wards have effectively controlled the spread of C.-diff. However, reports show that hospital cleaning budgets are being cut every year and that these reduced numbers of cleaning staff are often inadequately trained.
Finally, since being on antibiotics is a risk factor for C.-diff., hospitals that restrict the use of the type of antibiotics frequently associated with these infections have had more success in protecting patients.
"Health care consumers need to be aware that most U.S. hospitals are not consistently following basic infection control practices against C.-diff.," said McGiffert. "Patients are already having to remind doctors to wash their hands, but they shouldn't have to bring bleach with them to make sure their rooms are clean. Hospitals need to make sure that rooms are properly disinfected and that staff are following strict infection control practices at all times."